{"instruction": "Generate impression based on findings.", "input": "70-year-old male history of elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.8 x 6.4 x 5.6 cmPeripheral Zone: No significant abnormality noted.Central Gland: In the left anterior apex, there is a T2 hypointense nodule measuring 2.1 x 1.7 cm with associated restricted diffusion.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Probable extracapsular extension anteriorly.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Highly suspicious transitional zone nodule in the left anterior apex with probable extracapsular extension."}
{"instruction": "Generate impression based on findings.", "input": "56 year old female with brain mass, most likely meningioma. Rule out systemic involvement. Expressive aphasia. CHEST:LUNGS AND PLEURA: Atelectasis at the right lung base. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right breast mass with macrocalcification at image 30 of series 5 measures 2 cm in diameter. 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: Laparoscopic band at gastroesophageal junction is in the expected position. Normal appendix in the right lower quadrant. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Foley catheter in decompressed bladder. 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. Right breast mass.2. Lap band at GE junction.3. No occult malignancy was found. "}
{"instruction": "Generate impression based on findings.", "input": "Back pain. Postoperative changes of a posterior laminectomy at L4 and L5.L1-2: Disk disease with posterior disk bulge. Bilateral facet hypertrophy. No significant central canal stenosis. L2-3: Posterior disk bulge, bilateral facet hypertrophy and thickening of the ligamentum flavum with mild narrowing of the spinal canal. Bilateral neuroforaminal narrowing. L3-4: Grade 1 retrolisthesis of L3 on L4. Degenerative disk disease is present. There are severe endplate changes and multiples lytic foci, very suspicious for a diskitis/osteomyelitis or metastatic disease. There is extensive soft tissue abnormality in the spinal canal and in paravertebral region, with involvement of neuroforamina. There is likely impingement of nerve roots within the spinal canal and right neuroforamen. Please correlate with a dedicated MRI of the lumbar spine.L4-5: Grade 1 retrolisthesis of L4 on L5 with degenerative disk disease including loss of disk height and posterior disk bulge / herniation. There is bilateral spinal canal and neuroforaminal narrowing, and likely nerve impingement.L5-S1: Grade 1 retrolisthesis of L5 on S1 with posterior disk bulge and bilateral neural foramen narrowing. There is extensive soft tissue abnormality in the spinal canal and neuroforamina, probably causing encasement or impingement of nerve roots.A small sclerotic lesion is seen in the left ilium. This likely represents an enostosis, but blastic bone metastasis can have similar appearance.", "output": "1.Degenerative disease of the lumbar spine as described above. Postoperative changes of posterior laminectomy extending at L4 and L5 level.2.There is extensive L3-L4 disk disease and endplate destruction with multiple lytic lesions, and extensive soft tissue abnormality within the spinal canal, neuroforamina and paravertebral region, very suspicious for discitis/osteomyelitis versus metastatic disease.3.Spinal canal and neuroforaminal narrowing at multiple levels.4.Small sclerotic lesion in the left ilium. This likely represents an enostosis, but blastic bone metastasis can have similar appearance.5.Findings were discussed with Dr. Pettit at time of final reporting of the study."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for left hip labral tear History: hip pain left side with clicks and piriformis and sciatica ACETABULAR LABRUM: No significant abnormality noted. The labrum is in tact without evidence of tearing.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. The bone marrow signal is normal.SOFT TISSUES: No significant abnormality noted. ADDITIONAL", "output": "Normal MRI of the left hip."}
{"instruction": "Generate impression based on findings.", "input": "Headache [R51], Reason for Study: ^Reason: any evidence of CSF leak post contrast History: headaches post-exerctional after bearing down For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-2 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis.", "output": "Normal L-spine MRI scan except minimal bulging of disc at the level of L5-S1.Comment: If clinically indicated, nuclear medicine cisternogram can be considered for further imaging evaluation of CSF leakage."}
{"instruction": "Generate impression based on findings.", "input": "Reason: mild aphasia prior CVA, please assess History: language problems, mild attentional problems The CSF spaces are appropriate for the patient's stated age with no midline shift. No diffusion restriction is appreciated.There are small foci of encephalomalacia present along the left middle and inferior frontal gyrus as well as a punctate lesion in the left hand motor area. There are associated tiny foci of SWI signal loss along the associated cortex.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is diffuse calvarial thickening. Marrow signal is diminished", "output": "1.There are small foci of encephalomalacia present in the left inferior and middle frontal gyri as well as a punctate focus in the left hand motor area. These most likely are related to a prior ischemic event.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They are most likely vascular related, however, they are nonspecific and can be seen with demyelination or vasculitis ,for example, depending on the clinical context. 3.Diffuse calvarial thickening is a nonspecific findings. Please correlate with the clinical history.4.There is no evidence for acute ischemic cerebral infarction. 5.Marrow signal is diminished which is non-specific. It could relate to chronic disease, anemia, myeloproliferative disorder, renal failure etc."}
{"instruction": "Generate impression based on findings.", "input": "Phlebitis and thrombophlebitis of unspecified site [I80.9], Reason for Study: ^Reason: dissection History: right sided neck pain; thrombophlebitis of neck Motion artifacts degraded image quality.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.In particular, there is no evidence of high signal intensity around craniocervical arterial system on fat saturated T1 weighted images indicating possible arterial dissection. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Bilateral mastoid air cells show opacification.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of arterial dissection on this scan."}
{"instruction": "Generate impression based on findings.", "input": "Male, 44 years old. Knee instability MENISCI: There is branching signal abnormality within the posterior horn and body of the medial meniscus indicating a complex, predominantly horizontal tear. There is also blunting of the free edge of the body of the medial meniscus. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity of the articular cartilage of the patella which may represent early degeneration, but this is equivocal. We see no fluid-filled defects.LIGAMENTS: Mild edema along the superficial band of the MCL is nonspecific but could represent a sprain in the correct clinical context. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "Complex tear of the medial meniscus and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic breast cancer. At the left lamina and spinous process of C3, there is sclerotic lesion with mild expansion. Subtle changes of similar appearance are also seen at level of C2. The left C2 - C3 facet joint is indistinct. Given the history of breast cancer, metastatic disease needs to be considered, although the lack of significant progression based on comparison of prior MRI is less typical. Degenerative disease is again present, with disc-osteophyte complex at C5-C6 level, causing spinal canal stenosis. There is also neural foramina narrowing bilaterally secondary to degenerative disease of uncovertebral joints.", "output": "1. Sclerotic lesions at left lamina and spinous process of C2 and C3 vertebral levels, which can represent metastatic disease, although the reported stability between the two prior MRI studies is unusual.2. Degenerative disease of the cervical spine as described above. Please also correlate with MRI cervical spine."}
{"instruction": "Generate impression based on findings.", "input": "94 years Female (DOB:9/22/1922)Reason: episodic dizziness/unawareness; possibly TIAs; significant vascular disease? History: episodic dizziness/unawareness; possibly TIAs; significant vascular disease?PROVIDER/ATTENDING NAME: DIANE L. ALTKORN DIANE L. ALTKORN MRI of the brainThere is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of T2 and FLAIR signal hyperintensity are present in the cerebellum and brainstem. The lesion in the right middle cerebellar peduncle is associated with susceptibility effect.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells demonstrate opacities in the right mastoid more than the left. These are nonspecific. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are very small. The right vertebral artery is larger than the left vertebral artery.", "output": "1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 10 years old. History of a left parietal DNET, S/P craniotomy tumor resection, 6 month f/u since last MRI, evaluate for residual tumor or new tumor. Again seen are postoperative findings of left parietal craniotomy for resection of a small left parietal tumor. The resection cavity lies along the posterior aspects of the supramarginal and angular gyri in the inferior parietal lobule. There is stable to slightly decreased overlying dural enhancement. A small area of curvilinear enhancement extending into the resection cavity from the dura is unchanged and likely postoperative in nature. There is no evidence of residual or recurrent tumor.The pineal gland is prominent and enhancing, unchanged from prior studies. Otherwise, the brain morphology and signal characteristics are within normal limits. There is no evidence of intracranial hemorrhage, mass effect or edema. The ventricles and basal cisterns are normal in size and configuration. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.", "output": "1. Continued evolution of postoperative findings related to resection of a small left inferior parietal lobule tumor, without evidence of residual or recurrent tumor.2. Enhancing pineal mass is unchanged from prior exams."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question : Rule out intracranial lesion causing seizures. Signs and symptoms: Seizures Nonenhanced head CT:There is no evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white differentiation is within normal.Previously reported periventricular foci of low-attenuation on MRI examination of brain are not identified on this examination.Calvarium demonstrate postoperative changes of bilateral temporal small craniotomies.Extensive paranasal sinuses and mastoid air cells are unremarkable.", "output": "Negative nonenhanced head CT. "}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with history of sickle cell disease and anti-phospholipid syndrome presenting with altered mental status, agitation, and tachycardia. Rule out acute intracranial abnormalities. