Instruction: Generate impression based on findings.

Input: Multiple myeloma and ependymoma, evaluate interval change Five lumbar type vertebral bodies are presumed to be present. Again seen are multiple compression fractures including the T11, T12, L2, L3, and L4 vertebral bodies, not significantly changed since prior study from 2/19/2015. Relatively worse height loss is at T12 with approximately 70% loss of height. No bone marrow edema associated with the fractures to suggest recent loss of height.There is worsening of marrow signal abnormality including a rounded lesion involving the L3 vertebral body measuring approximately 2 cm in diameter, which is not definitively appreciated previously. There is also increased in diffuse mottled appearance of the bone marrow signal particularly from the L5 level through the pelvis. Multiple enhancing lesions are evident involving the sacrum and iliac bones bilaterally, which are new since 2/19/2015.Postoperative changes of laminectomy are seen at the L4-L5 and L5-S1 levels with small residual fluid collection in the posterior extradural soft tissues again noted.Multilevel degenerative changes are seen, as described below:L1-2: Mild disc bulge and unchanged small superimposed left paracentral disc extrusion with superior migration posterior to the L1 vertebra. No significant spinal canal stenosis. Minimal bilateral foraminal narrowing. L2-3: Mild facet and ligamentum flavum hypertrophy. Mild disc bulge. No significant spinal canal stenosis. Minimal right foraminal narrowing. L3-4: Mild facet and ligament flavum hypertrophy. Mild disc bulge. Unchanged prominent epidural fat contributes to mild narrowing of the spinal canal without significant stenosis. Mild bilateral foraminal narrowing. L4-5: Postsurgical change. Moderate facet and ligamentum flavum hypertrophy. Mild disc bulge. No significant spinal canal stenosis. Mild to moderate neural foraminal narrowing, left worse than right. L5-S1: Postsurgical change. Moderate facet and ligament flavum hypertrophy. Mild disc bulge with a small superimposed central protrusion. No significant spinal canal stenosis. Minimal to mild bilateral neural foramen stenosis.Abnormal areas of enhancement involving the sacral spinal canal at the S1 and S2 levels are not significantly changed and consistent with history of known ependymoma. No new or enlarging epidural tumor.

Output: 1. Compared to 2/19/2015 there is diffuse worsening of bone marrow signal with development of multiple new enhancing osseous lesions which are most apparent in the pelvis. Findings would be consistent with interval progression of osseous metastases/myelomatous involvement.2. No significant change in multiple chronic compression fractures.3. No significant change in residual enhancing tumor within the sacral spinal canal at the S1 and S2 levels compatible with known myxopapillary ependymoma.


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 knee was localized fluoroscopically, and a spot radiograph was obtained. 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 needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 20 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: 64 seconds

Output: Successful left knee arthrogram.


Instruction: Generate impression based on findings.

Input: 50-year-old male. Cirrhosis. HCC status post resection. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Widening of the fissures consistent with cirrhotic morphology. Segment 8 resection scar, unchanged. No evidence of local recurrence.Subcentimeter subtle arterially enhancing focus in the left lateral segment which becomes isointense on portal venous images and does not washout (series 9, image 29), does not meet criteria for a HCC, unchanged and possibly a perifusion abnormality. No focal mass suspicious for HCC is identified.Patent hepatic vasculature. No biliary ductal dilatation. No evidence of portal vein hypertension.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Broad mouthed ventral hernia containing nonobstructed small bowel loops.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of local recurrence or new hepatocellular carcinoma. Nonspecific subcentimeter enhancing focus in the left lateral segment of the liver, unchanged from 2013, may be a perfusion abnormality.


Instruction: Generate impression based on findings.

Input: 79-year-old female with history of IPMN status post Whipple (4/2014), complicated by biliary anastomotic stricture status post percutaneous drain placement, with internal stent placement (2/2016). ABDOMEN:LIVER, BILIARY TRACT: Serpiginous arterially enhancing foci in the right lobe of the liver favored to be perfusional. There is a T2 mildly hyperintense focus measuring 2.2 x 1.3 cm in segment six of the liver, unchanged, although still nonspecific. There is been significant decrease in intrahepatic biliary ductal dilatation. There is mild residual left intrahepatic biliary ductal dilatation. Status post cholecystectomy and hepaticojejunostomy. There is pneumobilia.SPLEEN: No significant abnormality noted.PANCREAS: Post surgical changes of Whipple procedure. The main pancreatic duct is dilated up to 8 mm with pancreatic parenchymal atrophy. There is minimal decrease in the number of side branches visualized. A pancreatic body side branch type IPMN measures 9 x 8 mm, unchanged (series 9, image 151).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right upper pole renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large amount of stool within the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Significant decrease in extent of intrahepatic biliary ductal dilation now with mild left intrahepatic biliary ductal dilation. 2.Decrease in pancreatic ductal dilation with side branch type IPMN that appear unchanged.


Instruction: Generate impression based on findings.

Input: 42-year-old male with elevated PSA. No prior biopsies. PELVIS:PROSTATE:Prostate Size: 3.7 x 4.3 x 2.0 cm.Peripheral Zone: Diffuse heterogeneous streaky T2 signal throughout the peripheral zone is compatible with prostatitis which lowers the sensitivity for the detection of prostate cancer. There is a 5 x 4 mm T2 hypointense focus in the right peripheral zone base with corresponding restricted diffusion in early arterial enhancement.Central Gland: No significant abnormality.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No extracapsular extension is present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: In the left inguinal canal is a peripherally enhancing T1 hypointense T2 hyperintense collection measuring 1.8 x 1.6 cm with punctate susceptibility artifact.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with prostatitis which lowers the sensitivity for the detection of prostate cancer.2.T2 hypointense focus in the right peripheral zone base with corresponding restricted diffusion and early arterial enhancement suspicious for malignancy.3.Postsurgical appearance in the left inguinal canal with peripherally enhancing fluid collection as described above.


Instruction: Generate impression based on findings.

Input: Bilateral leg weakness, evaluate for disc disease Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is at the lower limits of normal in position at the lower L2 level.There is fairly mild generalized facet arthropathy. 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: Mild disc desiccation and minimal bulge. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation and minimal bulge. Minimal effacement of the left lateral recess. Otherwise no significant spinal canal or neural foraminal stenosis.L5-S1: Dorsal annular fissure with small central and right paracentral paracentral disc protrusion. There is contact of the right S1 nerve root in the lateral recess without evidence of impingement. Spinal canal is otherwise patent. There is mild right neural foraminal stenosis. Left neural foramen is patent. Paraspinous soft tissues are within normal limits. There are multiple cysts involving the right kidney.

Output: 1. Very mild multilevel degenerative changes in the lumbar spine. There is minimal effacement of the lateral recesses at L4-L5 and L5-S1 as described above and mild right L5-S1 neural foraminal narrowing. Otherwise no significant spinal canal or neural foraminal stenosis at any level.2. Conus is at the inferior L2 level which is at the lower limits of normal.


Instruction: Generate impression based on findings.

Input: Clinical question: History of Chiari decompression and syrinx. Evaluate for change to CSF flow. Signs and symptoms: Yearly follow-up. Nonenhanced cervical MRI:Postoperative changes of suboccipital decompression with persistent mild crowding of cerebellar tonsils remain identical to prior exam.Examination redemonstrates a short segment expansile syrinx of cervical cord traversing from C4 to C7 without significant change in size. It measures at approximately 41.3 mm compared to prior study measurements of 39.7. The largest transaxial dimensions of the syrinx is at T6 level and measuring at 8.5 in transverse and 6.6-mm in AP axis. This is compared with prior study measurements of 7.9 x 6.4-mm. There is no detectable signal abnormality of the cord immediately surrounding the syrinx.CSF flow study demonstrate normal biphasic flow through the foramen magnum anteriorly and posteriorly as well as through the fourth ventricle and the aqueduct. Considering the technique difference between the two exam there is no convincing evidence of change.

Output: 1.Revisualization of stable postoperative changes of Chiari decompression.2.Revisualization of expansile syrinx of the cervical cord which measures at 8.5 x 6.6-mm compared to prior study measurements of 7.9 x 6.4-mm. 3.CSF flow study similar to prior exam demonstrate presence of biphasic flow through the foramen magnum both anterior and posteriorly as well as through the fourth ventricle and the aqueduct.


Instruction: Generate impression based on findings.

