Instruction: Generate impression based on findings.

Input: 4-year-old status post Chiari decompression. Evaluate Chiari and syrinx. There has been evolution of postoperative changes of Chiari decompression which included suboccipital craniectomy, C1 laminectomy, and reduction of cerebellar tonsillar tissue. There has also been evolution of the previously seen diffusion abnormality involving the inferior cerebellum. The cerebellar tonsils and cervicomedullary junction remain caudally displaced with persistent crowding at the foramen magnum at the C1-C2 level; retroflexed dens also contributes to the crowding. Cerebellar tonsils extend to the mid to lower C2 level on the right, previously at the C2-C3 level on preoperative study. There is interval decrease in T2/FLAIR signal abnormality involving the inferior cerebellum. No new parenchymal signal abnormality is seen. No suspicious intracranial mass, midline shift, or herniation. Ventricles remain normal in size. Subcentimeter pineal cyst is unchanged. Cystic arachnoid space extension superiorly along the anterior superior surface of the tentorium cerebell is also unchanged. Extradural suboccipital fluid collection is again seen and compatible with a pseudomeningocele. There is mild to moderate mucosal thickening in the right maxillary sinus which is increased in the interval. There is also mild additional scattered paranasal sinus opacification.CSF flow imaging again demonstrates focally attenuated biphasic flow through the anterior aspect of the foramen magnum, similar to prior. Flow through the posterior aspect of the foramen magnum is similar to recent prior but improved since preoperative MRI from 5/25/2016. There appears to be preserved flow into the fourth ventricle.MRI CERVICAL SPINE

Output: 1. Postoperative changes of Chiari decompression have evolved in the interval. The residual cerebellar tonsils and cervicomedullary junction remain caudally displaced with persistent crowding at the foramen magnum at the C1-C2 level, although improved compared to preoperative study. 2. There has been interval progression of cervical and partially imaged thoracic syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with mesothelioma, being treated with PD1 antibody, presenting with an episode of encephalopathy. Confluent T2 hyperintensity seen within the periventricular white matter with scattered additional foci in the subcortical white matter and brainstem. None of these lesions is associated with restricted diffusion. There is no pathologic intracranial enhancement. No evidence of parenchymal edema or mass effect is seen. The ventricles and sulci are proportionately prominent compatible with underlying volume loss. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Scattered small foci of susceptibility in the bilateral cerebral hemispheres may reflect tiny chronic microhemorrhages.

Output: 1.No evidence of any active inflammatory or neoplastic process is seen intracranially.2.Findings are noted which may reflect chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: Knee pain. Question of ACL injury or meniscus tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. There is minimal fraying of the posterior medial femoral condyle articular cartilage. There is generalized thinning of the patellar articular cartilage. No full-thickness chondral defect is identified. The lateral compartment articular cartilage is intact.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Intact menisci and ligaments. 2. Mild thinning/fraying of the patellar and medial femoral condyle articular cartilage.


Instruction: Generate impression based on findings.

Input: 42-year-old female with history of right upper quadrant abdominal pain. Exam somewhat limited without intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Scattered, probably benign cysts. No intrahepatic biliary ductal dilatation. The common bile duct measures up to 6 mm.SPLEEN: No significant abnormality noted.PANCREAS: Normal appearing pancreatic duct. Normal pancreatic parenchyma. No evidence of divisum or annular pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No findings to account for the patient's right upper quadrant pain.


Instruction: Generate impression based on findings.

Input: Reason: intracranial stenosis History: right face and left arm weakness MRI of the brainThere are five to eight 2-8 mm size foci of diffusion restriction are present along the right precentral and postcentral gyri. There are a couple 2mm sized foci of diffusion restriction along the right precuneus and cuneus.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional similar appearing lesions present in the brainstem.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is approximately 40% narrowing of the mid basilar artery.There is mild narrowing at the origins of the superior and inferior divisions of the right middle cerebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is small The posterior communicating arteries are not readily visualized. The left vertebral artery is very small.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is high-grade stenosis present the origin of the left vertebral artery. Left vertebral artery is small compared to the right vertebral artery throughout its cervical course.

Output: 1.Small foci of acute infarction are present in the right parietal lobe, right pre-and postcentral gyri and right occipital lobe. The vascular distributions include right posterior cerebral artery territory and the right middle cerebral and territory. The posterior communicating arteries are tiny.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Punctate lesions in the pons and midbrain are most likely vascular related.4.There is mild narrowing at the origins of the superior and inferior divisions of the right middle cerebral artery.


Instruction: Generate impression based on findings.

Input: 62-year-old male with acute shortness of breath and hemoptysis. Rule out PE. PULMONARY ARTERIES: No evidence of pulmonary embolus.LUNGS AND PLEURA: Severe emphysema. Right hilar and peribronchial thickening with adjacent interstitial and air space disease concerning for with lymphangitic spread of diseaseMEDIASTINUM AND HILA: Bulky AP window lymph nodes, the largest of which measures 2 x 2.6-cm, (image 37, series 6). and moderate pericardial effusion. Right hilar mass has ill-defined borders but grossly measures 4.7 x 4.1cm (image 86, series 8) which sounds and narrows the right upper lobe bronchus and right upper pulmonary artery. The distal aspect of the right upper lobe bronchus is narrowed measuring approximately 4 mm (image 36, coronal series).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Right adrenal gland is incompletely imaged but has a bulky appearance which is nonspecific and may be further evaluated with dedicated adrenal CT or MRI if clinically indicated.

Output: 1. Bulky mediastinal lymphadenopathy and right hilar mass with adjacent interstitial and airspace disease concerning for primary neoplasm with local extension and lymphangitic spread.2. Bulky right adrenal gland as described above.


Instruction: Generate impression based on findings.

Input: Posttraumatic headache, unspecified, intractable. 17 years, Male, headache and dizziness. No intracranial mass or mass-effect. There are areas of cortical volume loss with adjacent T2/FLAIR hyperintensity involving the lateral cortex of the right lateral temporal as well as the inferior frontal lobes. There is susceptibility artifact related to patient's braces which limits evaluation of the bilateral frontal lobes on the susceptibility weighted and diffusion-weighted sequences. There is a punctate focus of susceptibility involving the left occipital deep white matter. Subtle focus of susceptibility is also questioned in the left cerebellar hemisphere. No surrounding edema. No evidence of acute ischemia or hemorrhage. No extra-axial collections. Major flow-voids are preserved. Mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are grossly unremarkable within the limits of the susceptibility artifact from patient's braces.

Output: 1. Small areas of encephalomalacia involving the cortex of the right inferior and right lateral temporal lobes may be related to prior trauma. There are also punctate foci of susceptibility in the left occipital white matter and left cerebellar hemisphere which are compatible with chronic microhemorrhages. These are nonspecific but may be also be related to remote trauma.2. Brain parenchyma appears otherwise unremarkable without intracranial mass or mass effect.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis Brain: There are least 6 T2/flair hyperintense lesions involving the bilateral periventricular and subcortical white matter including pericallosal/periventricular lesions with an ovoid morphology. Lesions include the bilateral pericallosal white matter, splenium of the left corpus callosum, left anterior temporal subcortical white matter and adjacent to the left occipital horn. Possible tiny juxtacortical lesions involving the superior frontal gyri. Few lesions with T1 hypointensity are noted. No lesions with enhancement are seen. There is a small lesion involving the right middle cerebellar peduncle. No other infratentorial lesion is appreciated. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchymal volume is within normal limits. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Possible tiny cyst in the posterior aspect of the pituitary, not well evaluated. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: There are T2 hyperintense lesions in the cervical cord, most prominent of which are seen at the left ventral C3 level and the left aspect of the cord at the C6-C7 level. There may be additional tiny lesions such as at the left dorsal C4 level. Small lesion involving the left T1 level is also noted. There is some intrinsic T1 hyperintensity associated with the left C6-C7 lesion. No significant enhancement is appreciated.Vertebral body heights in the cervical spine are normal. Alignment is normal. Mild degenerative changes are seen with disk osteophyte complexes at C4-C5 and C5-C6 including disk extrusion at the C5-C6 level with effacement of the left ventral thecal sac. There is mild left neural foraminal stenosis at the C5-C6 level. Otherwise, no significant spinal canal or neural foramina stenosis is appreciated. Bone marrow signal is benign.