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles are midline and demonstrate normal morphology and volume. Increased density in the suprasellar cistern may be due to partial volume averaging, though correlation with MRI may be helpful to further evaluate as clinically indicated.The calvaria and skull base are radiographically normal. There has been interval partial opacification of the right mastoid air cells and right frontal sinuses, with the remainder the visualized paranasal sinuses are normally pneumatized.", "output": "1. Mild inflammatory changes around the visualized right mastoid air cells.2. Increased density in the suprasellar cistern may result from artifact, though correlation with MRI to assess for sellar pathology may be helpful if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out stroke. Signs and symptoms: Same. Nonenhanced brain MRI:No evidence of acute intracranial process and in particular no detectable acute ischemic stroke.Very few punctate foci of periventricular nonspecific flair hyperintensity are noted. Although nonspecific considering patient's stated age of 73 this appearance could represent mild degree of chronic nonhemorrhagic small vessel ischemic strokes. The signal intensity of brain parenchyma is otherwise within normal. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination the brain otherwise.On axial T2 series 6 there is abnormal signal intensity right internal carotid artery across the skull base and with a tiny central signal void suggestive of very high grade stenosis of right internal carotid. The supraclinoid right internal remains patent however very small in caliber. The evaluation vascular imaging is highly recommended. Emergency room staff was notified of this finding by the radiology on call resident.12 bilateral vertebral arteries, basilar artery and left internal carotid artery is unremarkable.", "output": "1.No detectable acute ischemic process.2.Minimal chronic small vessel ischemic strokes only in the subcortical/periventricular white matter. Unremarkable brain parenchyma otherwise.3.Abnormal signal intensity of the right internal carotid artery across the skull base and with a tiny central signal void highly suggestive of high grade of stenosis. Follow-up with dedicated vascular imaging is highly recommended."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Non-Hodgkin's lymphoma with CNS involvement status post chemotherapy. Signs and symptoms: Restaging. Pre- and post enhanced complete spine MRI:Cervical spine images demonstrate normal signal intensity and alignment of vertebral column without abnormal enhancement. Normal signal intensity and caliber of cervical cord and without abnormal enhancement.No significant degenerative disease or spinal stenosis at any level is detected. There is revisualization of very faint thin smooth enhancement of few of the cervical nerve roots bilaterally in a symmetrical fashion without detectable thickening of the nerve roots is again noted. Finding is nonspecific however less likely possibility of tumor cannot be entirely excluded. There is no detectable enhancement of the leptomeningeal lining of the cervical cord.Thoracic spine images demonstrate normal alignment of vertebral column without abnormal enhancement. There is uniform marrow signal changes of the lower thoracic spine similar to prior exam and likely representing postradiation change. This finding extends from T10 inferiorly through the sacral spine and consistent with prior radiation change.There is revisualization of a stable focus of intradural extra medullary enhancement (axial series 13 image 25) in the left lateral thecal sac at T5 level measuring approximately 5 mm at the base along the dura and 5 mm in transverse axis similar to prior exam in size, density and extent. Differentials of a nerve sheath tumor or small focus of metastatic disease should be considered.There is no convincing evidence of any additional foci of abnormal leptomeningeal enhancement. This is a similar observation is prior study.No evidence of a spinal stenosis or neural foraminal compromise at any level.Lumbar spine images demonstrate uniform diffuse marrow signal changes of the vertebral column consistent with prior radiation therapy. There is subtle enhancement of the endplates abutting the L2-L3 disc representing degenerative changes. Finding was also noted on prior exam and without change.The signal intensity and morphology of the lower most visualized thoracic cord, conus and cauda equina is within normal.On post enhanced images there is uniform faint enhancement of cauda equina without detectable clumping, focal areas of thickening or tumor. This finding was not as conspicuous on prior exam which likely is techniques related. Finding could represent posttreatment changes however correlation with CSF analysis is recommended to exclude less likely possibility of leptomeningeal carcinomatosis.", "output": "1.Cervical MRI demonstrate smooth thin symmetrical faint enhancement along the nerve roots without significant change since prior exam. Unremarkable cervical MRI otherwise. The signal intensity and caliber of cervical cord is within normal and without detectable enhancement of its leptomeninges.2.Thoracic MRI demonstrates a single stable focus of intradural extra medullary enhancement ( 5 x 5 mm) in the left lateral aspect of spinal canal at T5 level. Differentials of isolated focus of the meningeal tumor or a nerve sheath tumor should be considered. No detectable additional foci of leptomeningeal enhancement.3.Lumbar MRI demonstrate smooth uniform thin enhancement of the cauda equina without focal thickening of clumping. This finding was not as conspicuous on prior exam which could be technique related. To entirely exclude leptomeningeal carcinomatosis follow up with CSF analysis is recommended. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 53 years old, with altered mental status and oropharyngeal dysfunction. History of hemorrhagic medulla/pons stroke. No new lesions seen on CT. Susceptibility, T2 hyperintensity and T2 shine through artifact are seen within the medulla. The medulla is not edematous, and if anything, there appears to be a component of encephalomalacia. Patchy nonedematous T2 signal also continues into the upper cervical cord. Elsewhere in the brain, no restricted diffusion is seen. Numerous patchy foci of periventricular and subcortical T2 hyperintensity are demonstrated. No parenchymal edema or mass effect is detected. No abnormal extra-axial fluid collection is seen. Numerous scattered foci of susceptibility are evident within the brainstem and cerebellum, and to a lesser degree the cerebral hemispheres, compatible with chronic microhemorrhage. No acute intracranial hemorrhage is detected.The dura appears to be mildly and diffusely thickened. The marrow signal of the calvarium is uniformly more hypointense than what is typically seen. A mucous retention cyst is evident in the right maxillary sinus.", "output": "1.Findings in the medulla which would be compatible with the stated history of prior stroke in this area.2.Signal abnormality within the medulla and upper cervical cord is felt most likely to be chronic as there is no evidence of swelling or mass effect.3.Elsewhere in the brain, moderately extensive chronic small vessel ischemic disease is seen, but there are no suspected acute abnormalities.4.Diffuse mild thickening of the dura is of uncertain etiology. However, it may be reactive to changes in the overlying calvarium which demonstrates relatively hypointense marrow signal. This in turn is a nonspecific finding which can reflect normal variation as well as a variety of metabolic conditions such as chronic renal disease."}
{"instruction": "Generate impression based on findings.", "input": "5-year-old male status post trauma rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Within the posterior occipital bone there is a 1 mm of displacement without adjacent hemorrhage. The fracture line extends from the skull base through the occipital bone just above the transverse sinus. MRI/MRV may be considered as clinically indicated to determine involvement of the adjacent vascular structures.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. Right posterior occipital bone fracture, displaced by approximately 1 cortex width with extension cranial to the transverse sinus. MRI/MRV may be considered as clinically indicated to determine involvement of the adjacent vascular structures.2. No acute intracranial abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with newly diagnosed triple negative left breast invasive ductal carcinoma presents for bilateral staging MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A 5.0 x 4.5 x 4.4 cm heterogeneously enhancing mass is present at the 2:00 position of the left breast. A small amount of non-mass enhancement extends posteriorly from the mass. Total area of enhancement in the upper outer left breast measures 6.5 x 4.5 x 4.4 cm. Susceptibility artifact from biopsy clip is present along the superior medial margin of the mass. No additional areas of abnormal enhancement are seen in the left breast.No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.", "output": "1. Enhancing 5.0 cm mass at the 2:00 position of the left breast, compatible with the patient's known malignancy. A small amount of non-mass enhancement extends posteriorly from the mass. Total area of enhancement is 6.5 x 4.5 x 4.4 cm.2. No MRI evidence for malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Baseline scan prior to starting U. treatment to brain metastases. Signs and symptoms: Metastatic melanoma. Enhanced MRI of brain:This examination was performed after and in few CT of abdomen and no additional contrast was administered for this exam.There is no evidence of any abnormal enhancement of brain parenchymal or leptomeninges to suggest metastatic disease. There is also no evidence of any lytic or sclerotic changes of calvarium to suggest skull metastases lesion.No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Very subtle periventricular low attenuation of brain parenchyma although none is specifically is highly suspected of mild small vessel disease of indeterminate age.Paranasal sinuses and mastoid air cells are well pneumatized and unremarkable.", "output": "1.Negative enhanced CT of brain and calvarium for metastatic disease.2.Very minimal small vessel disease of indeterminate age."}
{"instruction": "Generate impression based on findings.", "input": "40 year-old female with low back pain. There are five lumbar vertebrae with small ribs noted at L1. Moderate degenerative disc disease affects L3-L4. The remaining intervertebral disc spaces are preserved. Mild anterior wedging of L1 is noted as seen on the prior MRI. Vertebral alignment is within normal limits.", "output": "Degenerative disc disease of L3-L4 and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval for meniscal tear; patellar tendon tear; articular cartilage defect History: knee patellar dislocation, subluxation and tendonitis with chronic pain unresponsive to time and therapy MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified along the medial or lateral compartments. Note is made of linear decreased signal abnormality affecting the articular cartilage along the lateral facet of the patella likely representing a full-thickness articular cartilage fissure (image 15; series 7). There is a tiny amount of increased bone marrow signal abnormality within the posterior aspect of the lateral tibial plateau which may represent a resolving contusion.LIGAMENTS: There is partial thickness tearing involving the proximal fibers of the ACL (image 17; series 7). The PCL appears intact. The MCL and LCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. The medial retinaculum appears intact, although the proximal fibers are not reliably visualized without fat suppression on axial images.ADDITIONAL", "output": "1. Partial tear of the proximal fibers of the ACL which may be subacute or chronic in etiology.2. Full-thickness articular cartilage fissure along the lateral facet of the patella. Edema within the superior aspect of Hoffa's fat pad. These findings can be seen in patellofemoral instability."}