Input: Ms. Davis is a 64 year old female presenting with a palpable mass in the left breast found to have bilateral suspicious masses on 10/21/2016 diagnostic workup now participating in Allen Penn Research study. Personal history of esophageal cancer treated with radiation and chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.In the right breast 2:00 location, posterior depth, there is an irregular enhancing mass measuring 15 x 11 x 12 mm (AP x TR x CC). This corresponds to the mass detected on mammography and ultrasound in the right upper inner breast.In the left breast 3:00 location, middle depth, there is an irregular enhancing mass with a contiguous satellite mass posteriorly measuring 13 x 8 x 10 mm in total (AP x TR x CC). This corresponds to the mammographically detected calcifications in the left lateral breast and to the mass detected on ultrasound. In the left breast at the 12:00 position, posterior depth, there are 2 intramammary lymph nodes which demonstrate a normal morphology and correspond to lymph nodes seen on prior years mammography.The axillary regions are suboptimally evaluated due to technical factors, especially in terms of evaluating for fatty hila. Within this limitation, no grossly abnormal axillary lymph nodes are identified in either axillary region.A gastric pull-up is noted in the thorax and was more fully characterized on prior chest CT.

Output: Bilateral suspicious breast masses. An ultrasound-guided biopsy with clip placement was performed of each immediately following this MRI. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Thoracic spine:Postoperative changes are noted from T2 through T4 including T3 and T4 laminectomies. At the T3/4 level, the thoracic cord narrows, and changes course from midline to anterolateral abutting the dura, and then resuming a more normal midline course at the T4/5 level with resumption of anteriorly located CSF. The cord maintains a normal intensity signal appearance.Mild anterior wedge deformity is noted of T8 and T9 without marrow edema consistent with chronic deformity.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates a small left paracentral disc extrusion that extends below the disc level without significant associated mass effect or stenosis.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates mild disc bulge without cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The visualized intra-abdominal and paraspinal contents are unremarkable.The conus terminates at L1/2 and is normal in signal and morphology. Upon prone maneuvering, the conus and cauda equina translate anteriorly.L1/2: UnremarkableL2/3: Asymmetric bulge to left causing mild left neural foraminal stenosis.L3/4: Diffuse annular disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild bilateral lateral recess and mild bilateral neural foraminal stenosis.L4/5: Small left paracentral disc protrusion, superimposed asymmetric bulge to the left, ligamentum flavum thickening, moderate left facet hypertrophy, and mild right facet hypertrophy. There is mild left lateral recess, moderate left neural foraminal, and mild right neural foraminal stenosis.L5/S1:Right paracentral disc protrusion, diffuse annular disc bulge, ligamentum flavum thickening, severe bilateral facet hypertrophy, and bilateral facet effusions. Bilateral S1 nerve root sheath origins are abutted, with flattening noted on the left, and flattening with compression noted on the right. There is moderate left neural foraminal and mild-to-moderate right neural foraminal stenosis.

Output: 1.At the T3/4 level, the thoracic cord narrows, and changes course from midline to anterolateral abutting the dura, and then resuming a more normal midline course at the T4/5 level with resumption of anteriorly located CSF. The cord maintains a normal intensity signal appearance. Given the short segment nature of the cord narrowing and course variance resulting in the appearance of a "kink", this may suggest a dural defect possibly with cord herniation.2.L2/3: Mild left neural foraminal stenosis.3.L3/4: Mild bilateral lateral recess and mild bilateral neural foraminal stenosis.4.L4/5: Mild left lateral recess, moderate left neural foraminal, and mild right neural foraminal stenosis.5.L5/S1:Bilateral S1 nerve root sheath origins are abutted, with flattening noted on the left, and flattening with compression noted on the right. There is moderate left neural foraminal and mild-to-moderate right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Previously seen patchy areas of abnormal T2/STIR hyperintensity throughout the cervical cord are similar except for interval left lateral involvement at the C2-C3 level. Previously, areas of abnormal signal were often associated with mild cord expansion. This is resolved, with minimal if any areas of slight decreased cord volume. Additional patchy abnormal signal extends into the medulla, where previous discrete oval lesions were identified.The cervical spine is in normal alignment, with mild reversal of the normal cervical lordosis centered at C4-C5. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated.At C4-C5 and C5-C6, there are very shallow left paracentral disc protrusions without stenosis, which appear new since the prior exam.THORACIC SPINE

Output: 1. Patchy abnormal signal throughout the cervical and thoracic cord consistent with known demyelinating disease. Overall, previously expanded areas of cord abnormality and decreased, with scattered mild areas of volume loss suggested. Mild expansion of the cord at the T8 level which may indicate more recent plaque. Left lateral involvement at C2-C3 appears to be new since the prior exam.2. Mild spondylotic changes as detailed above without high-grade stenosis at any level.


Instruction: Generate impression based on findings.

Input: Images are degraded by motion artifact. FLAIR images are nondiagnostic.No diffusion-weighted abnormalities are identified. No evidence of acute hemorrhage. Stable appearance of the DBS leads extending from bilateral frontal burr holes, through the frontal lobes, with tips just caudal to the thalami bilaterally. Appropriateness of the lead placement should be determined by the referring physician. There is linear T2 hypointensity correlating with the known connectors, which appear to course close to the skin surface but are not optimally evaluated on MRI due to metal susceptibility artifact. No evidence of focal fluid collection. There is iron deposition of the bilateral globus pallidus compatible with history of Parkinson's disease. The ventricles and sulci are unchanged in size There are no masses, mass effect or midline shift. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. Redemonstration of a well demarcated CSF signal intensity in the apex of the petrous apices with no change since multiple prior studies. The exact etiology of this finding is not clear however it may represent small meningoceles. Partially empty sella. Opacification of the left mastoid air cells. The orbits are unremarkable. No suspicious enhancement is identified.

Output: 1.DBS leads without significant change from prior CT. Appropriateness of the lead placement should be determined by the referring physician.2.Electrode connectors appear to course close to the skin surface along the right upper neck, but are not optimally evaluated with MRI due to metal susceptibility artifact. CT may be more helpful. No focal fluid collection.3.Interval opacification of the left mastoid air cells which is nonspecific. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 60-year-old female with pain at the posterior tibial tendon medially at the inferior aspect of the medial malleolus. Evaluate for tear. TENDONS: There is increased signal abnormality within the posterior tibialis tendon at the level of the medial malleolus consistent with tendinosis. There is circumferential fluid within the tendon sheath of the posterior tibialis tendon suggesting a mild tenosynovitis. There is a small amount of subcutaneous edema in the surrounding area. There is also increased bone marrow signal abnormality within the medial aspect of the talus underlying the posterior tibialis tendon likely reflecting reactive osteitis. The extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is increased signal abnormality within the talus underlying the posterior tibialis tendon which likely represents a reactive osteitis. Moderate to severe degenerative changes affect the talonavicular joint with osteophyte formation and joint space narrowing and degenerative subchondral signal abnormality. Degenerative osteoarthritic changes affect the midfoot articulations. There is subchondral cyst formation within the lateral aspect of the tibial plafond.ADDITIONAL

Output: 1. Findings consistent with posterior tibialis tendon tendinosis and tenosynovitis. Other findings as described above.2. Findings consistent with sinus tarsi syndrome.


Instruction: Generate impression based on findings.

Input: Grade 3 oligodendroglioma. Status post surgery, TMZ and RT/PCV Initiated Avastin treatment since the prior MRI. There are changes of prior tumor resection from right anterior right frontal lobe with associated dural thickening and volume loss as well as susceptibility effect. However, the periventricular contrast-enhancing tissue anterolateral and superior to the frontal horn and anterior body of the left lateral ventricle has increased in size. Transaxially, it measures 3.0 cm x 1.5 cm compared to 1.2 cm x 0.5 cm previously and is associated with mild mass-effect. It is mildly, heterogeneously T2 hypointense relative to the surrounding white-matter T2-hyperintensity and shows diffusion restriction. On the other hand, contrast enhancement is less pronounced compared to the previous examination. On dynamic susceptibility-weighted contrast-enhanced MR perfusion shows the abnormality to be hypoperfused compared to the adjacent parenchyma. This may reflect evolving posttreatment change though the overall picture is confounded also by recent treatment by Avastin. Otherwise, focal T2-hyperintensity in the posterior-inferior right temporal lobe with associated foreign loss, encephalomalacia, is unchanged. There are tiny foci of encephalomalacia in the right cerebellar hemisphere, likely chronic infarcts.The orbits are unremarkable. There is no destructive skull lesion.