Output: 1. At least 6 T2/FLAIR hyperintense lesions involving the supratentorial and one in the infratentorial white matter, several of which demonstrate a morphology and distribution consistent with demyelinating disease. No lesions with enhancement to suggest active demyelination. Brain parenchymal volume is maintained. Several T1 hypointense lesions are also noted. No prior study is available for comparison.2. Multiple T2 hyperintense lesions in the cervical cord such as the left ventral C3 and left C6-C7 levels compatible with chronic demyelinating plaques. Small upper thoracic lesion at left T1 level also noted. No lesions with enhancement to suggest active demyelination.3. Small disk extrusion at the left C5-C6 level with mild left neural foraminal stenosis. Otherwise no significant spinal canal or neural foramina stenosis in the cervical spine.


Instruction: Generate impression based on findings.

Input: FIGO IIB cervical cancer status post chemoradiation, MRI for brachial planning PELVIS:UTERUS, ADNEXA: Persistent tethering and linear soft tissue signal seen at level of posterior cervix reflecting parametrial involvement (see images 35 through 37 series 501), evaluation suboptimal due susceptibility artifact related to interval placement of tandem and ovoids. Persistent mild focal T2 hyperintensity seen involving posterior cervix (similar to earlier exam) and small nabothian cyst formation seen. Site is located within 1 cm of superior aspects of ovoids and located posterior to and approximately 2 to 2.5 cm from end of tandem. Accounting for these differences and differences in technique overall appearance without significant change, no corresponding postcontrast enhancement identified. Instilled vaginal gel and vaginal tube noted.BLADDER: Foley catheter in underdistended bladder, small gaseous foci also seen.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Rectal tube in place. Increased perirectal fat.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Interval placement of tandem and ovoids related for radiation therapy. Associated susceptibility artifact makes evaluation suboptimal but accounting for differences in technique no significant change in posterior cervical lesion. Persistent tethering and linear soft tissue signal seen at level of posterior cervix related to parametrial involvement and/or scarring. Please refer to discussion above.


Instruction: Generate impression based on findings.

Input: 11-year-old female with right thigh pain who presents for evaluation of the menisci. MENISCI: The medial and lateral menisci are normal in signal and morphology.ARTICULAR CARTILAGE AND BONE: No evidence of a fracture, osteochondral defect, or articular cartilage defects.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament are intact.EXTENSOR MECHANISM: Quadriceps and patellar tendons are intact.ADDITIONAL

Output: No evidence of a meniscal tear as clinically questioned.


Instruction: Generate impression based on findings.

Input: Small cell neuroendocrine carcinoma of nasopharynx/sinus with extension to the skull base, s/p cisplatin/etoposide + concurrent RT completed in November 2014, now with leptomeningeal only disease recurrence. The patient is status post resection of the bilateral superior and middle turbinates, and nasal septum. There is prominent mucosal thickening in the bilateral maxillary sinuses, which has decreased slightly on the left. Trace fluid is identified within the mastoid air cells, left greater than right. There is diffuse hyperenhancement of the nasopharyngeal mucosal space, but no evidence of discrete mass lesion or upper cervical lymphadenopathy. There is a T2 hyperintense, enhancing lesion within the left inferior colliculus which restricts diffusion, compatible with increased cellularity. This measures 0.9 x 0.9 cm, previously 0.7 x 0.5 cm. There is an enhancing lesion within the mid to inferior right frontal lobe measuring 0.8 x 0.7 cm, previously 0.5 x 0.4 cm. There is unchanged enhancement and thickening of the pituitary infundibulum, measuring up to 5 mm in diameter. There is increased leptomeningeal disease, which now appears more confluent and extends along the cerebellum, midbrain, bilateral sylvian fissures, olfactory bulbs, trigeminal nerves (right greater than left), and cranial nerves VII and VIII. November median sulci also demonstrate diffusion restriction consistent with hypercellular leptomeningeal tumor.

Output: 1.Post treatment findings in the nasopharyngeal and sinonasal regions, with no measurable mass lesion within the sinuses.2.Progression of leptomeningeal disease involving the cerebellum, bilateral sylvian fissures, multiple cranial nerves and midbrain, with diffusion restriction noted along the cerebellar vermin sulci.3.Increased size of enhancing lesions within the inferior colliculus and right frontal lobe, consistent with metastatic disease.


Instruction: Generate impression based on findings.

Input: Multiple myeloma. Evaluate for lesion in the lumbar spine. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is dextroscoliosis of the lumbar spine with apex at the L2-L3 level. There is severe loss of disc height at the left L2-L3 level. There is increased edema involving the L2-L3 endplates and enlargement of a Schmorl's node involving the superior L3 endplate. Schmorl's node involving the inferior endplate of L2 is similar to prior. No definite myelomatous lesion in the lumbar spine is appreciated. There is nonspecific heterogeneous bone marrow particularly in the pelvis with areas of T1 hyper and hypointensity similar to prior. The conus medullaris is normal in position.There is mild to moderate facet arthropathy throughout the lumbar spine. Additional details regarding degenerative changes as below: L1-L2: Mild disc bulge. No spinal canal or neural foraminal stenosis. L2-L3: Diffuse disc bulge, eccentric to the left with effacement of the left lateral recess and moderate left neural foraminal stenosis. No significant central spinal canal or right neural foraminal stenosis. L3-L4: Disc bulge, ligamentum flavum thickening, and facet arthropathy. There is mild spinal canal and mild left greater than right neural foraminal narrowing.L4-L5: Mild disc bulge and facet arthropathy without significant spinal canal or neural foraminal stenosis. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are grossly unremarkable.

Output: 1. There is nonspecific heterogeneity of the bone marrow as before without definite evidence of myelomatous lesion in the lumbar spine.2. Severe loss of height involving the left aspect of the L2-L3 disc space with associated dextroscoliosis and interval increase in bone marrow edema and endplate irregularity at this level. 3. There is moderate left L2-L3 neural foraminal as well as lateral recess stenosis as before. There is also mild L3-L4 central spinal canal stenosis as before.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of frontal lobeClinical question: preop planning for tumor removalSigns and Symptoms: seizures: preop planning The patient is status post left frontal lobe surgery for removal of a left frontal lobe mass. Since the prior exam from 6/17/2015 a new 18mm focus of T2 signal change has developed along the left fontal lobe at the anterior aspect of the left superior frontal gyrus at the inferior and anterior aspect of the surgical site. This now enhances heterogenously following contrast administration. It has not changed substantially in size since 10/21/2015.T2 signal change adjacent to and inferior and posterior to the surgical site remains stable when compared to the previous exams.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Since the prior exam in June, a new focal lesion has developed at the anterior aspect of the left frontal lobe adjacent to the anterior and inferior margin of the surgical site which is suspicious for local recurrence. This has not changed substantially since the 10/21/2015 exam.


Instruction: Generate impression based on findings.

Input: 6-year-old male with history of epilepsy, ADHD, behavioral issues with intense headache in afternoon and waking the patient in the middle of the night. Evaluate for abnormalities. There is no evidence of intracranial hemorrhage, mass or edema. No abnormal enhancement in the brain or leptomeninges.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: Diagnosis: Compression of brain. Variants of migraine, not elsewhere classified, without mention of intractable migraine without mention of status migrainosusClinical question: Please evaluate for meningeal enhancement. Known Chiari.Signs and Symptoms: Right arm numbness and positional headaches. MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils are low lying. No abnormal enhancing lesions are appreciated intracraniallyNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No intracranial mass lesions are appreciated.2.There are only minor degenerative changes present in the cervical spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out intracranial pathology. Signs and symptoms: Syncope without head trauma. Non-infused CT of brain:There is diffuse prominence of cortical sulci, CSF cisterns and ventricular system. Patchy areas of periventricular low attenuation region represent small vessel disease of indeterminate age. In comparison with the prior MRI examination no gross interval change is appreciated.There is no evidence of hemorrhage, acute cortical stroke, mass effect or midline shift.