{"instruction": "Generate impression based on findings.", "input": " Again demonstrated are post surgical changes related to left parietal lobe tumor resection with areas of increased T1 signal and susceptibility effects within the treatment cavity related to blood products. No abnormal enhancement to suggest recurrence. A small extra-axial fluid collection is seen which is less prominent along the left parietal convexity. The ventricles are normal in size. No mass effect or midline shift.There is mildly increased T2 signal which extends inferiorly within the periatrial region similar to previous.Previously demonstrated T2 hyperintense, enhancing mass in the left operculum demonstrates interval mild increase in size and slightly more heterogeneous enhancement on post gadolinium images relating to necrosis, overall measuring 3.7 x 2.7 x 3.1cm and previously 3.1 x 2.3 x 2.7 cm. Enlargement is more prominent when compared to 5/7/2015 study.Ventricles are normal in size. There is no mass effect or midline shift. The basal cisterns remain patent.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.", "output": "1. Compared to 5/7/2015 and 6/9/2015, there is continued enlargement of the left frontal operculum mass likely representing a separate focus of high-grade glial neoplasm. Increased necrosis within this tumor is also demonstrated.2. Stable postsurgical changes at the left parietal lobe resection cavity without discrete lesion to suggest recurrence at this site."}
{"instruction": "Generate impression based on findings.", "input": "Low back pain and hip pain. Sciatica, right side. For the purposes of numbering, there are 4 lumbar type vertebral bodies and a fifth transitional segment labeled S1 for the purposes of this study. As such the most inferior well-defined disc space is labeled L4-S1. Vertebral body heights are within normal limits. Alignment is within normal limits. No marrow infiltrating or destructive osseous lesions. T1 hyperintense focus involving the left aspect of S1 is compatible with hemangioma. Small nonspecific sclerotic focus involving the right iliac bone also present on prior CT 5/13/2016. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge with small left extraforaminal disc protrusion. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-S1: Disc desiccation and minimal bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Small sacral perineural cysts incidentally noted. Paraspinous soft tissues are within normal limits.", "output": "1. Mild degenerative changes in the lumbar spine without significant spinal canal or neural foraminal stenosis at any level.2. Note transitional anatomy with 4 lumbar type vertebral bodies."}
{"instruction": "Generate impression based on findings.", "input": "Pituitary tumor and multiple meningiomas, 6 month evaluation for changes. Pituitary: There are postoperative findings related to transsphenoidal surgery. There is no significant interval change in the pituitary mass with suprasellar and bilateral cavernous sinus extension, as well as invasion into the clivus. Indeed, there is unchanged encasement of the left juxtasellar internal carotid artery and mass effect upon the optic apparatus, which displays regional volume loss. Brain: There are postoperative findings related to right frontal craniotomy with right frontal lobe encephalomalacia. There is no significant interval change in the multiple dural-based enhancing mass lesions, including along the tentorium with mass effect and edema in right occipital lobe, in the left anterior sylvian region, right frontal convexity and along the left anterior falx cerebri. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, paranasal sinuses, skull and scalp soft tissues appear unchanged.", "output": "1. No significant interval change in the invasive pituitary macroadenoma with massa effect upon the optic apparatus and encasement of the left internal carotid artery.2. No significant interval change in the multiple intracranial meningiomas, including the dominant left tentorial lesion with associated right occipital lobe edema."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Disease progression History: schwannomatosis and bone lesions Please note that comparison to the prior examination is suboptimal due to technical differences between the protocols.Pelvis:Several small foci of signal abnormality are identified within the bones of the pelvis bilaterally. The reference lesion(s) seen on the prior study, presumably within the right ilium posteriorly, appears less confluent on the current study than on the prior study. For future reference purposes, a ring-enhancing lesion within the right ilium, lateral to the right sacroiliac joint, measures approximately 1.4 cm in its greatest transverse diameter. There is low signal intensity within the left ilium, posteriorly, which may represent a site of prior surgical biopsy with adjacent foci of metallic susceptibility artifact in the overlying soft tissues. There are small foci of abnormal signal intensity and enhancement also noted within the proximal femoral, bilaterally. Mild osteoarthritis affects both hips. Mild osteoarthritis affects the sacroiliac joints. Degenerative disc disease affects the lower lumbar spine. There is a fluid collection with thin peripheral enhancement within the lateral subcutaneous fat of the right hip, measuring approximately 4 cm in the craniocaudal dimension, perhaps representing a seroma from prior surgery. There is a small minimally enhancing mass along the S2 nerve root which may represent a small schwannoma. There is an ovoid mass measuring approximately 1 cm within the vastus lateralis muscle on the left which may also represent a peripheral nerve sheath tumor.Right femur:There is poorly defined intermediate signal intensity within the femoral diaphysis which may simply represent red marrow. There are small subcentimeter schwannomas in the right sciatic nerve within the proximal thigh and also in the distal thigh which measures approximately 1.3 cm in its greatest diameter. There is an additional schwannoma within the vastus lateralis measuring approximately 1.2 cm in its greatest diameter. There is a small amount of fluid within the knee joint.", "output": "1. Multiple small marrow-based lesions within the pelvis and proximal femora, as described above, of uncertain etiology.2. Multiple small nerve sheath tumors as described above."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with intermittent swelling and pain in the dorsal mid foot. Evaluate for stress fracture or ganglion cyst TENDONS: The tendons appear intact.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibiofibular syndesmotic complex appears normal. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: Bone marrow signal intensity is within normal limits without evidence of stress fracture. We see no osteochondral defects.ADDITIONAL", "output": "Mild subcutaneous edema without evidence of stress fracture or ganglion."}
{"instruction": "Generate impression based on findings.", "input": "62 years, Male, glioblastoma on TMZ/TTF. Note examination is limited to 3-D T1 sequence and is inadequate for assessment of tumor progression. Again seen is evidence of resection of right paramedian frontal tumor with soft tissue thickening along the anterior resection cavity margin and to a slightly lesser degree along the posterior and inferior resection cavity margin, which was also noted and better assessed previously with gadolinium. Ventricles are unchanged in size. No midline shift or herniation. There is extensive T1 hypointensity in the right cerebral hemisphere which is again seen and much of it likely represents vasogenic edema and posttreatment changes.", "output": "Patient was claustrophobic and examination was prematurely aborted. This study is not adequate for assessment for tumor progression. "}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female for evaluation of meniscal tear MENISCI: There is a large complete radial tear through the posterior horn and body of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is degeneration of the articular cartilage of the medial femoral condyle above the torn meniscus. There is mild edema within the medial tibial plateau below the torn meniscus. There is near-full-thickness to full-thickness degeneration of the articular cartilage of the undersurface of the patella along the median eminence and along the medial facet resulting in the defect that is just over 1 cm. There is underlying degenerative signal abnormality within the subchondral bone. Focal degeneration of the articular cartilage of the inferior aspect of the medial facet of the femoral trochlea with underlying subchondral cyst formation. The lateral tibiofemoral compartment is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1.Complete radial tear of the medial meniscus as described above.2.Cartilage degeneration and joint effusion."}
{"instruction": "Generate impression based on findings.", "input": "Dizziness, unsteady gait: progressive imbalance with walking for 6 weeks. History of invasive anorectal carcinoma. There is mild cerebellar volume loss, particularly involving the vermis. There is a subcentimeter linear focus of susceptibility effect in the left pons with slight extension into the cerebral peduncle. There is also patchy T2 hyperintensity throughout the pons. In addition, there is mild scattered cerebral white matter T2 hyperintensity, particularly in a periventricular distribution and mild diffuse cerebral volume loss. There is no evidence of mass or acute infarct. There is no abnormal intracranial enhancement. There is a mega cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and ears are grossly unremarkable. The skull appears to be intact. There are bilateral lens implants. There is mucosal thickening in the ethmoid sinuses.", "output": "1. Nonspecific mild cerebellar volume loss, particularly involving the vermis, and mild diffuse cerebral volume loss. 2. A subcentimeter linear focus of susceptibility effect in the left pons with slight extension into the cerebral peduncle may represent a chronic hemorrhagic lacunar infarct. 