Output: The ependymal/subependymal abnormalities left frontal lobe has progressed since the previous examination from March 2016, being larger and more diffusion-restricted. However, contrast enhancement and perfusion characteristics have decreased since the previous examination but this may reflect the patient being on antiangiogenic treatment. Therefore, this progressing abnormality may reflect evolving posttreatment change or progressive tumor recurrence. Other posttreatment findings remain unchanged.


Instruction: Generate impression based on findings.

Input: Exam obtained for research purposes only. Research scanning of both breasts was performed with the research protocol. The images are stored for research analysis. Formal interpretation was not performed, existing data are not to be used for clinical purposes.

Output: This study was completed for research purposes only. Formal interpretation was not performed, existing data are not to be used for clinical purposes.


Instruction: Generate impression based on findings.

Input: MRI Brain: There is an unchanged round focus of increased T2 signal within the right transverse sinus. Additionally, there is unchanged increased T2 signal in the right proximal internal jugular vein. Prior CT venogram demonstrated no evidence of proximal right internal jugular vein thrombus. The ventricles and sulci are unchanged. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. There is deformity of the bilateral globes.MRV Brain: There is unchanged round filling defect in the right transverse sinus, most compatible with an arachnoid granulation. The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent.

Output: 1. No convincing evidence of dural venous sinus thrombosis on this study. 2. Increased T2 signal in the right proximal internal jugular vein can be seen with slow flow normally or possibly related to internal jugular vein occlusion more inferiorly in the neck. Doppler ultrasound can be considered if clinically indicated.3. Unchanged round focus of increased T2 signal within the right transverse sinus is most compatible with an arachnoid granulation.


Instruction: Generate impression based on findings.

Input: Per medical record: 23 year old male with history of fistulizing ileocolonic Crohn's disease diagnosed in March 2011. Biopsies from the right colon which were reviewed by our pathologist here at the University of Chicago showed patchy chronic colitis with severe activity consistent with a diagnosis of Crohn's disease. SBFT done here in May 2011 (transferred here from OSH) showed active fistulizing disease of the TI. Previously on Cipro, Flagyl, Pentasa. Has been maintained on Remicade 10mg/kg every 8 weeks since 2011 in combination with AZA 50 mg. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.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. Normal-appearing bowel loops without dilation, wall thickening, or abnormal enhancement. No fibrofatty changes in the mesentery. No abdominal fluid collections. The ileocecal valve is identified and within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal-appearing bowel loops without dilation, wall thickening, or abnormal enhancement. No fibrofatty changes in the mesentery. No abdominal fluid collections. The ileocecal valve is identified and within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of active Crohn's disease or specific bowel pathology otherwise.


Instruction: Generate impression based on findings.

Input: Knee pain There is a tiny density posterior to the lateral femoral condyle which likely corresponds to a small focus of calcification within the articular cartilage seen on prior MRI. The knee otherwise appears normal.

Output: Essentially normal radiographs of the knee with no specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 25 year old man with dilated non-ischemic cardiomyopathy, family history of heart failure (father with CHF in his 40's), referred for cardiac MR to evaluate for possible etiologies. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 181 ml/m2 (normal range: 74+/-15), the LVEDV is 478 ml (normal range 142+/-34), the LV end systolic volume index is 150 ml/m2 (normal range 25+/-9), the LVESV is 398 ml (normal range 47+/-19). There is global hypokinesis. There is mild late gadolinium enhancement in the mid inferoseptum at the RV insertion point, which can be seen in pulmonary hypertension. There is a focus of mild late gadolinium enhancement in the mid inferolateral and inferior wall which is atypical for previous infarction, and suggestive of previous inflammation, fibrosis or infiltrative process.The native T1 myocardial relaxation time is 1090ms in the basal septum. This value is borderline elevated.There is no evidence for myocardial iron overload (T2* relaxation time 30-38ms). There is no LV thrombus visualized on today's study. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 27%, the RV end diastolic volume index is 148 ml/m2 (normal range 82+/-16), the RVEDV is 391 ml (normal range 142+/-31), the RV end systolic volume index is 107 ml/m2 (normal range 31+/-9), and the RVESV is 284 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is upper normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall right pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severely dilated left ventricle with severely reduced systolic function (EF 17%). There are two foci of late gadolinium enhancement seen; one is located at the inferoseptum at the RV insertion point, which is a nonspecific finding that can be seen in pulmonary hypertension. There is a second focus of mild late gadolinium enhancement in the mid inferolateral and inferior wall which represents previous infiltration, inflammation or fibrosis. 2. No LV thrombus is visualized on today's study. 3. Severely dilated right ventricle with severely reduced systolic function (EF 27%). 4. Severe biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: New focal right upper extremity weakness, concern for stroke 2 weeks ago. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mils scattered cerebral and pontine white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. 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 are small right maxillary sinus retention cysts and trace secretions in a right anterior ethmoid sinus.

Output: Findings suggestive of chronic small vessel ischemic disease, but no evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: 49-year-old female to assess for right silicone implant rupture or fracture. History of bilateral nipple sparing mastectomy and silicone implant reconstruction 11/2012. Now with right implant shape change, firm corner from ripple, 1 cm thickening at 6 oclock along IMF History: right reconstructed breast implant shape change, skin thickening Status post bilateral mastectomies. There are postsurgical changes of bilateral silicone implants without evidence of intracapsular or extracapsular rupture. There is a focus of nonmass enhancement at the 5 to 6:00 position of the right reconstructed breast abutting the skin and implant which measures approximately 2.5 x 0.7 x 0.4 cm (ML X AP X SI). No suspicious enhancement is seen within the left reconstructed breast.There is an enhancing mass in the right lower axillary region posteriorly at approximately the 10:00 position which measures 0.7 x 0.5 x 0.9 cm and has T2 characteristics suggesting a low-lying lymph node.

Output: 1.Nonmass enhancement at the 5 to 6:00 position of the right breast between the implant and the skin. Differential includes infection/inflammation or recurrent disease. Recommend MR directed ultrasound for further evaluation.2.No evidence of implant rupture.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 70-year-old female with complaint of confusion, and aphasia. Patient on Coumadin. Rule out intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity and apparent low distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered. Well-defined area of encephalomalacia involves the left occipitoparietal region consistent with previous ischemic event.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: No acute intracranial abnormalities. Diffuse hypodensity and apparent low distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered.


Instruction: Generate impression based on findings.

Input: 90 year-old male with CLL and splenomegaly. Abdominal aortic aneurysm measured 3.5 cm in January 2, 2008. Known pancreatic mass. Bilateral lower quadrant abdominal pain. This examination is limited by the absence of intravenous contrast. ABDOMEN: Lung Bases: Bibasilar dependent atelectatic changes and increased interstitial markings suggesting borderline congestive heart failure. Status post median sternotomy. Small bulla in the right lower lobe. Cardiomegaly. Liver, Biliary Tract: Hypodense lesions in the liver, two in the left lobe and one in the right lobe. Lack of IV contrast precludes further characterization. Ultrasound may be helpful for further evaluation. No evidence of biliary dilatation. Cholelithiasis is present without evidence of cholecystitis. Spleen: Spleen is enlarged measuring 14 cm. Kidneys, Ureters: Punctate stone in the upper pole of the right kidney. Multiple fluid attenuating lesions in both kidneys which cannot be further characterized without IV contrast. Mild caliectasis is present in the left kidney. Complex left renal cyst. Adrenal Glands: No significant abnormality noted Pancreas: 2.5 x 2.5 cm fluid attenuating lesion at the tail of the pancreas. Lack of IV contrast precludes further evaluation. This represents a cystic neoplasm or pseudocyst, unlikely a solid neoplasm. The MRI scan showed two irregular cystic lesions communicating with pancreatic duct, smaller one in the body and larger lobulated lesion in the tail of the pancreas. These most likely represents a branch type duct IPMT (intraductal papillary mucinous tumor). Chronic pancreatitis. Retroperitoneum, Lymph Nodes: Infrarenal abdominal aortic aneurysm measuring 3.2-cm in its largest AP dimension. Common iliac arteries are unremarkable other than atherosclerotic changes.Bowel, Mesentery: Multiple soft tissue masses are present in the small bowel mesentery largest measuring 2.1 x 2.2 cm on image number 77/142. The etiology of these masses is probably CLL. The masses are stable.Bones, Soft Tissues: No significant abnormality noted Other: No significant abnormality noted PELVIS: Prostate, Seminal Vesicles: No significant abnormality noted Bladder: No significant abnormality noted Lymph Nodes: No significant abnormality noted Bowel, Mesentery: Nonobstructive bowel containing right inguinal hernia at axial image 119/142.Bones, Soft Tissues: No significant abnormality noted Other: A trace of ascites are present.