Output: 1.Findings consistent with small vessel disease of indeterminate age.2.Prominence of cortical sulci and ventricular system is stable since prior MRI examination.3.No evidence of acute hemorrhage or cortical stroke.


Instruction: Generate impression based on findings.

Input: Bilateral ACA and left MCA territorial ischemic infarctions. CTA evidence of left carotid bulb plaque irregularity. The 3D T1 weighted WATS sequence was applied.However, the images are blurred especially on posterior lateral aspect of the left carotid bulb prevents detailed analysis.Subtle linear low signal intensity (arrows on series 801, image 29/50) delineating carotid luminal high signal intensity might represent fibrous cap of carotid plaque and irregularity with interruption of the linear low signal intensity could represent ruptured portion of carotid plaque.However, there is no evidence of definitive evidence of fibrous cap interruption or intra-plaque hemorrhage (usually showing high signal intensity on T1 weighted image) on this scan.Black blood imaging attempt was not successful to show carotid bulb wall.Therefore, this MR exam is non-diagnostic.

Output: Non diagnostic MR imaging.


Instruction: Generate impression based on findings.

Input: Diagnosis: Injury, unspecifiedClinical question: hemorrhage, vestibular injurySigns and Symptoms: blunt trauma, nausea, headache Images of both right and left internal auditory canals images demonstrate normal neural bundles. There is normal appearance of the membranous labyrinth with no evidence of enlargement of the endolymphatic ducts at the level of the vestibular aqueduct bilaterally.The right vertebral artery flow-void appears very small and hypoplastic.

Output: Normal non-contrast MRI examination of the internal auditory canals.


Instruction: Generate impression based on findings.

Input: Shoulder pain for months. Evaluate for calcific tendinitis. There is a slight lateral downsloping of the acromion process, but otherwise the shoulder appears normal without periarticular calcifications or other findings to account for the patient's pain.

Output: No calcific tendinopathy or other specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Right locked jaw, muscle spasms of right jaw muscles. Abnormality of right TMJ, hypertrophy of right facial/mastication muscles? The right mandibular condyle is appropriately situated within the mandibular fossa on the closed mouth sequences. There is appropriate anterior translation of the mandibular condyle on the open mouth sequences. The articular disc is unremarkable, situated between the mandibular condyle and articular eminence on all sequences. I see no frank arthritic changes such as synovitis or erosion.The left mandibular condyle is appropriately situated within the mandibular fossa on the closed mouth sequences. There is appropriate anterior translation of the mandibular condyle on the open mouth sequences. The articular disc is unremarkable, situated between the mandibular condyle and articular eminence on all sequences. I see no frank arthritic changes such as synovitis or erosion.The musculature in the vicinity of the temporomandibular joints appears symmetric.

Output: Normal-appearing temporomandibular joints bilaterally, without findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Evaluate for headaches. Rule out PRES syndrome: History of kidney transplant and chronic headaches. Recent worsening of headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered cerebral white matter T2 hyperintense foci. The ventricles and basal cisterns are normal in size and configuration. The cerebellar tonsils are minimally low-lying. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Mild scattered cerebral white matter T2 hyperintense foci are nonspecific, but not suggestive of posterior reversible encephalopathy syndrome.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: History of recurrent fistulas. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Best seen on the post contrast imaging is a fistula tract extending from approximately4:00 position extending into the ischioanal fossa inferiorly to the medial gluteal cleft with a Seton in place. There is also a small fistula extending from approximately the 6:00 position of the anal canal extending anteriorly and towards the left and likely communicates with the above-described fistulous tract best seen on the DWI images (series 9/115).No drainable fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Transsphincteric fistula extending from the 4:00 position of the anal canal and inferiorly to the medial gluteal cleft with a Seton in place. This likely communicates with a 6:00 position short fistulous tract as well.


Instruction: Generate impression based on findings.

Input: Reason: Radiographic findings consistent with osteomyelitis of the fifth metatarsal on XR, right heel with eschar/wound, OM of right heel? OM seen on XR? There is bony destruction of the head of the fifth metatarsal and base of the fifth proximal phalanx with underlying abnormal signal intensity in the adjacent bone, indicating osteomyelitis. Adjacent to the fifth MTP joint is a collection of fluid signal intensity, measuring 2 cm in cross-section and 2 cm in longitudinal dimension, likely representing an abscess that perhaps communicates with the fifth MTP joint. The middle and distal phalanges of the fifth toe and remaining phalanges appear normal. There is mild signal abnormality in the head, neck, and distal diaphysis of the first metatarsal that may be degenerative in etiology or perhaps represent bone infarction but we see no adjacent soft tissue defect to suggest osteomyelitis. The bones of the midfoot appear normal. There is ulceration with reticulation of underlying subcutaneous fat of the posterior soft tissues of the heel with minimal edema of the inferomedial aspect of the posterior calcaneal tuberosity that we suspect reflects reactive osteitis rather than osteomyelitis. There is edema of the subcutaneous fat along the dorsum of the foot and ankle and fatty atrophy of the ankle and foot musculature.

Output: 1. Osteomyelitis of the fifth metatarsal head and base of the proximal phalanx with adjacent abscess perhaps arising from the fifth MTP joint.2. Heel ulceration with mild signal abnormality in the calcaneus which we suspect represents reactive osteitis rather than osteomyelitis.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (6/3/15, 6/10/15), ultrasound images of both breasts (6/10/15), images from ultrasound guided biopsy of right breast and postprocedural mammographic images (6/11/2015), breast MRI (6/17/2015) performed at Silver Cross Hospital. DIGITAL MAMMOGRAPHIC IMAGES (6/3/15, 6/10/15):The breast parenchyma is composed of scattered fibroglandular elements. An irregularly shaped asymmetry is seen at 12:00 position in the right breast measuring approximately 35 mm.In the left breast at the medial aspect, there is a subcentimeter circumscribed oval mass, likely benign.No suspicious microcalcifications are seen in either breast.ULTRASOUND IMAGES OF BOTH BREASTS (6/10/15):In the right breast at 12:00 position, there is a irregularly shaped hypoechoic/isoechoic lesion, corresponding to the asymmetry on the mammogram. The lesion measures at least 12 mm.In the left breast there is a small cyst measuring 5 mm, corresponding to the circumscribed benign-appearing mass seen on the mammogram.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL MAMMOGRAPHIC IMAGES (6/11/2015):Ultrasound guided biopsy for the evaluation shaped hypoechoic lesion in the right breast at 12:00 position is performed. A biopsy needle is placed at the anterior aspect of the lesion. Postprocedural right mammographic images show a marker clip placed anterior aspect of the abnormal asymmetry. Per outside radiology report, the pathology result was benign breast tissue, which is discordant.BREAST MRI (6/17/2015):Imaging protocol is described in the outside radiology report.There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.In the right breast, an irregularly shaped enhancing mass measuring 36 x 21 x 18 mm at 12:00 position, corresponding to the area of abnormalities on mammogram and ultrasound. Enhancing intramammary lymph node is seen at lower outer quadrant in the left breast. No suspicious enhancement is seen in the left breast. No abnormal lymph nodes are seen in either axilla.