3. Patchy T2 hyperintensity throughout the pons and mild scattered cerebral white matter T2 hyperintensity particularly in a periventricular distribution likely represent chronic small vessel ischemic disease4. No evidence of intracranial hemorrhage, mass, or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "58 year-old the female status post craniotomy for epilepsy, complaint of headache There is post craniotomy change at the right temporal region. Images demonstrate subcutaneous soft tissue edema, small amount of extra axial fluid collection and pneumocephalus along the surgical incision, and patchy hyperattenuation blood and low attenuation air bubbles in the right temporal lobe surgical site. Hypodense signal in the right temporal lobe is likely a mixture of surgery cavity and vasogenic edema secondary to the surgical manipulation. All are expecting post surgery change. There is no evidence of large hematoma formation or hydrocephalus. The findings are similar to the MRI study done on 9/21/11.The gray-white matter differentiation is preserved in the remainder structure. However, the cortical sulci of the right cerebral hemisphere is effaced when compared to the contralateral side. There is minimal midline shift to the left approximately 3mm and mild compression of the right lateral ventricle. The findings are suggestive of parenchyma edema on the right, which is relative new when compare to previous MR study. In addition, there is small patchy hypoattenuation in the right frontal lobe cortex (image 18,19). This can be secondary to positioning, however, small ischemic change can not be completely excluded.There is large calcification along the anterior interhemispheric falx and the right frontal dura. The superior sagittal sinus appears hypoattenuation in density, which may secondary to blood loss. Except for craniotomy, the remainder calvarium is unremarkable. Calvarium, visualized paranasal sinuses, orbits and mastoid air cells are unremarkable.", "output": "1. Effacement of the cortical sulci with preserved gray-white matter differentiation of the right cerebral hemisphere, minimal midline shift and partial compression of the right lateral ventricle. The findings are suggestive of parenchyma edema.2. Expected post surgery change as detailed above.3. There is small patchy hypoattenuation in the right frontal lobe cortex. This can be secondary to positioning, however, small ischemic change can not be completely excluded. Non-infusion CT is not sensitive to detect early parenchyma ischemia. If cortical ischemia is suspected on clinical setting, a MRI study may help further evaluate. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Well-differentiated papillary mesothelioma with invasive foci. Please compare to prior outside exams. ABDOMEN:LIVER, BILIARY TRACT: Normal signal intensity of the liver with homogeneous enhancement. No focal liver lesion is identified. There is no biliary ductal dilatation. The gallbladder is normal in appearance. No gallstones are identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cysts are identified. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No soft tissue density is seen in the left lower quadrant to correlate with findings on outside CT. There is no definite evidence of metastatic or recurrent disease in the abdomen or pelvis.BOWEL, MESENTERY: The bowel is of normal caliber without obstruction. The appendix appears normal.BONES, SOFT TISSUES: Mild degenerative disc disease affects the lower lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is normal in appearance. The left ovary is atrophic. The right ovary is not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter pelvic lymph nodes are present.OTHER: Bilateral breast implants are noted.", "output": "1.No measurable disease is identified in the abdomen or pelvis.2.Subcentimeter pelvic lymph nodes, which are not enlarged by size criteria."}
{"instruction": "Generate impression based on findings.", "input": "72 years Female (DOB:9/17/1943)Reason: rule out structural lesion including MS History: gait problem, blurry vision, weaknessPROVIDER/ATTENDING NAME: GABRIELLA L BORRELLI GABRIELLA L BORRELLI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate T2 and FLAIR hyperintense foci are present in the brainstem. There are enlarged perivascular spaces in the basal ganglia.There is a punctate focus of signal loss in the right centrum semiovale on susceptibility weighted imaging. In isolation this is of microhemorrhages are known clinical significance.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery flow-void is very small.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "Periventricular and subcortical white matter lesions of a moderate degree and a few punctate lesions in the brainstem are nonspecific. At this age they are most likely vascular related. Although not particularly characteristic of demyelination based on the morphology and pattern of demyelination cannot be excluded based on this exam. These lesions are nonspecific and demyelinating disorder is in the differential diagnosis.."}
{"instruction": "Generate impression based on findings.", "input": "Reason: liver lesion noted on CT scan please characterize History: liver lesion on CT scan ABDOMEN:LIVER, BILIARY TRACT: In the right lobe of the liver, there is a 8.6 x 5.9 x 9.1 cm lobulated mass (series 1202 image 477, series 701 image 20). This mass remonstrates relatively homogeneous T1 isointense, T2 mildly hyperintense signal and diffusely decreased signal on out of phase sequences. There is avid homogeneous arterial phase enhancement, some contrast retention seen on subsequent delayed imaging. There is mass effect on the vessels with adjacent perfusion abnormality in the right lobe of the liver. The remainder of the liver demonstrates questionably mild signal loss on out of phase imaging, otherwise, normal morphology and size. No intrahepatic or intrahepatic biliary ductal dilatation.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: Small nonenlarged left paraaortic lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fluid within the subcutaneous fat of the right and posterior abdominal walls likely related to recent surgery.OTHER: No significant abnormality noted.", "output": "1.Large 9 cm mass within the right lobe of the liver with signal characteristics that are most consistent with a hepatic adenoma given the patient's age, gender and absence of cirrhotic liver background, specifically the HNF-1 alpha subtype.2.Questionable mild diffuse hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "History of colon cancer status post resection with adrenal nodule seen on CT. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology without a focal lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left adrenal nodule measures approximately 1.0 x 0.4 cm. The difference in size is likely due to different imaging modalities. There appears to be loss of signal on out of phase imaging (series 802/32), compared to in phase imaging (series 801/32), suggestive of a lipid rich adrenal adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from abdominal colectomy with right lower quadrant end ileostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "The left adrenal nodule measures approximately 1.0 x 0.4 cm. Subtle loss of signal on out of phase imaging is suggestive of a lipid rich adrenal adenoma. However, its small size limits characterization and a follow-up CT in 6 months is suggested. "}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with right frozen shoulder ROTATOR CUFF: Increased signal abnormality within the distal supraspinatus tendon, consistent with tendinopathy. No full-thickness tear is seen. The muscles and tendons of the rotator cuff are otherwise intact.SUPRASPINATUS OUTLET: The AC joint is unremarkable. There is a small amount of fluid within the subacromial subdeltoid bursa. The coracohumeral ligament and subcoracoid fat pad appear within normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The labrum is grossly intact..BICEPS TENDON: Normally situated within the bicipital groove.ADDITIONAL", "output": "Distal supraspinous tendinopathy without evidence of rotator cuff tear. No specific evidence of adhesive capsulitis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 43 years old. Reason: evaluate for nodule History: right thyroid nodule, slight thyroid enlargement RIGHT LOBE MEASUREMENTS: 2.8 x 2.4 x 5.2 cmLEFT LOBE MEASUREMENTS: 2.3 x 1.9 x 5.5 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Mildly heterogeneous echotexture. A small spongiform nodule within the superior pole of the right thyroid lobe measures 0.5 x 0.4 x 0 .3 cm, with mild internal vascularity.LEFT LOBE: Mildly heterogeneous echotexture. A complex cystic nodule within the inferior pole of the left thyroid lobe measures 0.7 x 0.5 x 0.6 cm, without internal vascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are noted. A left level 3 lymph node measures 1.0 x 0.3 x 1.4 cm. A left level 2 lymph node measures 0.9 x 0.4 x 1.4 cm.OTHER: No significant abnormality noted.", "output": "Bilateral subcentimeter spongiform and complex cystic lesions are likely benign ."}
{"instruction": "Generate impression based on findings.", "input": "Q.D. MENISCI: There is complex tearing of the posterior horn of the medial meniscus which extends to the tibial articular surface. Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild articular cartilage loss of the medial femoral condyle anteriorly with associated degenerative marrow signal. The remaining cartilage of the medial, lateral, and patellofemoral compartments is otherwise intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Complex tear of the posterior horn of the medial meniscus.2. Mild articular cartilage loss of the medial femoral condyle.3. Small joint effusion."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female undergoing radiation therapy. Evaluate for split renal function. The posterior abdominal radionuclide angiogram demonstrates prompt, symmetrical perfusion of the kidneys.Sequential renal images show the left kidney to be of normal size and morphology. There is decreased size of the right kidney, particularly of the right lower pole, as seen on prior MRI and which may be due to postsurgical change versus scarring from prior infection or infarct.There is prompt uptake and excretion of the radiopharmaceutical by both kidneys. The estimated contribution of the right kidney to total renal function is 42% and that of the left kidney is 58%. On washout phase, there is pooling of radiotracer in the dilated right renal pelvis with delayed clearance from the proximal right collecting system. The half time of tracer clearance from the left kidney is 12.2 minutes and that from right kidney is 185 minutes. As a result, partial obstruction cannot be excluded.", "output": "1. Mildly decreased contribution of the right kidney to total renal function as detailed above.2. Delayed washout of radiotracer from the dilated right renal pelvis, and as a result, partial obstruction cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for new baseline of recurrent GBM prior to initiating Tx on ALLIANCE HSPPC96 vax trial. History: recurrent GBM. The patient has undergone left-sided occipital craniotomy for debulking of a mass involving the left occipital lobe and posterior temporal lobe. There remains enhancing component of the tumor adjacent to the occipital horn of the left lateral ventricle previously measuring 39 x 19 mm axial dimensions and it currently measuring 50 x 38 mm axial dimensions. There is increased cerebral blood volume present at this location. Microvascularity can be identified in this same location on the susceptibility weighted imaging. There are blood products present at the operative site. There is a vasogenic pattern of edema which was also present on the prior exam and has not changed in extent compared small amount of extra-axial fluid is present at the site of the craniotomy flap. Associated T2 and flair signal hyperintensities surrounding this mass has mildly increased in extent and involves more of the medial aspect of the left parietal lobe than on the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The sella is made of a developmental venous anomaly along the right frontal lobe associated with a small hemorrhagic lesion which is unchanged since the previous exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Since the prior exam the patient's left occipital mass has increased in size suggesting progression. 