Output: Multiple hypodense liver lesions. Hypodense mass involving the pancreatic duct and tail is stable. Multiple mesenteric soft tissue masses and splenomegaly. The appearance is consistent with known CLL. These findings are stable.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to suboccipital craniectomy for Chiari malformation. The cerebellar tonsils are unchanged in appearance. There is unchanged retroflexion of the dens resulting in diminished CSF anteriorly at the craniocervical junction and slightly turbulent simultaneous bidirectional flow just inferiorly at the level of the dens. The turbulence is decreased compared with the prior exam. There is adequate CSF space posteriorly at the craniocervical junction, with biphasic flow visualized. There is unchanged posterior tenting of the cervicomedullary junction compatible with adhesion.

Output: Post-operative findings related to sub-occipital craniectomy with an unchanged possible adhesion at the cervicomedullary junction as well as unchanged dens retroflexion resulting in diminished and slightly turbulent CSF flow anteriorly. The CSF flow dynamics do appear slightly improved compared with the prior exam.


Instruction: Generate impression based on findings.

Input: History of elevated PSA and previous negative biopsies. PELVIS:PROSTATE:Prostate Size: 3.7 x 5.3 x 6.0 cm.Peripheral Zone: The peripheral zone is thinned.In the left mid-gland/apex paramedial region there is a focus measuring 7 mm of T2-weighted hypointensity with associated restricted diffusion which may represent a site of prostatic adenocarcinoma.In the left mid-gland paramedial region there is an additional focus measuring 6 mm of abnormal signal intensity. Central Gland: In the anterior apex there is a focus of ill-defined T2-hypointensity with equivocal restricted diffusion and possible early enhancement, amenable to biopsy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suspicious 7 mm left mid gland/apex and a 6 mm left mid gland paramedial foci.2. Anterior apex lesion may represent a BPH nodule, however is amenable to MRI/US fusion biopsy.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, with myoclonic jerks in the upper extremities, intermittent dementia and mutism, concern for encephalitis. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is noted.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The mesial temporal lobe structures are symmetric and normal. Single voxel MR spectra obtained over the mesial temporal lobes show normal metabolite patterns. Likewise, multi voxel spectroscopy performed over a larger region of the temporal lobes shows no significant abnormality.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation with no specific findings on conventional MR images or on MR spectroscopy to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of prostate cancer status post robotic-assisted laparoscopic prostatectomy. 10/12/2015 biopsy showed 3+4 left apex and 3+3 right lateral apex prostatic adenocarcinoma. PELVIS:PROSTATE:Prostate Size: 3.4 x 5.0 x 4.5 cmPeripheral Zone: In the paramedial apex there is a 1.0 x 0.9 cm focus of T2 hypointensity (series 701/14) and associated restricted diffusion (series 1003/204) suspicious for prostatic adenocarcinoma. Additional focus noted in the left lateral apex measuring approximately 5 x 4 mm (series 701/16; series 1003/244).Central Gland: Changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant 1.0 cm lesion in the paramedial apex is suspicious for prostatic adenocarcinoma. No evidence of extraprostatic extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Patient with right parotid swelling and pain x 2 years. Now constant and seems localized to tail. Negative for stones on endoscopy. Assesses for neoplasm versus inflammationion. There is a skin marker overlying the right parotid tail, where there is a lobulated enhancing structure that measures up to 15 mm in length and 4 mm in width. There is an also unchanged 5 mm diameter nodule more superiorly along the superficial aspect of the parotid gland. Otherwise, the parotid glands display diffuse fat infiltration and the right parotid gland is slightly larger than the left parotid gland. There is no evidence of radioattenuating calculi or ductal dilatation. There is no evidence of significant cervical lymphadenopathy. The thyroid gland appears are unremarkable. There is an unchanged irregular band of stranding in the left posterior lower neck subcutaneous tissues. The major cervical flow voids are intact. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable.

Output: A nonspecific structure that measures up to 15 mm within the right parotid tail and an unchanged 5 mm diameter nodule along the superficial aspect of the parotid gland may represent a lymph nodes. The rest of the right parotid gland otherwise appears to be unremarkable.


Instruction: Generate impression based on findings.

Input: Diagnosis: Brachial neuritis or radiculitis NOSClinical question: Right C5, 6 numbness and radiculopathySigns and Symptoms: pain, weakness numbness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present. There is mild loss of signal present at the C2-3, C5-4, C4-5 and C5-6 disc spaces indicating some disc desiccation. There is mild reversal of the normal cervical curvature present.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.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is smaller than the left vertebral artery.

Output: There are mild degenerative changes present in the cervical spine without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 18-year-old male with supraclavicular pain for 3 months worse on the left Right: No abnormal signal is noted within the clavicle. Although this study was not protocoled for evaluation of the rotator cuff, the rotator cuff tendons and muscles appear intact. The scalene muscles are visualized and within normal limits.Left: No abnormal signal is noted within the clavicle. Although this study was not protocoled for evaluation of the rotator cuff, the rotator cuff tendons and muscles appear intact. The scalene muscles are visualized and within normal limits. Incidentally noted is a prominent left internal jugular vein.

Output: No evidence of clavicular stress fracture as clinically queried. No abnormal bone marrow signal is noted within the clavicles.


Instruction: Generate impression based on findings.

Input: Several sequences are motion degraded. Given this caveat:There are scattered foci of T2 hyperintensity within the periventricular and subcortical white matter without associated mass effect, restricted diffusion, enhancement, or susceptibility abnormality.A 3-mm CSF intensity focus is present within the left hippocampus, as are a few similar appearing smaller foci in bilateral hippocampi. These represent unfused hippocampal sulcus remnants and have no clinical significance.The ventricles and sulci are normal in size for age. The cerebellar tonsils are in normal position. There are no 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. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Chronic small vessel ischemic disease without MRI evidence of acute ischemia.


Instruction: Generate impression based on findings.

Input: Dysmenorrhea, menorrhagia, clinical history of fibroids PELVIS:UTERUS, ADNEXA: There are multiple enhancing T2 hypointense uterine lesions compatible with fibroids. The largest of these appears subserosal in the posterior wall measuring 3.5 x 3.1 cm (series 5, image 24). A 2.4 x 1.9 cm fibroid centered anterior intramural (series 5, image 26) distorts the endometrial stripe and likely contains a submucosal component. The largest submucosal fibroid is anterior and measures 2.0 x 1.4 cm (series 5, image 28).The endometrial layer is indistinct and thickened, compatible with adenomyosis. Subcentimeter nabothian cysts are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A widemouthed left periumbilical fat-containing hernia is noted, without evidence of complication.

Output: 1.Multiple uterine fibroids, as described above.2.Adenomyosis.


Instruction: Generate impression based on findings.

Input: Plexiform neurofibromas. Evaluate for changes to known plexiform neurofibromas in patient with neurofibromatosis one. Again seen are multiple masses of increased signal intensity compatible with nerve sheath tumors and the patient's history of neurofibromatosis type I. Lesions are again noted adjacent to both lung apices and along the thoracic nerve roots and intercostal nerves. Subjectively, the overall appearance of the neurofibromas is similar to that seen on prior studies.A reference lesion in the right anterior chest wall measures 2.5 x 1.3 x 3.2 cm (image 25 of series 401, image 11 of series 601).A reference right-sided paraspinal lesion at the level of the thoracic inlet measures 3.3 x 2.1 x 3.4 cm (image 12 of series 401 and image 23 of series 601); the measurement technique is slightly different on the current study than on the prior study, accounting for the increase in numerical measurement values; however, subjectively, the lesion appears similar in size to that seen on the prior study.A reference right paraspinal lesion at the level of the thoracic inlet measures 3.5 x 0.8 x 2.5 cm (image 13 of series 401 and image 27 of series 601), subjectively appearing similar to that seen on the prior study.On the coronal and sagittal sequences, a relatively large neurofibroma is noted anterior to the left psoas muscle, measuring approximately 5 cm in diameter; it appears similar to that seen on the prior study. Numerous subcutaneous and paraspinal masses are also redemonstrated without significant interval change.Although evaluation of the cervical spine is limited on this chest MRI examination there is cervical spondylosis as well as increased signal intensity within the cord at the level of C6 that is comparable to that seen on the prior cervical spine MRI examination.