Output: 1. Suspicious MR enhancing lesion at 12:00 position in the right breast, corresponding to mammographic and sonographic abnormalities. Benign pathology result of this lesion is discordant with imaging findings. Repeat ultrasound guided biopsy of the right breast lesion is recommended. 2. No imaging evidence of malignancy in the left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Ms. Giacalone is a 43-year-old woman with personal history of left breast lumpectomy in 01/2013 for IDC treated with neoadjuvant chemotherapy and radiation. She presents for routine MRI imaging surveillance. There is scattered fibroglandular tissuein both breasts. Mild parenchymal enhancement is noted bilaterally.There are stable post-lumpectomy changes present in the left breast, including architectural distortion and skin retraction. There is no abnormal enhancement within the lumpectomy bed or elsewhere in the left breast.No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 58-year-old male with simple partial seizures. No restricted diffusion to suggest acute ischemia. In the limited context of this examination, no intracranial hemorrhage is identified. There is left greater than right T2/FLAIR hyperintensity seen within the subcortical and periventricular frontal white matter that is consistent with encephalomalacia. There is ex vacuo dilation of the left lateral ventricle and expanded perivascular spaces secondary to this confluent encephalomalacia in the left frontal lobe. The T2/FLAIR hyperintensity is also visualized within the left internal capsule, left external capsule, and left thalamus. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.Findings are compatible with encephalomalacia and gliosis in the left greater than right subcortical and periventricular white matter associated with extension into the left external capsule, left internal capsule and left thalamus. Etiology is nonspecific. Although it could be vascular related or could be related to other process resulting in encephalomalacia.


Instruction: Generate impression based on findings.

Input: Reason: concern for quad rupture History: pain Evaluation is limited due to the large field of view utilized to evaluate the quadriceps tendon as well as extensive susceptibility artifact within the quadriceps tendon from prior repair.MENISCI: There is truncation of the inner fibers of the posterior horn of the medial meniscus, which may reflect prior meniscectomy or repeat tearing. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is marked thinning of the articular cartilage of the patellofemoral compartment. The bone marrow signal is within normal limits.LIGAMENTS: The posterior collateral and anterior collateral ligaments are intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: Extensive susceptibility artifact within the quadriceps tendon limits evaluation. The tendon appears irregular and thickened with associated intermediate signal intensity which may reflect scarring or tendinosis, and is likely at least partially intact.ADDITIONAL

Output: 1.Evaluation of the quadriceps tendon is limited by extensive susceptibility artifact from prior repair; however, the tendon is thickened and irregular, but appears to be at least partially intact.2.Defect in the posterior horn of the medial meniscus may reflect prior meniscectomy or re-tearing.3.Moderate joint effusion.4.Marked thinning of the articular cartilage of the patellofemoral compartment.


Instruction: Generate impression based on findings.

Input: Headache. MS. Street renal transplant. No intracranial bleed. Mildly prominent extra-axial space and sulci. Moderate patchy periventricular and subcortical white matter low-attenuation are again seen. Gray-white differentiation is preserved. Basal cisterns are patent. Ventricles are symmetric and normal in size. Visualized paranasal sinuses and mastoid air cells are clear.

Output: No acute intracranial abnormality. No significant interval changes in the appearance of the brain since prior exam, allowing for comparison with the previous study a different modality, brain MRI October 28, 2009.


Instruction: Generate impression based on findings.

Input: 82 years Male (DOB:2/21/1934)Reason: syncope workup History: near syncopePROVIDER/ATTENDING NAME: NIR Y URIEL NIR Y URIEL MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR hyperintense focus is present in the brainstem, along the posterior aspect of the pons measures approximately 17 x 15 mm. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is 55% stenosis at the origin of the right internal carotid artery and 70% stenosis at the origin of the left internal carotid artery both of which are associated with intraluminal filling defects. The filling defect on the left is larger than the one on the right.The left A1 segment appears hypoplastic . The left internal carotid artery is smaller than the right internal carotid artery. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.55% stenosis at the origin of the right internal carotid artery and 65% stenosis at the origin of the left internal carotid artery both of which are associated with intraluminal filling defects. The filling defect on the left is larger than the one on the right. It is conceivable that this could represent intraluminal thrombus. Please correlate with the ultrasound findings.2.Periventricular and subcortical white matter lesions of a moderate degree as well as a lesion in the pons are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: New lung cancer diagnosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are subcentimeter areas of enhancement superficially along the cortex of the right precentral and postcentral gyri, with associated high T2 signal in the cortex. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is a subcentimeter enhancing lesion in the right frontal bone and a partially imaged lesion in the left C3 vertebra.

Output: 1. Subcentimeter areas of enhancement superficially along the cortex of the right precentral and postcentral gyri are compatible with metastases, perhaps leptomeningeal in nature.2. A right frontal bone lesion and a partially imaged lesion in the left C3 vertebra is also compatible with metastatic disease.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 17 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium for subsequent MRI arthrogram of the left hip.


Instruction: Generate impression based on findings.

Input: 70-year-old female with Parkinsonism, gait and balance issues with falls backwards, evaluate midbrain and cerebellum and ventricles. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is moderate to severe periventricular and to a lesser degree subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. No significant change since prior study from 12/27/2013. There is also a small focus of T2 hyperintensity in the right paramedian upper aspect of the pons likely reflecting chronic infarct and present on 5/13/2015 CT but not definitively seen on prior MRI from 2013. There is is moderate degree of global parenchymal volume loss. No disproportional volume loss involving the brainstem or cerebellum is appreciated.There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Moderate to severe periventricular, and to a lesser degree subcortical, white matter T2/FLAIR hyperintensity is nonspecific but likely related to chronic small vessel ischemic disease. Prior inflammation or demyelination are additional considerations. There is also a chronic right pontine lacunar infarct. 2. No disproportional volume loss involving the brainstem or cerebellum. No evidence of hydrocephalus. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 22 years old Male. History of repeated shoulder dislocation (4 dislocations in the last 4 months). Evaluate for glenoid bony loss. IMAGE ACQUISITIONS: CT of the right shoulder without contrast The osseous structures of the glenoid are intact with no evidence of osseous Bankart's fracture.Depression at the superior lateral aspect of the humeral heads is consistent with Hill-Sachs deformity which was noted on prior MRI dated 7/15/2010

Output: 1.No abnormalities in the osseous components of the glenoid.2.Hill-Sachs deformity of the humeral head is noted.


Instruction: Generate impression based on findings.

Input: 21-year-old female with right shoulder pain. Evaluate for rotator cuff tear ROTATOR CUFF: The tendons and muscle fibers of the supraspinatus, infraspinatus, subscapularis and teres minor appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly normal. There is small amount of fluid within the glenohumeral joint and subscapular recess which is not pathologic.BICEPS TENDON: The biceps tendon is normal throughout its course. ADDITIONAL

Output: 1. No evidence of rotator cuff tear as clinically questioned.2. The labrum is grossly normal. However if there is a question of labral pathology clinically, an MR arthrogram of the shoulder would be helpful for further evaluation.


Instruction: Generate impression based on findings.

Input: Neck pain with right arm paresthesias Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. Minimal degenerative changes are seen in the cervical spine with mild multilevel disk desiccation and mild facet arthrosis.The cervical spinal cord has normal signal characteristics and overall morphology.Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Minimal degenerative changes in the cervical spine. No significant spinal canal stenosis or neural foraminal stenosis at any level in the cervical spine.


Instruction: Generate impression based on findings.

Input: 80-year-old female with history of thoracic spine decompression, annual surveillance Redemonstrated is vertebral body height loss involving T8, T9, and T10 with significant wedge deformity of T9. There is also significant effacement of intervertebral disk spaces at these levels with increased fusion across the disc level at T8/9. Minimal edema within T9 and T10 have resolved. As before, there is exaggerated kyphosis of thoracic spine centered at T8/9, not significant changed. The alignment of vertebral column otherwise remains anatomical similar to prior exam.T2 hyperintensity within the thoracic cord at T7/8, T8/9, and T9/10, as well as 2 subtle punctate foci of T2 hyperintensity at the T8 and T10 levels are similar to prior exam. Postoperative changes of multilevel laminectomy at this level is stable. Post procedural T2 hyperintensity within the soft tissues has nearly resolved. Multilevel mild degenerative changes without significant associated stenosis is again noted. Redemonstrated is a partially visualized heterogeneously T2 hyperintense lesion within the right lobe of the thyroid gland measuring 22x18 mm in axial dimension which is unchanged.