2.There is redemonstration of a hemorrhagic lesion in the right frontal lobe along the inferior frontal gyrus most likely representing a cerebral cavernous malformation associated with a developmental venous anomaly..3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "37 years, Female, multiple sclerosis, follow-up for progression. Weakness of arms and legs. BRAIN: Compared to 4/3/2015, there is interval development of a new T2 hyperintense lesions in the brain, one of which involves the left precentral gyrus near the junction with the left middle frontal gyrus and one which involves the dorsal aspect of the lower medulla in the midline/paramedian region extending to the cervicomedullary junction. These two new lesions demonstrated enhancement.Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are again noted and consistent with known demyelinating disease. Additional infratentorial lesions including the right middle cerebellar peduncle and the left cerebellar hemisphere are again seen. Brain parenchymal volume is maintained. Few lesions with T1 hypointensity are also noted.No intracranial mass or mass effect. No midline shift, hydrocephalus, or herniation. Calvarium and extracranial soft tissue structures are grossly unremarkable.CERVICAL SPINE: There is a new T2 hyperintense lesion involving the cervicomedullary junction with enhancement as mentioned above. There are tiny T2 hyperintense lesions involving the bilateral ventrolateral aspects of the cervical cord at the C4-C5 level. These lesions are evident on the axial T2, axial mFFE, and STIR sequences and more subtle on the prior study. There is a questionable additional T2 hyperintense lesion involving the cervical cord at the C7 level. No abnormal enhancement is appreciated.Partially imaged thoracic cord demonstrates a T2 hyperintense lesion in the ventral cord at the T1-T2 level, which appears to be present on prior although better seen on current study.Vertebral body heights are normal. There is mild reversal of cervical lordosis. Alignment is otherwise maintained. There is no significant spinal canal or neural foraminal stenosis at any level. Scattered perineural cysts are incidentally noted in the neural foramina.", "output": "1. Multiple supra- and infratentorial T2 hyperintense lesions consistent with known demyelinating disease. Compared to MRI brain dated 4/3/2015, there is interval development of two new lesions involving the left frontal lobe and cervicomedullary junction. These lesions demonstrate enhancement. Findings are consistent with progression of disease with areas of active demyelination.2. There are small T2 hyperintense lesions in the cervical cord at the C4-C5 level and partially imaged upper thoracic cord, which were present previously. Aside from the cervicomedullary junction lesion mentioned above, no new lesions or lesions with enhancement in the cervical cord are appreciated."}
{"instruction": "Generate impression based on findings.", "input": "Female, 68 years old, with headache and tremors, known small cell lung cancer, evaluate for metastases. Motion artifact degrades image quality on several sequences. No evidence of mass effect or pathologic parenchymal or extra-axial enhancement is seen. No restricted diffusion is evident. Encephalomalacia of the right inferior frontal lobe is likely related to prior infarction. Scattered periventricular T2 hyperintensities are also noted, most likely representing chronic microvascular ischemic disease. On postcontrast images, the pituitary gland appears to be inhomogeneously enhancing with an area of relative hypoenhancement posteriorly.No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are within normal limits for size and morphology.", "output": "1.No evidence of intracranial metastatic disease within the limitations of a motion degraded examination.2.No definite acute intracranial abnormalities. Sequelae of chronic right inferior frontal infarction are noted along with findings likely related to chronic microvascular ischemic disease.3.Incidental note is made of asymmetric hypoenhancement of the posterior aspect of the pituitary. This is probably an incidental finding and unrelated to the patient's presenting symptoms. If clinical concern warrants, dedicated pituitary imaging can be considered."}
{"instruction": "Generate impression based on findings.", "input": " There is no evidence for intracranial hemorrhage or diffusion-weighted abnormalities. Redemonstration of the right ACA and MCA territory encephalomalacia compatible with prior infarct. Scattered susceptibility artifact in the areas of MCA territory infarct compatible with hemosiderin deposition. There is also hyperintensity of the subcortical and periventricular white matter compatible with chronic small vessel ischemic disease. There is ex vacuo dilatation of the right lateral ventricle. Generalized cerebral volume loss. The white matter of the corpus callosal body is symmetrically thin, possibly developmental.There are no masses or midline shift. Redemonstration of focal prominence of CSF signal intensity in the midline along the posterior aspect of the posterior fossa which may represent a retrocerebellar cyst versus less likely mega cisterna magna, with mild mass effect upon the cerebellar hemispheres. There are no pathologic extraaxial fluid collections. Flow voids are present within the major proximal anterior vessels indicating patency. There is slight paucity of flow voids in the distal right MCA vessels on the right, compatible with known areas of chronic infarct. The basilar and vertebral flow voids are present but diminutive in size, likely developmental. Mucous retention cyst in the right maxillary sinus. Scattered bilateral ethmoid air cell opacity.", "output": "1.No evidence of acute ischemia or hemorrhage.2.Redemonstration of prior ischemia with extensive encephalomalacia of right ACA and MCA.3.Incidental retrocerebellar cyst versus less likely mega cisterna magna."}
{"instruction": "Generate impression based on findings.", "input": "PA/meniscal tear. Question of IAD left knee. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a 5-mm full-thickness chondral defect of the anterior lateral femoral condyle with underlying abnormal curvilinear T1 signal. This likely represent an osteochondral injury. No intervening fluid sensitive signal is identified to suggest an unstable lesion.The articular cartilage of the medial and patellofemoral compartments is intact.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "Osteochondral injury of the anterior lateral femoral condyle without evidence of an unstable lesion."}
{"instruction": "Generate impression based on findings.", "input": "Sensorineural hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is patchy fluid signal within the bilateral mastoid air cells. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is diffuse paranasal sinus mucosal thickening.", "output": "1. No evidence of inner ear anomalies, cochlear nerve deficiency, or intracranial lesions.2. Patchy fluid signal within the bilateral mastoid air cells may represent effusions.3. Diffuse paranasal sinus mucosal thickening may represent sinusitis."}
{"instruction": "Generate impression based on findings.", "input": "Fluctuating Wiernicki and persistent right face and arm weakness. There is an area of high T2 signal and restricted diffuse in the medial left thalamus that measures up to 20 mm. There may be punctate foci of susceptibility effect within this lesion. The rest of 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": "Small left medial thalamus acute infarct with possible petechial hemorrhages, although assessment is limited by patient motion artifact."}
{"instruction": "Generate impression based on findings.", "input": "56 old female with LBP. Evaluate for spondylolisthesis L5-S1. There is a broad-based disc bulge at L5-S1 predominantly towards the left as well as mild moderate bilateral facet hypertrophy. There is associated effacement of the left lateral recess. There is mild deformity of the spinal canal at this level. There is mild neural foraminal narrowing bilaterally at this level. There is mild grade 1 anterolisthesis of L5 on S1. A disc bulge is also present at L3-L4 and L4-5 with no significant spinal canal or neural foraminal narrowing. The spinal cord displays normal signal and morphology. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.", "output": "Mild multilevel degenerative changes of the lumbar spine predominantly affecting the L5-S1 level, where there is also mild anterolisthesis.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, 6 years old, with neuroblastoma, off therapy evaluation. Assess for progression of disease. Lobular enhancing masses are again seen within the anterior paraspinal tissues bilaterally.On the left, tumor becomes apparent first at the T4 level continuing down to the T10 level. There has been no change in craniocaudal extent. Likewise, the maximal transaxial dimension is not significant changed at 26 x 18 mm.On the right, tumor is redemonstrated within the right T4-5 neural foramen and extending between the fourth and fifth ribs. Tumor is also evident extending between the fifth and sixth ribs. This latter lesion measures 23 x 10 mm which, again, is not significantly changed from prior.No evidence of any new lesion is detected. A mild scoliotic deformity is evident. Spinal alignment, vertebral body morphology and marrow signal characteristics are otherwise unremarkable. Mildly prominent mediastinal and right hilar lymph nodes are unchanged and nonspecific.", "output": "Stable bilateral anterior paraspinal masses are seen with no evidence to suggest any new or progressive lesions."}