Output: Neurofibromatosis with multiple neurofibromas appearing similar in size to those seen on the prior study. Other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: Is there a lateral meniscus or articular cartilage injury? History: lateral knee pain after injury yesterday; history of ACL reconstruction 2 years ago MENISCI: There is complex tearing through the anterior horn of the lateral meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal increased T2 hyperintense signal in the lateral femoral condyle and lateral tibial plateau, indicating contusion. There are multiple focal full-thickness tears of the articular cartilage of the lateral tibiofemoral compartment involving mainly the cartilage of the lateral femoral condyle. There is no acute fracture.LIGAMENTS: The MCL, LCL, and PCL are grossly intact. Postsurgical changes following prior ACL graft reconstruction are noted. The graft appears intact. There is scarring in the fat pad of Hoffa, likely postsurgical. EXTENSOR MECHANISM: The patellar and quadriceps tendons appear intact.ADDITIONAL

Output: 1. Complex tearing of the anterior horn of the lateral meniscus.2. Multiple full-thickness articular cartilage defects along the lateral femoral condyle.3. Contusions of the lateral femoral condyle and lateral tibial plateau.4. Other postsurgical changes following ACL reconstruction as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out structural abnormality. Signs and symptoms: Papilledema and headache. Pre and post enhanced brain MRI:There is no acute intracranial process and diffusion weighted images are negative.There is normal anatomical morphology of brain parenchyma and normal signal intensity on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Post contrast images fail to demonstrate any abnormal parenchymal or leptomeningeal enhancement. There is also no detectable abnormal enhancement of calvarium, soft tissues of the scalp, orbits or the paranasal sinuses.All mastoid air cells and bilateral middle ear cavities as well as paranasal sinuses demonstrate normal pneumatization signal pattern.

Output: Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, with non-small cell lung cancer brain metastases status post SRS to left frontal and occipital lesions, now with new lesions in the right frontal lobe and left occipital lobe. A 10 x 8 mm right frontal lobe lesion is redemonstrated with strong susceptibility artifact and no clear enhancement. This lesion causes no significant local or generalized edema. A 4 mm susceptibility inducing lesion at the left parieto-occipital junction is also redemonstrated showing no significant enhancement. Neither of these lesions has changed appreciably from the prior exam.Sequelae of the previously treated lesions in the left frontal lobe and inferior left occipital lobe are also redemonstrated without significant interval change. The left frontal lobe lesion in particular is associated with strong susceptibility artifact.A 3 mm focus of susceptibility along the right middle frontal gyrus is unchanged from the immediate prior examination. There is no definite enhancement associated with this lesion. No new susceptibility inducing or enhancing lesions are seen. An incidental developmental venous anomaly is seen within the left cingulate gyrus. No abnormal fluid collections are detected. The ventricular system is stable and normal in size.

Output: 1.No change in the appearance of the presumed hemosiderin stained metastatic lesions within the right frontal lobe and at the left parieto-occipital junction.2.A 3 mm focus of susceptibility along the right middle frontal gyrus without associated enhancement is unchanged and nonspecific.3.Previously treated lesions within the left frontal and left occipital lobe are stable in appearance.


Instruction: Generate impression based on findings.

Input: 36-year-old female patient with history of skiing accident and reduced internal rotation and left shoulder pain. ROTATOR CUFF: There is minimal increased T2 signal intensity within the supraspinatus tendon at its insertion. The rotator cuff musculature is within normal limits. The subscapularis, infraspinatus, and teres minor tendons are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The injected contrast is within the glenohumeral joint. The glenohumeral labrum is intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Bone contusion involving the greater tubercle of the humeral head.2.Minimal supraspinatus tendinopathy.


Instruction: Generate impression based on findings.

Input: 32 year old with a strong family history of breast cancer in her mother at age 48 and maternal grandmother at age 43. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.A focal non-mass enhancement is again seen in the right breast at 6 o'clock position without interval changes.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: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 14 years, Male, nystagmus and dizziness, history of Proteus syndrome and Klippel-Trenaunay-Weber syndrome.. No structural lesions in the brain are appreciated. No significant parenchymal signal abnormality. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Small focus of enhancement in the left frontal lobe, post gadolinium series 11 image 11, with susceptibility effect may represent a capillary telangiectasia or small developmental venous anomaly. Major flow-voids are preserved.Pituitary gland is mildly prominent in size which is within normal limits for age. There is mild to moderate opacification of the right frontal sinus and anterior ethmoid air cells and minimal opacification elsewhere in the paranasal sinuses. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: 1. Brain parenchyma appears within normal limits.2. Tiny focus of enhancement in the left frontal lobe with susceptibility effect which may represent a small incidental developmental venous anomaly or capillary telangiectasia.


Instruction: Generate impression based on findings.

Input: Left shoulder pain status post fall. History of greater tuberosity fracture. The suspected healing greater tuberosity fracture is better seen on the recent MRI examination. I see no discrete fracture line on the current study. Glenohumeral joint alignment is within normal limits. Mild osteoarthritis affects the glenohumeral joint. The bones appear slightly demineralized.

Output: Suspected healing greater tuberosity fracture is better seen on recent MRI study. I see no acute fracture or malalignment.


Instruction: Generate impression based on findings.

Input: Other symptoms and signs involving the musculoskeletal system [R29.898], Reason for Study: ^Reason: hx of metastatic melanoma, eval for mets to brain History: R shoulder twitching There is no evidence of acute ischemic lesion.Multiple susceptibility lesions on bilateral basal ganglia as well as a focal nodular susceptibility lesion on the right inferior parietal lobule are again seen without showing evidence of enhancement or surrounding edema.Curvilinear high signal intensity cortical lesions on the right inferior frontal gyrus , right parietal operculum and the left precentral gyrus are again seen without evidence of contrast enhancement, unchanged.There is no evidence of abnormal enhancement since prior scan.Scattered somewhat patchy bilateral periventricular white matter and centrum semiovale T2/FLAIR high signal intensity lesions indicating non specific small vessel ischemic lesions, unchanged.The ventricles, sulci and cisterns are unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. 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.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Unchanged multifocal bilateral basal ganglia and the right inferior parietal lobule susceptibility lesions.3. Curvilinear bihemispheric non enhancing T1 high signal intensity lesions are seen, unchanged.4. Unchanged non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Left-sided weakness and incontinence, evaluate for cord compression. Cervical spine:Alignment is anatomic. Vertebral body and intervertebral disc spaces are preserved. Mild left paracentral disc protrusion without significant spinal canal or neural foraminal stenosis is present at the C6-C7 level. Otherwise no significant degenerative changes or spondylolisthesis. No evidence of cortical compression at the cervical spine level. No pathological enhancement is noted.Thoracic spine:Alignment is anatomic. Vertebral body heights and intervertebral disc spaces are preserved. No significant spinal canal or neural foraminal stenosis is noted at the thoracic level. No pathological enhancement noted.Lumbar spine:Alignment is anatomic. Vertebral body heights and intervertebral disc spaces are preserved. There is a small left paracentral disc protrusion of the L5-S1 without evidence of spinal canal or neural foraminal stenosis. Postoperative findings involving the posterior soft tissues and spinous processes of L1 and L2 are noted. No pathological enhancement is present.

Output: Mild degenerative changes and postoperative findings of the spine as above, without specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Left posterior parietal lesion, f/u progression: paresthesias. Brain: There is an unchanged T2 hyperintense lesion involving the left parietal cortex and underlying white matter extending towards the ventricular margin in a linear configuration. There is an unchanged cystic pineal gland that measures up to 12 mm. 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Unchanged lesion in the left parietal lobe with features most suggestive of focal cortical dysplasia.2. Unchanged cystic pineal gland.3. No evidence of spinal cord lesions.


Instruction: Generate impression based on findings.