Output: 1.Minimal edema within T9 and T10 have resolved. There is increased fusion across the disc level at T8/9. The remaining changes of T8, T9 and T10 are stable. 2.Stable foci of thoracic cord T2 hyperintensity of the T8 through T10 levels is stable.3.Post procedural T2 hyperintensity within the soft tissues has nearly resolved.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges [D32.0], Reason for Study: ^Reason: yearly f/u for meningioma History: surveillance Again seen is an avidly enhancing dural-based enhancing extra-axial mass along the dorsal aspect of the clivus extending through the ventral foramen magnum to the upper C2 level. Inclusive of the dural tail, the lesion measures 3.9 x 1.8 cm in maximal transverse dimension in the sagittal plane and 2.7 x 2.4 cm in the axial plane, which represents no significant change from the prior study. This lesion impinges upon and significantly flattens the medulla, similar to the prior exam. There is susceptibility effect in the right aspect of the lesion which may represent calcification or chronic blood products.No additional intracranial masses or enhancing abnormalities are detected. Brain parenchyma is otherwise significant only for mild scattered T2 hyperintensities within the white matter which are unchanged and likely reflect chronic small vessel ischemic disease. Diffusion-weighted images are negative for evidence of acute ischemia. No intracranial hemorrhage or abnormal extra-axial fluid collections are detected. A left parietal approach ventricular shunt catheter is in stable position with distal tip along the septum pellucidum. The ventricles are stable in size with left lateral ventricle smaller than right. No hydrocephalus.There is redemonstration of a 7 mm enhancing T2 hyperintense lesion in the posterior right pituitary. Lesion demonstrates a more solid pattern of enhancement relative to prior. The lesion has not clearly grown, however, and the pituitary gland itself appears slightly decreased in size.Bone marrow signal characteristics are unremarkable. A mucous retention cyst is redemonstrated in the right maxillary sinus.

Output: 1. There is a stable meningioma extending along the dorsal clivus through the foramen magnum with unchanged mass effect on the medulla.2. A subcentimeter posterior right pituitary lesion appears more solidly enhancing but no larger than on prior examination.


Instruction: Generate impression based on findings.

Input: 54-year-old man with history of colon cancer and metastasis to the liver. ABDOMEN:LIVER, BILIARY TRACT: A T2 hyperintense lesion in segment 8 of the liver (series 5, image 7) measures 20 x 18 mm and abuts the right hepatic vein. This lesion corresponds to the FDG avid lesion seen on the outside PET. This lesion demonstrates mild, peripheral enhancement. Additional, smaller highly T2 hyperintense lesions are noted in segments 4 (series 5, image 9) and segment 2 of the liver (series 5, image 10).SPLEEN: The spleen appears normal.PANCREAS: The pancreas is atrophic, but otherwise appears normal. The previously seen peripancreatic lymph node is not visualized on this study.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance normally.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The patient is status post total colectomy. The visualized small bowel is normal.BONES, SOFT TISSUES: Bilateral hip prostheses are noted.OTHER: Small bilateral pleural effusions noted.

Output: 1.Solitary segment 8 liver lesion suspicious for metastasis.2.Previously seen FDG avid peripancreatic lymph node not visualized on today's study.3.Left lobe hepatic cysts.


Instruction: Generate impression based on findings.

Input: Clinical question: Structural brain lesion signs and symptoms: Weakness. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted images.There is normal anatomical morphology of the brain parenchyma and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal parenchymal, meningeal or calvarial enhancement.Normal visualization of nature intracranial arterial branches.Normal signal intensity and pattern of enhancement of intracranial venous sinuses.Slight prominence of the pituitary gland with normal pattern of enhancement is appropriate for patient's stated age of 33.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal signal intensity of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.

Output: Unremarkable 3 and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 64 year old with strong family history of breast cancer in mother and sister. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Tongue pain and burning. The tongue and other oral cavity structures appear unremarkable. There is no evidence of mass lesions. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures and orbits are unremarkable. There is a small retention cyst in the left maxillary sinus.

Output: No evidence of mass lesions in the tongue.


Instruction: Generate impression based on findings.

Input: 76 year-old woman with history of adenocarcinoma of the lung, status post right lower lobectomy CHEST:LUNGS AND PLEURA: Areas of consolidation and ground glass opacities are identified in the lingular segment of the left upper lobe as well as in multiple locations in the residual right right lung. These demonstrate significant interval increase compared to the prior outside exam and may represent multiple sites of bronchiolo - alveolar carcinoma. Multifocal infection is considered less likely.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy is identified.Cardiac size is normal without evidence of pericardial effusion. Pacemaker lead wires are noted.CHEST WALL: Right-sided pacer.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodensities, which may represent hepatic metastases. Dedicated imaging of the liver with CT and/or MRI is recommended.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes within the thoracic and lumbar spine.OTHER: No significant abnormality noted

Output: 1.Multifocal areas of mixed solid and ground glass opacities bilaterally, compatible with multiple sites of bronchiolo - alveolar carcinoma.2.Multiple hepatic hypodensities, which may represent hepatic metastases. Dedicated CT and/or MRI imaging of the liver is recommended. In addition, PET scanning may be of value.


Instruction: Generate impression based on findings.

Input: 68 year old with altered mental status. Patchy areas of periventricular and subcortical lucencies are consistent with small vessel disease of undetermined age. No evidence of hemorrhage, mass effect, midline shift or hydrocephalus is detected. Additional clinical history of metastatic colon cancer was relayed to the radiology resident on call. If concern for metastatic process or acute stroke is suspected an MRI is recommended.

Output: Small vessel disease of undetermined age. Please see above comments.


Instruction: Generate impression based on findings.

Input: Brain: Exam is limited by metallic artifact from braces, especially of the orbits and paranasal sinuses. Within these limitations, there is no restricted diffusion to indicate an acute ischemic infarct. No susceptibility weighted abnormalities to indicate hemorrhage within the limitations caused by extensive artifact. There are no masses, mass effect or midline shift. Several subcortical punctate white matter signal hyperintensities on flair and T2 imaging, including within the left superior frontal gyrus, are stable. The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. There is no abnormal enhancement within the brain. Cervical Spine: There is slight reversal of lordosis of the cervical spine. There is a small left paracentral disc protrusion with resultant mild to moderate spinal canal narrowing at the C3/4 level. No neuroforaminal stenosis is noted in the cervical spine. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The visualized paraspinal contents are unremarkable.

Output: 1.Evaluation of the brain is limited secondary to extensive artifact from braces. Within these limitations, there are no acute brain abnormalities.2.No discrete evidence of demyelination in the brain or cervical spine.3.There is a small left paracentral disc protrusion with resultant mild to moderate spinal canal narrowing at the C3/4 level.


Instruction: Generate impression based on findings.

Input: 67-year-old male experiencing right upper extremity weakness, history of invasive squamous cell carcinoma of the supraciliary ridge with chemoradiation treatment Motion is present on several series due to patient pain and sleeping. Repeat sequences were performed when possible. Given this caveat:Brain MRI:Redemonstrated are post-treatment findings in the left supraciliary region with a persistent infiltrative enhancing lesion in the left supra-orbital subcutaneous tissues with extension into the left orbital roof, traversing the frontal bone along the lateral aspect of the left frontal sinus with slight epidural extension and extraconal left orbital extension. Overall, the lesion appears unchanged in appearance given differences in technique.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no brain parenchymal masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. A left maxillary retention cyst is unchanged. The remaining paranasal sinuses and mastoid air cells are clear.Cervical spine MRI:Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Posterior osteophyte disc complex and bilateral facet hypertrophy. There is moderate left neural foraminal and severe right neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is moderate central and severe bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex eccentric to the left, bilateral uncinate hypertrophy, ligamentum flavum thickening and left facet hypertrophy. There is mild to moderate central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum flavum thickening. There is mild central, moderate left neural foraminal, and severe right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is severe left neural foraminal and moderate right neural foraminal stenosis.C7/T1: Endplate spurring eccentric to the right causes moderate right neural foraminal stenosis.