{"instruction": "Generate impression based on findings.", "input": "55 year old woman with history of adriamycin as part of chemotherapy for breast cancer, referred for cardiac MRI to evaluate cardiac function. Left VentricleThe left ventricle is severely dilated (previously moderately dilated) with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 115 ml/m2 (normal range: 65+/-11), the LVEDV is 200 ml (normal range 109+/-23), the LV end systolic volume index is 50 ml/m2 (normal range 18+/-5), the LVESV is 87 ml (normal range 31+/-10), the LV mass index is 34 g/m2 (normal range 67+/-11), and the LV mass is 60 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Normal myocardial T1 relaxation time. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mild-moderately dilated.Right VentricleThe right ventricle is severely dilated. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 140 ml/m2 (normal range 69+/-14), the RVEDV is 244 ml (normal range 110+/-24), the RV end systolic volume index is 71 ml/m2 (normal range 22+/-8), and the RVESV is 123 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. 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 FindingsBilateral breast implants are present. There is low signal intensity in the liver associated with a significantly reduced T2* decay time of 12.7ms. Taken together, this may suggest iron overload of the liver or recent iron infusion. 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 LV with normal systolic function (EF 56%). There is no late gadolinium enhancement to suggest previous underlying infiltrative, inflammatory or fibrotic myocardial processes.2. Severely dilated RV with normal systolic function (EF 50%). 3. Biatrial enlargement. 4. Low signal intensity in the liver associated with significantly reduced T2* decay time of 12.7ms, suggestive of iron overload in the liver or recent iron infusion. When compared to the previous cardiac MRI of 7/2014, the ventricular volumes have increased by one degree in size with no significant change in function. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with a history of multiple myeloma with 3 weeks of cough, hemoptysis. Bronchoscopy showed adenocarcinoma of the lungs. Rule-out brain metastases. There are areas of white matter hypodensity in the right frontal lobe. Given the history of a neoplastic primary, metastatic involvement cannot be ruled out. An MRI with contrast is recommended for further evaluation. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is partial opacification of the dependent portions of the left maxillary sinus, improved compared to the prior examination. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Patchy areas of hypodensity in the right frontal white matter. Given the history of neoplasm, an MRI is recommended for further evaluation to rule out metastatic foci as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "History of right mastectomy for IDC and DCIS in 2011. Status post right reconstruction and left breast reduction. There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.Status post right mastectomy with autologous reconstruction.No suspicious enhancement is seen in either the left breast or right reconstruction. Stable foci in the left breast are noted.No abnormal lymph nodes are identified in either axillary region.A few high T2 hepatic lesions are probably benign lesions such as cysts or hemangiomas. High T2 thoracic vertebral body lesion is also stable, probably a hemangioma.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "71 year old female with stage IIIB cervical cancer. Please evaluate disease extent for radiation planning purposes. Presents with vaginal bleeding. PELVIS:UTERUS, ADNEXA: There is irregular asymmetric enlargement of the cervix, area measures approximately 4.2 x 2.9 cm, with associated enhancement and increased signal abnormality, consistent with patient's history of cervical carcinoma. There is apparent extension of this signal abnormality and enhancement superiorly to involve the myometrium/uterine body. There is a fluid filled endocervical canal. Note is made of multiple low signal intensity masses within the fundus and body of the uterus, which enhance on postcontrast sequences, appearing most consistent with intramural and pedunculated/subserosal leiomyomas. There is a simple appearing left adnexal cyst measuring 1.6 cm in diameter. BLADDER: No significant abnormality noted.LYMPH NODES: There is left iliac lymphadenopathy measuring 1.9 x 1.0 cm (33; series 801). Right iliac lymph node, corresponding to the hypermetabolic focus on recent PET/CT examination, measures 0.7 x 0.5 cm (59; series 801).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Note is made of diffuse heterogeneous bone marrow signal abnormality which is nonspecific but may be seen in setting of anemia.", "output": "1.Findings consistent with the patient's history of cervical carcinoma with reference measurements provided above.2.Persistent bilateral pelvic lymphadenopathy, suspicious for metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: 78-year-old female with history of CVA. Now with slurred speech. Signs and symptoms: Slurred speech Nonenhanced head CT:Examination demonstrate mild to moderate findings of small vessel ischemic disease of indeterminate age in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Exclude possibly to overlapping new stroke recommend an MRI exam.There is no evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus.", "output": "Small vessel disease of indeterminate age."}
{"instruction": "Generate impression based on findings.", "input": "6-year-old male with history of T-cell lymphoma. Evaluate for relapse. There is no evidence of intracranial mass lesions. There is no evidence of acute intracranial hemorrhage or acute infarction. The left lateral ventricle is smaller than the right, likely a congenital normal variant. There is no abnormal parenchymal or meningeal enhancement. The major flow-voids are preserved. The sella and orbits are grossly within normal limits. The paranasal sinuses and mastoid cells are unremarkable. The skull and extracranial soft tissues are within normal limits.", "output": "No evidence of intracranial mass lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female 18 years old Reason: eval for ATFL tear and OCD talus; healing fifth MT fracture. History: ankle pain for months s/p inversion TENDONS: No significant abnormality noted.LIGAMENTS: The anterior and posterior talofibular ligaments are intact and demonstrate normal signal intensity and caliber.ARTICULAR SURFACES AND BONE: Linear high T2 signal traverses the known fracture of the fifth metatarsal base (series 6/6), with the fracture fragments in unchanged, near-anatomic alignment.ADDITIONAL", "output": "1.Linear high T2 marrow signal traversing the known fracture of the fifth metatarsal base, suggestive of nonunion.2.No evidence of anterior or posterior talofibular ligament injury."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic lung cancer, EGFR mutated. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered and confluent nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants and mild staphylomatous deformity of the globes. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is periodontal enhancement associated with tooth number 3.", "output": "1. No evidence of intracranial metastases. 2. Nonspecific cerebral white matter T2 hyperintensity may represent treatment effects or chronic small vessel ischemic disease. 3. Apparent periodontal inflammation associated with tooth number 3. "}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female with wrist pain, cyst LIGAMENTS: Contrast is seen within the radiocarpal joint with no communication with the mid carpal or distal radioulnar joint. The scapholunate and lunotriquetral ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is intact.TENDONS: No significant abnormality noted. BONES: Cysts are noted in the capitate and may be degenerative or idiopathic in etiology.ADDITIONAL", "output": "1.No evidence of TFCC tear. 2.Cystic lesion in the soft tissues along the ulnar side of the wrist may represent a ganglion although other lesions cannot be entirely excluded."}
{"instruction": "Generate impression based on findings.", "input": "Nonunion fracture, concern for osteomyelitis Again seen is a transverse fracture of the distal radial metaphysis with volar and lateral displacement of the distal fracture fragment. The margins of the fracture appear relatively well defined and although there is slight low T1 signal intensity of the proximal fracture margin, there is no convincing evidence of osteomyelitis. There is marrow edema within the distal radius, distal radial fracture fragment, and distal ulna related to the previously described fractures. Following contrast administration, there is enhancement of the distal radius but no evidence of surrounding fluid collection. The remaining surrounding soft tissues are normal in signal intensity.", "output": "Displaced transverse fracture of the distal radial metaphysis without definite evidence of osteomyelitis or abscess. Abnormal marrow signal intensity and enhancement of the distal radius is thought to represent reactive osteitis or inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Right buttock pain, bilateral leg pain, sport injury. Signs and symptoms: As above. Nonenhanced lumbar MRI: There is normal anatomical alignment of vertebral column.There is normal signal intensity of vertebral column. There is no detectable posttraumatic findings.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 is unremarkable.L3 -- L4 is unremarkable.L4 -- L5 demonstrate mild ligamentum flavum hypertrophy and unremarkable otherwise.L5 -- S1 demonstrate mild to moderate disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophy. There is a broad based central disk protrusion with resultant slight flattening and posterior displacement of thecal sac however without spinal stenosis or neural foraminal compromise. This finding is best appreciated on axial T2 series 701 image 6 and axial T2 series 901 image two.Perispinal soft tissues are unremarkable.", "output": "1.L5 -- S1 demonstrates mild-to-moderate disk disease, loss of disk height and a broad-based central disk protrusion without spinal stenosis or neural foraminal compromise as detailed.2.Unremarkable nonenhanced lumbar MRI otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Reason: knee osteoarthritis History: severe knee pain MENISCI: Increased signal intensity in the posterior horn of the lateral meniscus is compatible with intrasubstance degeneration, which extends to the tibial articular surface in linear fashion on one and possibly two sagittal sequences, suspicious for an undersurface tear. The posterior horn of the lateral meniscus also appears small, which may represent additional attritional tearing. The aforementioned degenerative signal/tearing extends into the body of the lateral meniscus. The anterior horn of lateral meniscus is within normal limits.There is a small focus of branching signal within the peripheral fibers of the posterior horn of the medial meniscus, extending to the femoral articular surface, which could conceivably represent a small partial thickness tear, but we see no fluid signal intensity entering the meniscus, and the current clinical significance of this finding is uncertain. There is mild intrasubstance degeneration of the body of the medial meniscus. The anterior horn of the medial meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: There is diffuse, near-full to full-thickness loss of cartilage along the lateral facet of the patella, with relatively mild degeneration of the articular cartilage of the medial facet. There is also near-full to full-thickness loss of articular cartilage along the lateral facet of the femoral trochanter along the inferior aspect. There are small underlying subchondral cysts within the patella.There is full thickness degeneration of the articular cartilage along the medial femoral condyle, above and anterior to the posterior horn of the medial meniscus, measuring approximately 2 cm in length in AP dimension, and over 1 cm in length in medial-lateral dimension.There is also full thickness cartilage loss along the posterior aspect of the lateral femoral condyle, with adjacent foci of intermediate signal, that we suspect represent displaced cartilaginous fragments. Thinning of the articular cartilage of the lateral tibial plateau, beneath the posterior horn of the lateral meniscus, is also noted.Tricompartmental osteophytosis is compatible with osteoarthritis.LIGAMENTS: There is mild edema along the medial collateral ligament, but the ligament itself is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1.Tricompartmental osteoarthritis as described above, most severely affecting the patellofemoral joint. Suspected meniscal tears may be degenerative in etiology.2.Large joint effusion with intra-articular loose bodies.3.Other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "72 year old female with history of hypertension, now presents with blurred vision and headache. A large area of hyperattenuation is noted in the right occipital and parietal lobes, extending into the right lateral ventricle, basal cisterns and subdural space along the right tentorium. This finding is consistent with an acute intraparenchymal and subdural hemorrhage. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Acute right occipital/parietal intraparenchymal, intraventricular, and subdural hemorrhage. This finding was discussed with Dr. Nasrallah at 45657."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male patient with cholestasis. ABDOMEN:LIVER, BILIARY TRACT: No intrahepatic or extra hepatic biliary ductal dilatation. No suspicious hepatic lesions. No filling defects within the gallbladder. SPLEEN: Splenomegaly, measuring up to 15 cm in craniocaudal dimension. Innumerable diffuse subcentimeter T2 hypointense lesions within the splenic parenchyma.PANCREAS: No pancreatic ductal dilatation. No focal pancreatic lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bronchial wall thickening in the lung bases.", "output": "1.No biliary ductal dilatation to suggest obstructive biliary pathology.2.Heterogeneous splenic parenchyma likely secondary to sarcoidosis."}
{"instruction": "Generate impression based on findings.", "input": "Male 35 years old Reason: Evaluate plexiform neurofibroma History: NF1, known plexiform tumors in chest Redemonstration of innumerable masses with increased signal intensity on fluid sensitive sequences, again compatible with nerve sheath tumors and history of neurofibromatosis type I. Lesions are again noted in the soft tissues adjacent to the right lung apex, with additional small concentration of lesions adjacent to the left lung apex. Lesions along the thoracic nerve roots and intercostal nerves at all levels. No new lesions are identified.Reference lesion in the right anterior chest wall measures 2.7 x 1.2 x 3.1 cm (image 23 series 401; image 10 series 601) previously 2.4 x 1.4 x 3.5 cm.Reference right-sided paraspinal region at the level of the thoracic inlet measures 2.9 x 2.0 x 3.5 cm (image 8 series 41; image 22 series 601) previously 2.9 x 2.1 x 3.4 cm.Reference right-sided paraspinal lesion at the level thoracic inlet measures 3.0 x 0.9 x 2.5 cm (image 10 series 401; image 25 series 601) previously 3.1 x 1.1 x 2.5 cm.No specific evidence of malignant degeneration on this noncontrast MR examination.", "output": "Findings are again compatible with neurofibromatosis, with significant interval change of index lesions or evidence of new lesions. "}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status. Altered mental status. New left sided facial droop There is a punctate focus of diffusion restriction present in the right fusiform gyrus and another punctate focus of diffusion restriction in the right cerebellar hemisphere in the right posterior inferior cerebellar artery territory.There is a slitlike focus of the hyperintensity with a little bit of signal loss located in the right basal ganglia neostriatum. It is associated with some susceptibility artifact. There is associated volume loss.On susceptibility imaging are punctate foci of signal loss present in the brainstem, right thalamus and in the left periventricular white matterThere is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There appears to be fetal origin of the left posterior cerebral artery.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The exam is mildly degraded on some of the sequences due to patient motion.", "output": "1.There are a couple tiny foci of cerebral infarction present one in the right cerebellar hemisphere and another in the right fusiform gyrus.2.There is an old hemorrhagic lesion in the right basal ganglia.3.There is a mild degree of microhemorrhages in the brainstem and right thalamus. Most likely these are related to hypertension. Please correlate with clinical history.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.The exam is mildly degraded on some of the sequences due to patient motion."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old woman with history of multiple sclerosis and paresthesias. There are multiple T2 hyperintense lesions within the cerebral and cerebellar white matter, overall similar in size and number when accounting for differences in imaging technique. Multiple, small lesions are more prominent on today's study, however this is likely due to technique, currently measures to 3 Tesla with thinner sections. There is no intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. The major flow-voids are preserved. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are bilateral maxillary mucosal retention cysts.", "output": "Probable stable size and number of demyelinating white matter lesions given differences in technique."}
{"instruction": "Generate impression based on findings.", "input": " Partially imaged cervical spine demonstrates postsurgical changes of prior anterior cervical fusion extending from C3 to C6. There is a disc bulge at the C6-C7 level with moderate spinal canal stenosis, more completely assessed on prior outside cervical spine study. There is suggestion of T2 hyperintensity involving the right aspect of the cord at the C6 level on the outside study which may be related to prior injury.Thoracic spine:The thoracic spine is in normal alignment. The vertebral body heights are maintained. There are ventral flowing osteophytes at multiple levels suggestive of diffuse idiopathic skeletal hyperostosis. There is T1 hyperintensity involving the disc spaces, particularly at T6-T7 and T10-T11 which be related to mineralization/calcification and can be confirmed on CT. There is T1 hyperintensity involving the vertebral body bone marrow at T8, T9, and superior aspect of T10 with associated enhancement. There is edema involving the disc space at the T7-T8 disc space with T2 hyperintensity and enhancement.There is prominence of the epidural fat extending from T5-T6 to T9-T10 levels. There is associated severe spinal canal stenosis with flattening of the thoracic cord from T6-T7 to T9-T10. Small T8-T9 disc bulge contributes slightly to the stenosis. There is suggestion of subtle T2 hyperintensity in the cord.Abnormal epidural enhancement is noted from T7-T8 to to the T9-T10 levels. There is also prominent paraspinous enhancement from T7-T8 to T9-T10 surrounding the bulky ventral and lateral osteophytes at this level.There is mild to moderate neural foraminal stenosis at T8-T9 bilaterally. Otherwise no significant neural foraminal stenosis in the thoracic spine.Lumbar Spine:Vertebral bodies in the lumbar spine are normal. Alignment is normal. Bone marrow signal is diffusely heterogeneous which is nonspecific but without discrete suspicious lesions evident. There is epidural lipomatosis narrowing the lumbar spinal canal, worst at the L4-L5 level. Individual levels as below:L1-L2: Minimal disc bulge. No significant foraminal stenosis. Minimal spinal canal narrowing related to epidural fat.L2-L3: Mild disc bulge and facet arthropathy. There is mild to moderate spinal canal stenosis related to epidural lipomatosis. No significant neural foraminal stenosis. L3-L4: Mild disc bulge and facet arthropathy. There is moderate spinal canal stenosis related to epidural lipomatosis. No significant neural foraminal stenosis. L4-L5: Diffuse disc bulge, bilateral facet arthropathy with distention of the left facet. There is moderate to severe spinal canal stenosis primarily related to epidural lipomatosis. Mild bilateral neural foraminal stenosis.L5-S1: Minimal disc bulge. Advanced bilateral facet arthropathy. There is moderate to severe spinal canal stenosis related to epidural lipomatosis. There is no significant neural foraminal stenosis.There is edema and enhancement surrounding the L4-L5 and to a lesser degree L5-S1 facet joints, likely on a degenerative basis.", "output": "1. Severe spinal canal stenosis with mild flattening of the cord from T6-T7 to the T9-T10 levels related to epidural lipomatosis. There is suggestion of associated subtle T2 cord signal abnormality. Epidural lipomatosis is also evident in the lumbar spine with moderate to severe spinal canal stenosis at the L4-L5 and L5-S1 levels.2. Multiple ventral flowing osteophytes suggestive of diffuse idiopathic skeletal hyperostosis (DISH). There is abnormal enhancement involving the T8-T10 vertebral bodies, T7-T8 disc and to a lesser degree adjacent intervertebral discs, abnormal epidural enhancement from T7-T8 to T9-T10, as well as abnormal paraspinous enhancement from T7-T8 to T9-10 levels surrounding the large thoracic osteophytes. These findings are favored to be on a degenerative basis and/or related to arthropathy such as DISH or CPPD. Much less likely enhancement is related to infection or neoplastic process. Facet arthropathy at L4-L5 and to a lesser degree L5-S1 is also evident with adjacent soft tissue enhancement; these findings are also likely on a degenerative basis.3. Partially imaged cervical spine demonstrates prior anterior cervical fusion from C3 to C6. There is a disc bulge at the C6-C7 level with moderate spinal canal stenosis, more completely assessed on prior outside cervical spine study. There is suggestion of T2 hyperintensity involving the right aspect of the cord at the C6 level on the outside study which may be related to prior injury.4. Mild to moderate neural foraminal stenosis at bilaterally T8-T9. Mild bilateral L4-L5 neural foraminal stenosis. Otherwise neural foramina in the thoracic and lumbar spine are patent."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Patient reports tearing sensation in right forearm. Rule out tendon tear. History: Patient reports tearing sensation in right forearm. We see no tendon tear. On the fat saturated fluid sensitive sequences, the muscle bellies of the extensor carpi radialis brevis and extensor digitorum are slightly hyperintense. We are uncertain if this represents artifact or the sequela of subacute denervation. We see no muscle atrophy. The muscles otherwise appear normal. We see no masses along the courses of the major nerves. There is fluid and/or synovitis affecting the distal radial ulnar joint. The wrist is not included in its entirety on this study, but the changes of rheumatoid arthritis are again noted as seen on prior radiographs.", "output": "1. No evidence of tendon tear.2. Minimal increased signal intensity within the extensor carpi radialis brevis and extensor digitorum is of uncertain clinical significance and may simply be artifactual, although this could represent subacute denervation.3. Distal radioulnar joint synovitis and findings of rheumatoid arthritis affecting the wrist."}