Input: 40-year-old male with new onset jaundice. Per Epic notes, reported history of hepatitis A infection 3 weeks ago. ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma demonstrates normal signal intensity. There is a 1.4 cm cyst within the inferior aspect of the right hepatic lobe. No suspicious hepatic lesions are identified. The hepatic vasculature is patent.The gallbladder is contracted. There is no intrahepatic biliary ductal dilatation. The common bile duct is upper limits of normal in caliber measuring 6 mm. No dominant strictures or biliary stones are identified.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal parenchymal signal intensity and enhancement. The pancreatic duct is not dilated. There is a 4 mm T2 hyperintense focus within the pancreatic head (series 3, image 32) which is nonspecific but most likely represents a sidebranch IPMN. There is a 12 x 18 mm area of intermediate T1 signal intensity within the pancreatic tail (series 4, image 52) which follows splenic parenchymal signal intensity and enhancement on all sequences and is compatible with an intrapancreatic splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts are present within the left kidney.RETROPERITONEUM, LYMPH NODES: There is confluent periportal lymphadenopathy (series 8, image 18). No additional lymphadenopathy is identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Periportal lymphadenopathy which is nonspecific but may be related to viral hepatitis. 2.Unremarkable appearing biliary tree without significant dilation, dominant stricture, or choledocholithiasis.


Instruction: Generate impression based on findings.

Input: 3+4 prostate adenocarcinoma in the left base and left apex. 3+3 disease in the left mid and right mid. PELVIS:PROSTATE:Prostate Size: 2.6 x 4.5 x 4.4 cmPeripheral Zone: 2.3 x 1.3 cm T2 hypointense lesion in the left base with restricted diffusion (series 801/19 and series 904/324) with arterial enhancement (series 1501/2095). Scattered ares of ill-defined T2 hypointense focus in the right mid-gland peripheral zone extending into the transition zone with subtle restricted diffusion measuring approximately 1.6 x 1.1 cm (series 801/14 and series 904/224) is non-specific.7 mm left apex restricting lesion with associated decreased T2-weighted signal (series 904/184).Central Gland: No significant abnormality noted.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: There is mild soft tissue spiculation adjacent to the left base lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant 2.3 cm lesion in the left base in addition to other suspicious foci compatible with patient's multifocal prostatic adenocarcinoma. Possible extraprostatic extension adjacent to the left base lesion without specific evidence of seminal vesicle invasion. No enlarged pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Metastatic renal cancer, back pain, abnormal CT findings. Allowing for differences in technique and slice selection, there is no significant change in overall size of destructive lesion involving the L1 vertebral body extending into the bilateral posterior elements, left greater than right, and associated with osseous expansion. There is mild to moderate narrowing of the left L1-L2 neural foramen where the tumor abuts the left L1 nerve root. There is also mild narrowing of the left T12-L1 neural foramina. There is convex bulging posteriorly of the L1 vertebral body into the ventral epidural space contributing to mild narrowing of the spinal canal at this level and similar to prior. Minimal epidural enhancement at this level is favored to be reactive. No convincing evidence of epidural or leptomeningeal tumor.Vertebral body heights in the lumbar spine are preserved. There are prominent degenerative changes at the L4-L5 level with grade 1 anterolisthesis, significant disc height loss, advanced bilateral facet arthropathy, and moderate degree of spinal canal stenosis at this level. There is mild spinal canal narrowing at L3-L4 and to an even lesser degree at L2-L3 similar to prior. Moderate right L3-L4 and moderate right L4-L5 neural foramen stenosis also again seen. Up to moderate left L5-S1 neural foraminal narrowing also again seen. These findings are not significant changed since prior.Status post left nephrectomy. Right superior pole renal mass better assessed on prior abdominal CT.

Output: 1. Compared to MRI dated 12/20/2014, there is no significant change in size of the destructive metastatic lesion involving the L1 vertebral body and posterior elements. There is convex posterior bulging of the vertebral body at this level contributing to mild spinal canal stenosis at this level. There is also mild to moderate degree of neural foraminal narrowing at the left L1-L2 and T12-L1 levels related to the tumor also similar to prior. No new lesions are appreciated.2. Degenerative changes are again seen including moderate spinal canal stenosis at the L4-L5 level associated with grade 1 anterolisthesis. There is also moderate degree of right-sided neural foraminal stenosis at this level on a degenerative basis. These findings are not significantly changed in the interval.


Instruction: Generate impression based on findings.

Input: 30 years, Female, visual change and optic nerve pallor prior outside ophthalmologist. Brain parenchyma appears within normal limits for age. Specifically, no signal abnormality is seen to suggest demyelinating disease. No findings to suggest seizure focus. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Dedicated orbital sequences were not obtained. However, no obvious signal abnormality within the optic nerves or lesions within the orbits are appreciated. Sella is grossly unremarkable. There is trace paranasal sinus mucosal thickening, which are otherwise clear.

Output: Brain MRI appears within normal limits. Specifically, no findings to suggest demyelinating disease in the brain.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out stroke. Signs and symptoms: Focal weakness, altered mental status. Nonenhanced head CT:Examination demonstrate mild-to-moderate degree of small vessel ischemic disease of indeterminate age. There is a left frontal periventricular white matter foci of low-attenuation which is believed to represent a lacunar infarct. Prominence size of this lesion (8 times 14-mm) may suggest acute state of this lesion. Please correlate with clinical exam and follow-up with an MRI if clinically is warranted.The cortical sulci, ventricular system and CSF cisterns remain within normal limits.There is no evidence of hemorrhage, mass-effect, midline shift or hydrocephalus.

Output: 1.Small vessel ischemic disease of indeterminate age.2.A lacunar infarct in the left frontal periventricular white matter appears prominent in size and measuring 8 times 14-mm. This finding could represent an acute lacunar infarct due to its large size. Please correlate with history and physical exam and if clinically warranted follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: Vaginal bleeding. Evaluation prior to brachytherapy. PELVIS:UTERUS, ADNEXA: Anteverted uterus.Nabothian cysts are noted.There is heterogeneity and abnormal enhancement of the endometrium with associated restricted diffusion extending into the outer myometrium most extensively at the right cornu (series 1105/300) where it appears to extend to the serosal surface. Additionally, there is subtle spiculated stranding/enhancement along this right anterolateral aspect of the fundus suspicious for extra-mural extension. Best measured on the DWI the lesion measures up to 4.3 x 5.1 cm (series 1105/300). There is no evidence of involvement of the cervical stroma. No evidence of invasion into adjacent soft tissue structures.BLADDER: No significant abnormality noted.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: Abnormal enhancement and restricted diffusion of the endometrium compatible with patient's histologically proven endometrial adenocarcinoma with tumor extension to the serosal surface and possible focal extramural extension as described. No cervical stromal involvement or pelvic lymphadenopathy is apparent.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Right lateral base 3+3. Left lateral base 3+3. PELVIS:PROSTATE:Prostate Size: 2.9 x 4.3 x 4.0 cm.Peripheral Zone: Right lateral mid gland/base there is a 12 x 6 mm focus of T2 weighted hypointensity with associated restricted diffusion and arterial enhancement with washout suspicious for prostatic adenocarcinoma.Central Gland: Changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The mass abuts the capsule for a long segment and likely extends outside of the prostate in the right base posteriorly. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 12 x 6 mm focus of suspected prostatic adenocarcinoma in the right lateral mid gland/base of the peripheral zone. Possible extracapsular extension near the right base posteriorly.


Instruction: Generate impression based on findings.

Input: Female 60 years old Reason: f/u abnl pancreas imaging on CT. On HD, Please use IV contrast, pt agrees to use and understands NSF risks. History: same ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. No significant intrahepatic biliary ductal dilatation. Status post cholecystectomy. Common bile duct measures 9 mm.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct measures 4 mm. It is dilated in its entirety up to the level of the ampulla. No discrete mass lesion is identified although the study is limited due to the lack of intravenous contrast. The narrowing appears to be at the level of the ampulla.ADRENAL GLANDS: There is a right adrenal gland nodule which is not significantly changed since 2007 and is presumed benign.KIDNEYS, URETERS: Atrophic kidneys with bilateral renal cysts.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: 1.Mildly dilated pancreatic duct without definite mass lesion. The obstruction is at the level of the ampulla and may be due to ampullary stenosis. The abnormal finding can be followed up with a 3 to 6 month MRI/MRCP if EUS or ERCP is not performed.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma with brain metastases following 4th cycle of immunotherapy. There has been interval decrease in size of the multiple treated supratentorial and infratentorial brain metastases, which contain T1 hyperintense components with susceptibility effect. For example, a left inferior frontal gyrus lesion measures up to 15 mm, previously 19 mm, and a right lateral cerebellar hemisphere lesion measures up to 8 mm, previously 10 mm. There is diffuse nonspecific periventricular white matter T2 hyperintensity. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged 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: Interval decrease in size of the treated supratentorial and infratentorial brain metastases.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with history of stroke and dementia with worsening memory loss. Extensive confluent periventricular white matter T2 hyperintensity is redemonstrated appearing similar to the prior examination. Numerous additional scattered more discrete foci of parenchymal T2 hyperintensity are also redemonstrated including within the pons, unchanged. No restricted diffusion is seen.There is no evidence of parenchymal edema or mass effect. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Multiple scattered foci of susceptibility artifact are seen in the cerebral hemispheres, the thalami on the brainstem suggesting chronic microhemorrhage. No pathologic parenchymal or extra axial enhancement is observed. The cerebral sulci and the ventricles are mildly and proportionately prominent suggesting some degree of underlying parenchymal volume loss.