Output: 1.Redemonstrated are post-treatment findings in the left supraciliary region with a persistent infiltrative enhancing lesion in the left supra-orbital subcutaneous tissues with extension into the left orbital roof, traversing the frontal bone along the lateral aspect of the left frontal sinus with slight epidural extension and extraconal left orbital extension. Overall, the lesion appears unchanged in appearance given differences in technique. Otherwise negative MRI of the brain.2.C2/3: Moderate left neural foraminal and severe right neural foraminal stenosis.3.C3/4: Moderate central and severe bilateral neural foraminal stenosis.4.C4/5: Mild to moderate central and severe bilateral neural foraminal stenosis.5.C5/6: Mild central, moderate left neural foraminal, and severe right neural foraminal stenosis.6.C6/7:Severe left neural foraminal and moderate right neural foraminal stenosis.7.C7/T1: Moderate right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 51 years old. Reason: re-evaluate osseous lesions seen on prior study, hx osseous sarcoid History: re-evaluate osseous lesions seen on prior study, hx osseous sarcoid Again seen are multiple round lesions within the sacrum, innominate bones, and proximal femora, many of which appear slightly smaller and less confluent on the current study than on the prior study. For example, a right intertrochanteric lesion measured 2.3 cm in craniocaudal dimension on the prior study, and now measures 2 cm. These lesions are of similar intensity to skeletal muscle on T1WI, hyperintense on T2WI, and enhance following contrast administration.Osteonecrosis of the femoral heads appears similar to the prior study, with osteoarthritis affecting both hips, left greater than right. Degenerative disc disease at L4-5 appears similar to the prior study.Lymphadenopathy seen on the prior study is again noted, although many of the lymph nodes appear slightly smaller in size. A uterine fibroid and nabothian cysts appear similar to the prior study accounting for slight positional differences.

Output: 1.Findings compatible with sarcoidosis as described above with lesions appearing smaller and less confluent on the current study than on the prior study.2.Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate hygroma. Signs and symptoms: Status post Chiari decompression with hygroma now on head CT. Continuous dizziness. Nonenhanced brain MRI:Unremarkable diffusion-weighted series. Examination demonstrate postoperative changes of Chiari decompression. There is postoperative epidural fluid collection/seroma at the surgical site with subtle mass effect and without significant expansion of subarachnoid space. There is mild remaining flattening deformity of the cerebellar tonsils without detectable signal abnormality. On sagittal images this collection measures approximately 40 mm in cranial cephalad axis and 12 mm in AP axis.There is a CSF signal intensity hygroma along the left hemispheric convexity. Hygroma in the posterior fossa is also detected surrounding the cerebellar hemispheres (left greater than right). This finding demonstrate no significant change since prior head CT examination from 10-12-15. The left hemispheric convexity hygroma measures approximately 7 to 8 mm in thickness. There is resultant subtle flattening deformity of the adjacent parenchyma and subtle mass effect on the left lateral ventricle and trace rightward deviation of midline of approximately 4 mm. Hypoechoic posterior fossa measures maximum of approximately 1.5 mm thickness.There is no evidence of ventriculomegaly. There is no signal abnormality of the brain parenchyma.Nonenhanced cervical MRI:Revisualization of the above detailed postoperative changes of suboccipital craniectomy.Normal signal intensity and alignment of vertebral column.Normal signal intensity and caliber of cervical and upper most visualized thoracic cord without evidence of syrinx.No spinal stenosis or neural foraminal compromise.CSF flow study demonstrates presence of biphasic flow through the foramen magnum anterior and without detectable flow posteriorly. There is also no detectable flow through the fourth ventricle or the aqueduct.

Output: 1.Nonenhanced brain MRI demonstrate postoperative changes of suboccipital craniectomy, epidural seroma immediately posterior to the surgical site with subtle mass effect as detailed-measured about. Right hemispheric convexity hygroma measuring approximately 7 to 8 mm without significant change since prior head CT examination and with resultant 4 mm midline shift. Thin approximately 1.5 mm maximum thickness of diffuse hygroma in the posterior fossa (left greater than right) without significant mass effect.2.Unenhanced cervical MRI demonstrate Chiari decompression postop changes. Normal signal intensity and caliber of the cord. Normal appearing biphasic flow through the foramen magnum anteriorly and absence of flow posteriorly. No detectable flow through the fourth ventricle or the aqueduct.


Instruction: Generate impression based on findings.

Input: Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: Pt with history of previous coiling, partially recanalized right cavernous carotid. Follow up MRI. History: See above. Brain MRINo evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. Minimal non specific small vessel ischemic disease.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 3mm sized partial recanalization of previously coiled right proximal cavernous sinus segment aneurysm, unchanged. No other aneurysm is seen.No evidence of intracranial arterial luminal stenosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Minimal non specific small vessel ischemic disease.3. Stable partial recanalization of the right proximal cavernous sinus segment ICA aneurysm since prior scan.


Instruction: Generate impression based on findings.

Input: Low back pain, history of lumbar fusion, radicular pain. Left lower extremity atrophy. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of normal lumbar lordosis.. Bone marrow signal is benign including T1 hyperintense lesions at the T11 and L2 vertebral bodies compatible with hemangiomas. The conus medullaris is normal in position. There are postsurgical changes of prior laminectomy at the L4-L5 and L5-S1 levels.Multilevel degenerative changes are seen, as described below:L1-L2: Mild disk bulge. No spinal canal or neural foraminal stenosis.L2-L3: Mild disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: Mild disk bulge. No spinal canal or neural foraminal stenosis.L4-L5: There is some loss of disk height and left paracentral disk protrusion with partial effacement of the left lateral recess which may be effecting the traversing L5 nerve root. There are prominent degenerative endplate marrow signal changes. There is mild right and moderate left neural foraminal stenosis. Central spinal canal is patent with laminectomy at this level noted. Mild facet arthropathy.L5-S1: There is severe loss of disk height and prominent degenerative endplate marrow signal changes. There is diffuse disk bulge which involves the bilateral lateral recesses and foramina. There is an osteophyte component. There is severe left and moderate to severe right foraminal stenosis. Central spinal canal is patent with laminectomy at this level noted. Mild facet arthropathy.Paraspinous soft tissues are postsurgical changes but are within normal limits. Bilateral renal cysts incidentally noted.

Output: 1. Advanced degenerative changes at the L4-L5 and L5-S1 levels with evidence of prior laminectomies at these levels. There is no significant spinal canal stenosis at any level. 2. There is moderate left L4-L5 and severe left L5-S1 neural foraminal stenosis which may be impinging on the left L4 and L5 nerve roots. There is also effacement of the lateral recesses at these levels, left greater than right, where there may be impingement of the traversing L5 and S1 nerve roots.


Instruction: Generate impression based on findings.

Input: 45 year old with biopsy proven left breast cancer. BRCA 1 positive. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a rapidly enhancing mass, measuring 11 x 11 x 18 mm (AP x LR x CC), at posterior 11 o'clock position in the left breast, consistent with the known cancer. Metallic artifact presumably from a marker clip is present immediately anterolateral to the mass.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal cancer in the left breast.2. No MRI evidence of malignancy in the right breast.3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Cervical spine:The anterior arch of C1 appears larger than typical, although the remainder of C1 appears intact without dysplasia. The immediately adjacent odontoid tip also appears atypical in appearance, yet without gross dysplastic change.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no stenoses.Thoracic and Lumbar spine:There is complex osseous dysplasia which begins at the T12/L1 level and includes only a partial L1 lumbar level, absent lumbar segments more inferiorly, with sacral agenesis. The paraspinal musculature also appears absent below the L1 level.The cord terminates just above the T10/11 level and demonstrates a blunt ended appearance. Nerve roots along the posterior central canal inferiorly demonstrate a thickened and clumped appearance. Neural foramina appear patent to the T12/L1 level, with nonvisualized neural foramina at the dysplastic L1/2 level, and none inferiorly.There appears to be a tract within the soft tissues that extends from the level of the dysplastic inferior aspect of L1 extending to the skin surface. There is a tiny, 6 mm, fluid appearing cystic portion along its mid aspect.