Output: 1.Findings are seen compatible with extensive chronic microvascular ischemic disease.2.Multiple scattered foci of microhemorrhage are also seen which may relate to small vessel ischemic disease though amyloid angiopathy can present similarly.3.A mild degree of generalized cerebral volume loss is demonstrated.4.No acute intracranial abnormalities.


Instruction: Generate impression based on findings.

Input: Elevated prolactin (33.75) and amenorrhea, with probable PCOS. The pituitary gland is not enlarged and appears to enhance normally. The infundibulum is intact and situated in the midline. There is no discernible mass lesion in the sellar or suprasellar region. The optic apparatus and cavernous sinuses are intact. There is a cystic pineal gland that measures up to 10 mm. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. 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 pituitary adenoma.


Instruction: Generate impression based on findings.

Input: Male, 70 years old. Avascular necrosis of left femoral head. Avascular necrosis affects the bilateral femoral heads. There is no evidence of collapse of the right femoral head. There is flattening of the left femoral head with severe osteoarthritis of the left hip including joint space narrowing and osteophyte formation.

Output: 1.End-stage avascular necrosis of the left hip with severe osteoarthritic changes.2.Avascular necrosis of the right femoral head without collapse.


Instruction: Generate impression based on findings.

Input: Evaluate for aneurysm, angio architecture. Left occipital cavernoma/venous anomaly. Aneurysm, attention communicating arteries. Headaches/possible seizure.TECHNICAL:Enhanced CTA of intracranial vasculature is performed.Utilizing an independent workstation reformatted images were acquired and utilized in interpretation of the exam.65 cc of Omnipaque 350 was administered for this study.A nonenhanced head CT was also performed. CTA of intracranial circulation:Patent and unremarkable bilateral intracranial vertebral arteries (dominant left vertebral) is noted. Bilateral pica branches are visualized and unremarkable. Basilar artery and all of its branches are within normal limits. Right vertebral artery is patent and within normal limits across the skull base and in its supraclinoid portion. Right ophthalmic artery is visualized and unremarkable. There is absence of posterior communicating artery on this side (anatomical variation). There is also anatomical variation off hypoplastic right A1. Right middle cerebral artery and its branches are unremarkable and without evidence of an aneurysm.Left internal carotid artery is larger than right and likely secondary to hypoplastic right A1.The left internal carotid artery is patent across the skull base and in its supraclinoid portion. The left ophthalmic artery is visualized and unremarkable.There is a prominent left posterior communicating artery however without evidence of an aneurysm as clinically is questioned. A dominant left A1 is present with filling of bilateral anterior cerebral arteries.There is a vascular fenestration of the distal portion of the left A1. The anterior communicating artery is unremarkable. The bilateral anterior cerebral arteries beyond the anterior communicating artery are unremarkable. The previously noted left occipital lobe cavernoma is not identified on this study. A developmental venous anomaly in the left occipital lobe over his present. This multi-branch developmental venous anomaly appears to traverse the left occipital lobe and in the vein terminating into the left perimesencephalic vein. On the outside MRI examination the left occipital developmental venous anomaly extends into the occipital horn of left lateral ventricle.Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Calvarium is intact.Visualized paranasal sinuses, mastoid air cells, middle ear cavities and orbits are unremarkable. A

Output: 1.Negative CTA of intracranial circulation for aneurysm. There are normal anatomical variations of hypoplastic right A1, absence of right posterior communicating artery and a prominent left posterior communicating artery, a small vascular fenestration of distal dominant left A1, developmental venous anomaly of left occipital lobe which appears to communicate with left perimesencephalic vein.2.Negative nonfused head CT.


Instruction: Generate impression based on findings.

Input: 77-year-old male with weakness, falls. Evaluate for cord compression. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is multilevel disc desiccation with moderate to severe loss of intervertebral disc space height at the L4-L5 and L5-S1 levels. There is approximately 6 mm, grade 1 of L5 on S1 anterolisthesis. There is additional minimal anterolisthesis of L2 on L3 and L3 on L4, as well as minimal retrolisthesis of L4 on L5. Degenerative bone marrow endplate changes are noted at the L4-L5 and L5-S1 levels. The conus medullaris is normal in position. Paraspinous soft tissues are within normal limits.Multilevel degenerative changes are seen, as described below:T11-T12: Only sagittal images were obtained. Within this limitation, there appears to be moderate right and mild left neural foraminal stenoses.T12-L1: Mild facet arthropathy. No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: Mild facet arthropathy and ligamentum flavum thickening. No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, facet arthropathy and ligamentum flavum thickening causes mild spinal canal stenosis, mild to moderate left and mild right neural foraminal stenoses.L3-L4: Moderate disc bulge, moderate to severe facet arthropathy and ligamentum flavum thickening causes mild to moderate spinal canal stenosis and mild bilateral neural foraminal stenosesL4-L5: Moderate disc bulge eccentric to the left, moderate facet arthropathy and ligamentum flavum thickening causes moderate spinal canal stenosis, moderate to severe left and moderate right neural foraminal stenoses.L5-S1: Moderate disc bulge with right foraminal protrusion and right paracentral annular fissure, as well as severe facet arthropathy, causes moderate to severe spinal canal stenosis, severe right and moderate to severe left neural foraminal stenoses. Of note, there is focal prominence of the ventral epidural fat at the right aspect of the L5 level causing moderate to severe maximal spinal canal stenosis at the mid L5 level.Degenerative changes of the left SI joint are also noted.

Output: 1. Multilevel degenerative changes of the lumbar spine, with moderate spinal canal stenosis at the L4-L5 level and moderate to severe spinal canal stenosis extending more inferiorly to the L5-S1 level.2. Multilevel neural foraminal stenosis, worst at the L4-L5 and L5-S1 levels. Additional details as above.


Instruction: Generate impression based on findings.

Input: 2 years, Male, with history of drop attacks. Brain parenchyma is within normal limits for age. Sulcation and myelination are within normal limits. No intracranial mass or mass effect. No evidence of cortical dysplasia, gray matter heterotopia or other lesions to suggest a seizure focus. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Diffuse opacification of the partially pneumatized paranasal sinuses is noted. There is also partial opacification of the mastoid air cells bilaterally.

Output: 1. MRI brain is within normal limits.2. Nonspecific paranasal sinus and mastoid air cell opacification.


Instruction: Generate impression based on findings.

Input: Ensure lesion stability prior to labor and delivery (2nd trimester pregnancy and known familial cavernomas). There are postoperative findings related to right temporal craniotomy. There is an unchanged small activity in the right pons with adjacent punctate susceptibility effect, which may be postoperative in nature. There is no appreciable change in the subcentimeter cavernous malformation in the anterior left external capsule and several other scattered punctate foci of susceptibility in the cerebral hemispheres, including within the right superior frontal gyrus, right cerebellar hemisphere, left thalamus, and bilateral temporal lobes. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: No interval change in the multiple cerebral cavernous malformations and superimposed apparent postoperative findings in the right pons.


Instruction: Generate impression based on findings.

Input: Female 8 years old Reason: concern for osteomyelitis History: pain, swelling, fever, elevated ESR/CRP A circumferential complex subperiosteal fluid collection surrounds the distal fibular diaphysis and metaphysis measuring approximately 6 mm in maximal thickness and 4.8 cm in craniocaudal dimension. Area of relative decreased signal within the subperiosteal fluid collection suggestive of pus/debris. The underlying fibular metadiaphysis demonstrates mottled decreased T1 marrow signal and punctate foci of high T2 signal as well as enhancement and edema of the surrounding subcutaneous fat and musculature. These findings are compatible with a subperiosteal abscess and osteomyelitis. Overlying skin thickening and edema of the subcutaneous fat suggestive of cellulitis. A small joint effusion is present.