Output: MRI evidence for caudal regression syndrome including lumbosacral agenesis.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: Pt w/ breast CA and brain mets. History: brain mets s/p SRS. 28 years Female (DOB:3/26/1988)Reason: Pt w/ breast CA and brain mets. History: brain mets s/p SRS.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS Comparing to prior scan, there are nodular and somewhat linear enhancing lesions especially on the right cerebellar hemisphere, one at the inferior aspect and another at the superior aspect. Both are measured about 1 to 2 mm in diameter. There are not associated with surrounding edema. Comparing to prior scan, the mass size has been significantly decreased.Supratentorially, there is no identifiable enhancing lesion on today's scan.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids of major intracranial vasculature are present.The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Opacification of the left maxillary sinus with mucosal thickening on the right maxillary sinus are seen.

Output: 1. Significant interval decrease of the size of the posterior fossa, especially on the right cerebellar hemispheric metastatic lesion since prior scan.2. Nonvisualization of previously seen enhancing metastatic lesion supratentorially.3. No evidence of acute ischemic or hemorrhagic lesion. No other abnormal enhancing lesion is seen.


Instruction: Generate impression based on findings.

Input: 22-year-old female with recurrent paraganglioma post MIBGEXAMINATION: MR abdomen and pelvis without and with IV contrast 2/25/2015 ABDOMEN:LIVER, BILIARY TRACT: Normal with no evidence of intra or extrahepatic biliary ductal dilatation. Gallbladder is normal.SPLEEN: Normal.PANCREAS: Normal. No evidence of pancreatic ductal dilatation.ADRENAL GLANDS: Redemonstration of a low T1, high T2 enhancing left suprarenal lesion measuring 2.5 cm x 2.4 cm (Series 501, image 19) previously measured 2.3 cm x 2.3 cm. The left adrenal gland is not identified separate from this lesion. The right adrenal gland is normal. KIDNEYS, URETERS: Normal bilaterally with no evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: There is a similar appearing aortocaval mass with prominent mass effect on the adjacent IVC measuring 3.0 cm x 2.8 cm (series 501, image 6) previously measured 3.1 cm x 2.7 cm. BOWEL, MESENTERY: Normal in caliber with no evidence of obstruction.BONES, SOFT TISSUES: Numerous enhancing lesions throughout the pelvis, proximal left femur and visualized spine which appear similar to prior. A lesion within the L5 vertebral body is again seen not significantly changed with epidural extension and partial effacement of the thecal sac as well as possible impingement on the exiting left S1 nerve root.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: NormalBLADDER: NormalLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal in caliber with no evidence of obstruction.BONES, SOFT TISSUES: Numerous enhancing lesions throughout the skeleton as described above.OTHER: No significant abnormality noted

Output: No significant interval change in left suprarenal mass as well as widespread osseous and retroperitoneal metastatic disease. Epidural extension of the L5 lesion with impingement on the exiting left S1 nerve root is not significantly changed.


Instruction: Generate impression based on findings.

Input: Male, 29 years old. Knee pain. Eval for quad strain; meniscal tear. MENISCI: There is vertically oriented intermediate signal within the peripheral fibers of the posterior horn of the lateral meniscus, likely representing a chronic, possibly healed tear that is continuous with the interface of the ligament of Wrisberg. This appears similar to that seen on the prior study. We see no fluid signal intensity within this tear to indicate instability. The remainder of the lateral meniscus and the medial meniscus appear normal.ARTICULAR CARTILAGE AND BONE: The articular cartilage and bone are normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps tendon and distal quadriceps musculature appear normal. The patellar tendon appears normal.ADDITIONAL

Output: Possible chronic, healed tear of the vascularized periphery of the posterior horn of the lateral meniscus. The knee otherwise appears normal.


Instruction: Generate impression based on findings.

Input: Low back pain, leg pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is straightening of the lumbar curvature and minimal retrolisthesis of L3 on L4 and L4 and L5. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is disc desiccation and mild disc bulge. There is no significant spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis. Mild facet arthropathy.L4-L5: There is disc desiccation and mild bulge without significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis. There is a Schmorl's node and mild edema involving the inferior L4 endplate on the left which is on a degenerative basis. Mild facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits. Left kidney is absent.

Output: 1. Disc bulges at L3-4 L4 and L4-L5 with mild-to-moderate neural foraminal stenosis as described above.2. No significant spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Mycosis fungoides and leptomeningeal disease: vision loss and loss of vision acuity with 3rd nerve palsy and ptosis. Orbits MRI: There is high T2 signal and mild hyperenhancement of the left inferior, medial, and superior oblique muscles. There may also be mild high T2 signal in the right inferior recuts muscle. The bilateral globes, lacrimal glands, and optic nerves are otherwise unremarkable. Brain MRI: There is diffuse enhancement of the bilateral oculomotor nerves, left more than right. There also appears to be enhancement of the cisternal segments of the bilateral trigeminal nerves, left more than right. Furthermore, there appears to be a greater degree of diffuse enhancement involving the bilateral facial nerves than usual. There is no evidence of abnormal enhancement in the cerebral sulci. There is nonspecific high T2 signal in the left peritrigonal white matter. The rest of the brain parenchyma appears to be unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: Abnormality involving the bilateral oculomotor and trigeminal nerves, left more than right, as well as possibly the facial nerves, with denervation effects in the extraocular muscles, particularly on the left side may be related to neoplastic involvement.


Instruction: Generate impression based on findings.

Input: History of small cell lung cancer with brain metastases treated with WBRT. There is a heterogeneously enhancing mass present along the medial aspect of the left temporal lobe currently measuring 19 x 13 mm axial dimensions and previously 27 x 13 mm axial dimensions. It is associated with T2 signal hyperintensity and some punctate foci of signal loss on susceptibility imaging. FLAIR signal abnormality associated with this particular lesion appears to have mildly regressed.A lesion located in the right medial temporal lobe patient's of the right lateral ventricle currently measures 15 x 15 mm axial dimensions and previously measured 8 mm axial dimensions. A lesion adjacent to the trigone of the left lateral ventricle at its junction with the temporal horn is not clearly visible on the prior exam but currently measures approximately 5 mm. Lesion located within the left hippocampus now measures 5 mm and previously measured 3 mm. FLAIR signal abnormality associated with these lesions appears to have increased.There is a cystic lesion present at the occipital horn of the left lateral ventricle which measures 10 x 19 mm axial dimensions. It has different signal intensity relative to CSF. On the prior exam it is not clearly distinguished. This particular lesion is associated with surrounding FLAIR signal hyperintensity.There several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These were also present on the prior exam.A lesion along the left occipital lobe lingual gyrus currently measures 20 x 11 mm and previously measured 6 x 7 mm.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small opacity in the left maxillary sinus. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.

Output: 1.There are multiple lesions scattered within the brain parenchyma the majority of which have increased in size relative the prior exam. The exception is a lesion in the left temporal lobe which has mildly decreased in axial dimensions. These are compatible patient's diagnosis of metastatic disease2.A cystic lesion is present in the occipital horn of the left lateral ventricle which appears to potentially represent entrapment of the occipital horn.


Instruction: Generate impression based on findings.

Input: Headache and dizziness. Syncope and collapse. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter. There is no pathological enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Scattered punctate foci of abnormal T2 signal within the periventricular and subcortical white matter, which are nonspecific.


Instruction: Generate impression based on findings.

Input: 26-year-old female with a history of migraine headaches presents with increased frequency and severity of headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 77 year old male with history of biliary stricture and evidence of chronic pancreatitis on EUS. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in contour. There is mild extrahepatic biliary duct dilatation with the common bile duct measuring 12 mm in diameter, appearing similar to the prior study. There is associated narrowing at the level of the head of the pancreas. No significant intrahepatic biliary ductal dilatation. No focal parenchymal lesions. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: There is marked atrophy of the pancreas. A small volume of residual tissue demonstrating signal characteristics of normal pancreas remains in the pancreatic head, unchanged. The main pancreatic duct is markedly dilated measuring 12 mm in diameter, previously 10 mm. The main pancreatic duct is again noted to smoothly taper just proximal to its junction with the common bile duct. No mass lesion is evident. In response to secretin administration, there is normal opacification of the entire duodenum up to the ligament of Treitz, however, there appears to an overall blunted response to secretin augmentation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Hemangioma in the L2 vertebral body.OTHER: No significant abnormality noted.