Output: 1.Osteomyelitis of the distal fibular metadiaphysis with an associated subperiosteal abscess.2.Findings consistent with cellulitis.3.Small joint effusion.


Instruction: Generate impression based on findings.

Input: 43 year old male with history of hypertension, hyperlipidemia and history of premature ventricular contractions and nonsustained ventricular tachycardia with stress testing presenting for evaluation for possible scar or fibrosis. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 237 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 130 ml (normal range 47+/-19), the LV mass index is 33 g/m2 (normal range 85+/-15), and the LV mass is 75 g (normal range 164+/-36). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of myocardial iron overload.Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. There are no focal wall motion abnormalities or aneurysms noted. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 219 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 109 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild left ventricular dilation with mildly reduced systolic function (LVEF 45%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 50%) without evidence of focal aneurysm or wall motion abnormality .3. Mild to moderate left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 37-year-old male with history of left knee pain. Evaluate for meniscal tear. MENISCI: Globular and linear signal abnormality throughout much of the lateral meniscus indicates intrasubstance degeneration. Within the anterior horn of the lateral meniscus, there is linear signal intensity which contacts the tibial articular surface indicating an undersurface tear. Loculated foci of near-fluid signal intensity near the lateral margin of the lateral meniscus likely represents perimeniscal cyst formation.The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is focal near-full thickness to full-thickness articular cartilage loss of the femoral trochlea centrally and inferiorly. There is minimal subjective thinning of the remainder of the articular cartilage.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The extensor mechanism is unremarkable.ADDITIONAL

Output: Intrasubstance degeneration and undersurface tearing of the lateral meniscus as above.1.Focal degeneration of the articular cartilage of the femoral trochlea.2.Small joint effusion.


Instruction: Generate impression based on findings.

Input: 77-year-old male with history of lumbosacral pain. There is mild straightening of the lumbar spine in the sagittal plane. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is mild sacral canal epidural lipomatosis. There is diffuse paraspinal muscle atrophy. There are bilateral probable renal cysts, although incompletely characterized. The vertebral body heights are well-maintained. However, there is disc space loss and vacuum disc phenomenon at multiple levels. There are multilevel degenerative endplate changes with a few Schmorl nodes, with additional degenerative changes as follows:T12-L1: There is a disc bulge, but no significant spinal canal stenosis or neural foramen narrowing.L1-2: There is a disc bulge and facet hypertrophy resulting in mild spinal canal stenosis and mild bilateral neural foramen narrowing. There is a small amount of fluid within the left facet joint.L2-3: There is a disc bulge, ligamentum flavum thickening, and facet hypertrophy resulting in moderate spinal canal stenosis and mild bilateral neural foramen narrowing. There is a small amount of fluid within the right facet joint.L3-4: There is a disc bulge, ligamentum flavum thickening, and facet hypertrophy resulting in severe spinal canal stenosis and mild to moderate bilateral neural foramen narrowing. There is fluid within bilateral facet joints.L4-5: There is a disc bulge, ligamentum flavum thickening, and facet hypertrophy resulting severe spinal canal stenosis and mild to moderate bilateral neural foramen narrowing. L5-S1: There is a disc bulge ligamentum flavum thickening, and facet hypertrophy with mild spinal canal stenosis. There is moderate bilateral neural foramen narrowing.

Output: Extensive multilevel degenerative spondylosis of the lumbar spine, which is most pronounced at L3-4 and L4-5, where there is severe spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 67 years old Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: 4 by 2.7 by 2.9 cm.Peripheral Zone: Again noted a dark focus measuring 5 x 3 mm on the ADC map on image number 244. This has not significantly changed compared to previous study. Another duct focus in the left apex measuring 5 x 4 mm on image number 184 is also unchanged. Asymmetric dark focus in the left central zone best seen image number 784 is also unchanged. Post ablation changes in the right apex.Central Gland: BP H.Seminal Vesicles: Not presentExtracapsular Extension: Not presentBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Bilateral dark foci on ADC map in the right mid peripheral zone, left apex and left central zone not significantly changed from previous study.


Instruction: Generate impression based on findings.

Input: 55-year-old woman with family history of breast cancer in multiple relatives including maternal niece at age 32, maternal aunt and maternal cousin presents for bilateral screening breast MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally, limiting sensitivity of MRI. RIGHT BREAST: There is moderate duct ectasia especially inferiorly. A 5 mm oval mass in the upper outer quadrant near the 10:00 position with thin septation and benign kinetics is typically benign in appearance and likely a fibroadenoma. There is no suspicious appearing mass, or focus of temporal enhancement. LEFT BREAST: There is mild duct ectasia. There is no suspicious mass, morphology or focus of temporal enhancement.No abnormal lymph nodes are identified in either axillary region.OTHER: There is a T2 bright well circumscribed lesion in a lower thoracic vertebra measuring 7 x 7 mm (series 401, image 59). This was also present on a spine MRI from 2009 and appears similar allowing for differences in technique.

Output: No MRI evidence for malignancy. Bilateral duct ectasia, right greater than left.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 69-year-old female with radicular pain. Evaluate for lumbar spinal stenosis in patient with bilateral lower extremity radiculopathy (right greater than left). 5 lumbar vertebral bodies are present. There is grade 1 anterolisthesis of L4 on L5. Multilevel degenerative changes as described below:At L5-S1 loss of disc space height, disc desiccation, diffuse disc bulge with chronic endplate reactive changes as well as facet and ligamentum flavum hypertrophy. There is moderate encroachment of the neural foramen on the right and mild encroachment encroachment of the neural foramen on the left. At L4-5 there is mild anterior subluxation of L4 on L5 associated with uncovering of the disc. There is loss of disc space height and disc desiccation present. There is moderate bilateral facet and ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recesses. There is a effacement of the spinal fluid surrounding the nerve roots within the thecal sac. There is a moderate to severe degree of spinal stenosis.At L3-4 there is loss of disc space height, disc desiccation, diffuse disc bulge, mild facet hypertrophy and moderate ligamentum flavum hypertrophy. There is effacement of the CSF surrounding the nerve roots within thecal sac bilaterally. There is mild narrowing of the neural foramina bilaterally. There is moderate degree spinal stenosis.At L2-3 there is loss of disc space height, disc desiccation, diffuse disc bulge with associated endplate reactive changes including increased signal T1 without increased signal on the STIR sequence compatible with chronic changes. There is mild facet hypertrophy and ligamentum flavum hypertrophy. There is mild effacement of the spinal fluid surrounding the nerve roots within the thecal sac bilaterally. Overall there is a mild degree of spinal stenosis. At L1-2 there is diffuse disc bulge with no significant spinal canal stenosis or neuroforaminal narrowing.At T12-L1 there is diffuse disc bulge with no significant spinal canal stenosis or neuroforaminal narrowing.At T11-T12 there is diffuse disc bulge with no significant spinal canal stenosis or neuroforaminal narrowing.

Output: 1.There are multilevel degenerative changes present in the lumbar spine which are worse at L4-5 where there is mild subluxation associated with moderate to severe spinal stenosis.2.There is also moderate encroachment of the nerve roots within the right neural foramen at L5-S1 due to a lateral disc protrusion. 3.There is a moderate degree of spinal stenosis at L3-4.


Instruction: Generate impression based on findings.

Input: Lumbar pain, right buttock pain with fever, elevated CRP. Evaluate for abscess and osteomyelitis. There is prominent anterior epidural enhancement at L4-S1 that measures up to 8 mm in thickness with several punctate areas that do not enhance. There is associated narrowing of the spinal canal in conjunction with a disc bulge at L5-S1. There is also mild diffuse bone marrow T2 hyperintensity and enhancement at L5-S1, where there is endplate irregularity, but no enhancement within the disc space. The vertebral body heights are preserved and the vertebral column alignment is anatomic. There appears to be patchy enhancement in the posterior subcutaneous tissues overlying the right sacrum, although this area is incompletely imaged.

Output: 1. Prominent anterior epidural enhancement at L4-S1 that measures up to 8 mm in thickness with several punctate areas that do not enhancement may represent phlegmon associated with spinal canal narrowing in conjunction with a disc bulge at L5-S1. Enhancement within the adjacent vertebral bodies may represent reactive changes from degenerative spondylosis, although superimposed early osteomyelitis cannot be excluded, particularly in the posterior portion of the L5 vertebral body.2. Apparent patchy enhancement in the posterior subcutaneous tissues overlying the right sacrum may represent cellulitis, although this area is incompletely imaged.