Output: Persistent findings consistent with chronic pancreatitis. There is main pancreatic duct and common bile duct dilation with associated narrowing at the level of the pancreatic head, most consistent with benign stricturing which may be a sequela of chronic pancreatitis. There are no focal pancreatic mass lesions identified.


Instruction: Generate impression based on findings.

Input: 2-year-old previously healthy male with a recent history of abdominal lymphovascular resection 4 weeks ago, who presents with new onset focal seizures (left arm stiffening, staring, drooling). Please evaluate for brain malformation or abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears within normal limits, including bilateral terminal zones of myelination in the posterior cerebral hemispheres. No findings to suggest seizure focus are appreciated. Specifically, there is no evidence of gray matter heterotopia or cortical dysplasia. The bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal mucosal thickening.

Output: No findings to suggest seizure focus are appreciated.


Instruction: Generate impression based on findings.

Input: Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus [G43.509], Reason for Study: ^Reason: vision changes with headache History: vision changes There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Polypoid soft tissue lesion on the posterior aspect of nasal cavity which appears to be connected to the left inferior turbinate posterior aspect with homogenous enhancement. This lesion suggest possible nasal polyposis, thus clinical correlation/inspection is recommended. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or intracranial abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement intracranially.3. Possible nasal polyposis especially left inferior posterior turbinate, clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: 45-year-old male with history of EBV lymphoma proliferation in HIV. Follow-up. BRAIN: Limited intracranial images demonstrate no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.NECK SOFT TISSUES:The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The lingual tonsils appear slightly prominent. No frontal masses are noted. There are many cervical lymph nodes at multiple levels.Small intraparotid lymph node is borderline in size measuring 12 x 8 mm (series 4, image 36). Small level 2 lymph node posterior and inferior to the right parotid gland is 11 x 8 mm (series 4, image 41). Small level 2 lymph node anterior to the sternocleidomastoid muscle anterior to the carotid artery measures 17 x 6 mm, (series 4, image 44). Additional multiple small lymph nodes are present throughout the visualized soft tissues not enlarged by CT criteria.Minimal multilevel degenerative change affects the visualized cervical spine without evidence of central canal or neuroforaminal stenosis. Vertebral body hypertrophy with posterior bridging osteophyte present at T1-T2 which is causing posterior indentation into the visualized cervical central canal. Due to CT technique and artifact in the spinal cord cannot be evaluated. There is clinical concern for cord compromise an MRI may be considered. The osseous structures are otherwise unremarkable.LUNG APICES:Lung apices are clear bilaterally.

Output: 1. Multiple lymph nodes some of which are borderline many of which are not pathologically enlarged by CT criteria, none of which demonstrate pathologic enhancement. No additional masses identified.2. Slight prominence of the lingual tonsils of uncertain etiology.3. Vertebral body hypertrophy with posterior bridging osteophyte present at T1-T2 which is causing posterior indentation into the visualized cervical central canal. Due to CT technique and artifact in the spinal cord cannot be evaluated. There is clinical concern for cord compromise an MRI may be considered.


Instruction: Generate impression based on findings.

Input: CSF leak, plan for OR. Additional history includes prior right hemispherectomy for epilepsy. Status post right hemispherectomy. A left transoccipital catheter terminates in the right cerebral hemisphere cavity, unchanged. Dysmorphic and collapsed third and left lateral ventricles are unchanged. Periventricular white matter T2 hyperintensity is again seen, and grossly unchanged. A complex cystic collection in the posterior left cerebral hemisphere is unchanged. No evidence of restricted diffusion to suggest acute infarct. Carotid, basilar, and left sided major intracranial flow voids are present indicating patency. The right lenticular shaped extradural collection has decreased in maximal diameter currently measuring 12 mm, previously up to 19 mm, and is now predominantly air-filled. The paranasal sinuses and mastoid air cells are clear.

Output: Postoperative changes of right hemispherectomy with decreasing right extradural fluid collection.


Instruction: Generate impression based on findings.

Input: 69-year-old female with a history of glioblastoma multiforme presents with generalized weakness. There is redemonstration of a large right frontotemporal lobe mass involving the insula consistent with patient's biopsy proven glioblastoma multiforme. There is hypodensity surrounding this mass consistent with a combination of tumor infiltration and vasogenic edema. Periventricular white matter hypoattenuation also noted. These findings appear similar to the prior studies though MRI would be more accurate for evaluation of tumor progression.There is no evidence of a new intracranial mass or focal lesion. There is no evidence of acute territorial ischemia. There is no acute intracranial hemorrhage or extra-axial fluid collection. While there remains 4mm of right to left midline shift, the sulci and ventricles appear slightly more prominent than in November 2011, probably on the basis of treatment related change (e.g. steroids). There is no basal cistern effacement or herniation.Right frontal bone burr hole. The remainder of the calvaria and skull base are radiographically normal. The visualized mastoid air cells are clear. Partial opacification of the ethmoid sinuses bilaterally. Bilateral lens prosthesis.

Output: 1. No acute intracranial abnormality.2. Right frontotemporal mass with surrounding edema, similar to the previous examination when allowing for differences in modalities. No significant interval change in associated leftward midline shift. MRI examination would be more sensitive for evaluation of tumor progression.


Instruction: Generate impression based on findings.

Input: Gait imbalance with veering left greater than right. No restricted diffusion abnormality to suggest acute ischemia. The brain parenchymal signal intensity is within normal limits for age. There is a juxtacortical punctate focus of T2 hyperintensity in the left superior frontal gyrus, which is nonspecific. The ventricles, sulci, and basal cisterns are normal in size and configuration. There is no evidence of regional mass effect or midline shift. The cerebellum is normal in appearance without evidence of atrophy. The cerebellar tonsils are normal in position. No abnormal foci of enhancement are noted. Incidentally noted is a developmental venous anomaly in the right middle frontal gyrus. A focus of susceptibility in the right occipital lobe likely represents old microhemorrhage or mineralization. There is no associated edema. There is patchy paranasal sinus mucosal thickening/opacification involving the ethmoid air cells and maxillary sinuses. The orbits are within normal limits.

Output: No evidence of cerebellar atrophy or other specific findings which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: visual field loss left side history of pituitary cyst "collapsed" There is no evidence of intracranial hemorrhage, mass, or acute infarct. Punctate T2 hyperintense foci in the left periventricular white matter and right corpus callosum are not significantly changed. There is no abnormal intracranial enhancement. Ventricles and sulci are prominent for age suggesting volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.A 2 mm lesion which is hypoenhancing and hypointense on T2 is more evident on this exam but was likely present on prior exams accounting for differences in technique. There is an additional 3 mm T2 hyperintense focus more posteriorly and superiorly which is unchanged from the prior exams. Please note that this lesion is not seen on current dynamic images as it is not included within the slices sampled. Pituitary size and shape otherwise appears normal. Pituitary stalk appears normal. No significant mass effect on the chiasm.

Output: 1.No findings to explain visual field deficit.2.A 2 mm lesion which is hypointense on T2 and hypoenhancing is unchanged from prior exams accounting for differences in technique and may represent a remnant pars intermedia cyst or other incidental pituitary cyst.3.A 3 mm T2 hyperintense focus within the pituitary is unchanged from prior exams and may represent a cystic microadenoma or another incidental pituitary cyst.4.Stable minimal white matter changes within the brain.


Instruction: Generate impression based on findings.

Input: New onset panhypopituitarism on anti-cancer immune modulator with hypophysitis as side effect; rule out mets or other causes of pituitary failure There is heterogenous enhancement of the pituitary gland without significant enlargement of the gland or the pituitary infundibulum. The posterior pituitary bright spot is intact. There is no evidence of mass lesions. The optic apparatus and cavernous sinuses are intact. The imaged intracranial structures are unremarkable.

Output: Heterogenous enhancement of the pituitary gland may represent treatment-related necrotizing hypophysitis.