{"instruction": "Generate impression based on findings.", "input": "47 years Male (DOB:12/31/1968)Reason: 3T scanner, please evaluate for AVM History: HHT, at risk for cerebral AVMsPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a developmental venous anomaly present in the right cerebellar hemisphereThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is no arterial supply identified to the patient's right cerebellar developmental venous anomaly.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the left PCA. The LVA is larger than the RVA.", "output": "1.No evidence for cerebrovascular occlusive disease.2.DVA right cerebellar hemisphere. 3.No convincing evidence for intracranial aneurysm or AVM based on this exam."}
{"instruction": "Generate impression based on findings.", "input": "Reason: lateral meniscus tear History: left knee pain. MENISCI: Complex multidirectional tear of the lateral meniscus including oblique and horizontal components through the body and complete displacement of the posterior horn posteriorly. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. Bone marrow signal is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "Complex multidirectional tear of the lateral meniscus as described above."}
{"instruction": "Generate impression based on findings.", "input": "21 years Female (DOB:10/10/1995)Reason: pituitary cystic lesion, enlarge in Sep 2015 w possible hemorrhage associated with headache, also has infratentorial lesion. History: normal vision and endocrine functionPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI brain:There is a 32 x 36 mm sagittal dimension and 52 x 36 mm axial dimension cystic mass in the posterior fossa compatible with arachnoid cyst associated with bone remodeling which appears largely unchanged when compared to the previous exam it follows spinal fluid on all pulse sequences.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right sigmoid sinus appears to be absent. The left sigmoid sinus is large. The straight sinus is relatively small. The right transverse sinus is smaller than the left transverse sinus. The right transverse sinus appears to drain into vein of Labbe.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:There is redemonstration of a T1 hyperintense focus in the inferior aspect of the pituitary at the midline is unchanged compared to prior exam. It measures approximately 2 mm in size.The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally.", "output": "1.Stable pituitary lesion which could represent a Rathke's cyst.2.There is a compatible with an arachnoid cyst in the posterior fossa which is stable compared to the prior exam.3.Findings suggest congenital absence or hypoplasia of the right sigmoid sinus."}
{"instruction": "Generate impression based on findings.", "input": "27 year old with history of bicuspid aortic valve being referred for evaluation of possible aortopathy. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 87 ml/m2 (normal range: 65+/-11), the LVEDV is 172 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 64 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 79 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 45 ml/m2 (normal range 69+/-14), the RVEDV is 89 ml (normal range 110+/-24), the RV end systolic volume index is 45 ml/m2 (normal range 22+/-8), and the RVESV is 89 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The leaflet number cannot be determined on this study. 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 sinus of Valsalva is 35 x 31 mm, STJ 30 x 29 mm, ascending aorta 31 x 29 mm, ascending (just proximal the right brachiocephalic) 30 x 29 mm, thoracic aorta (just distal the left subclavian) 21 x 21 mm, descending aorta 18 x 17 mm. No evidence of aortic coarctation. 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. Normal left ventricular size and systolic function (LVEF 63%)2. Normal right ventricular size and systolic function (RVEF 55%) 3. No evidence of inflammation, fibrosis or infarct as evidenced by lack of LGE. 4. Aortic dimensions as described above. No evidence of coarctation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female 36 years old Reason: h/o Crohn's, s/p 2 resections with possible proximal to previous anastomosis. intermittent obstructions. History: elevated crp, intermittent obstructions with bloating ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Signal dropout on out of phase images consistent with diffuse hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 1.4 cm. It is unchanged in size compared to prior CT 11/27/13. It demonstrates signal dropout on out of phase images and is consistent with adenoma.KIDNEYS, URETERS: Subcentimeter T2 hyperintensity within the left kidney compatible with a renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post ileocecectomy. Second side-to-side small bowel anastomosis in the mid/distal ileum. In the distal ileum in the region of the anastomosis and in the neoterminal ileum there are segments of mild hyper enhancement of the wall of the bowel with minimal edema in this region. There is no significant wall thickening or increased signal high B value diffusion weighted images.There is focal narrowing of the rectum which persists on serial sequences with mild wall edema and hyperenhancement (series 22, image 69).Additionally there is tethering of the neoterminal ileum to rectum in this region suggestive of underlying adhesions (series 22, image 79; series 23, image 24). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral physiologic ovarian follicles. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid.", "output": "1. Mucosal hyperenhancement and mild edema involving the neoterminal ileum and a focal segment of rectum. Focal adhesions are identified between these two abnormal segments of bowel. 2. Hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old male with recurrent right shoulder dislocation. Assess for glenoid anterior fracture.IMAGE ACQUISITIONS: CT of the right shoulder without contrast. Coronal oblique and sagittal oblique reformats were obtained. 3-D reconstructions were performed on an independent workstation. There is deficiency of the anterior/inferior glenoid as seen on the prior MRI examination. This results in loss of articulating surface along the inferior aspect of the glenoid. We are uncertain whether this is congenital or due to long-standing trauma (i.e., repeated anterior dislocations). Currently, the margins of the glenoid are corticated.There is a curvilinear focus of calcification along the anterior/inferior margin of the glenoid. This measures just over 1 cm in greatest dimension. This may represent an old adherent fracture fragment or capsular calcification.Currently, the glenohumeral joint alignment is within normal limits. However, there is flattening of the postero-lateral humeral head, indicating Hill-Sachs deformity from prior dislocation.The bones are otherwise within normal limits. The soft tissues are within normal limits given the limitations of CT relative to MRI.", "output": "Deficiency of the anterior/inferior glenoid which may be congenital or due to repeated anterior dislocations. "}
{"instruction": "Generate impression based on findings.", "input": "Necrotizing fasciitis, recent below-knee amputation Knee: The patient has undergone below knee amputation. Very little soft tissue overlies the distal margin of the remaining tibia and areas of signal void are noted within the surrounding soft tissues and within the medullary cavity of the distal tibia which may represent foci of gas. There is edema within the medullary cavity of the distal tibia noted on series 5 which in conjunction with the suspected gas is concerning for osteomyelitis. There is also increased signal intensity within the medullary cavity of the distal end of the remaining fibula on the fat-suppressed T2 sequences; however there is relatively normal corresponding T1 marrow signal and therefore this may reflect reactive osteitis as opposed to true osteomyelitis. There is superficial ulceration along the distal end of the stump with circumferential thickening of the skin which enhances following contrast administration. There is reticulation of the subcutaneous fat which also enhances reflecting cellulitis. There is mild heterogeneous edema and enhancement of the remaining musculature of the calf indicating inflammation but we see no rim-enhancing inter- or intramuscular collection to suggest abscess. There is a small knee joint effusion with synovial enhancement indicating mild synovitis.The study was not tailored for the evaluation of the internal derangement of the knee. There is mild osteoarthritis of the knee but no findings to suggest ligamentous disruption or an unstable meniscal tear. An additional focus of low signal intensity is identified in the proximal tibia which may reflect a bone infarct. An ossicle distal to the patellar tendon may relate to remote trauma but is not necessarily of any clinical significance.Femur: The cellulitis detailed above extends proximally into the proximal thigh to about the level of the lesser trochanter. Although there is reticular enhancement of the subcutaneous fat and mild enhancement of the posterior crural fascia, the degree of enhancement is less pronounced than that seen more distally suggesting a greater proportion of \"cold edema\" rather than inflammation. There is mild edema of the vastus medialis, vastus lateralis, hamstring musculature, and adductor musculature on the T2-weighted sequences with very mild enhancement of the medial margin of the distal vastus lateralis and its adjacent fascia indicating inflammation. Intramuscular edema is also noted on the T2-weighted images but does not appear to enhance following gadolinium with the exception of a thin area of intramuscular enhancement between the margin of the vastus lateralis and sartorius distally. We see no rim-enhancing inter or intramuscular fluid collection to suggest abscess and the bone marrow signal of the femur is normal. There is mild edema of the distal fibers of the gluteus maximus muscle with mild enhancement. There are several enlarged inguinal lymph nodes which enhance following gadolinium administration.", "output": "1. Surgical changes of below-knee amputation with signal void extending into the medullary canal of the remaining distal tibia that may represent gas, concerning for osteomyelitis. Correlation with radiographs is recommended.2. Soft tissue inflammation as described above indicating cellulitis with additional edema extending into the thigh. We cannot confirm nor exclude necrotizing fasciitis on the basis of these images. Additional findings are described above."}
{"instruction": "Generate impression based on findings.", "input": "Female 52 years old Reason: evaluate for lymphatic disease History: rectal cancer Pathology states that a proximal rectal lesion from recent colonoscopy is compatible with invasive well-differentiated rectal adenocarcinoma. The lesion on colonoscopy report was described as diffuse flat and multilobulated. Overall image quality: GoodPELVIS:UTERUS, ADNEXA: 3.2 x 1.7 cm ovoid lesion in the left lateral pelvis (801:47) is felt to represent an ovary, however, the right ovary is not well seen. Patients uterus is atrophic/surgically absent.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: 7 mm, anterior to the rectosigmoid colon (801:46). Other tiny nodes are also seen. For example a 5 mm node (801:45) right posterior lateral to the rectosigmoid colon.Lymph nodes outside the mesorectal fascia: Subcentimeter left internal iliac node (801:58) is nonspecific.BOWEL, MESENTERY: No discrete identifiable tumor is seen. Majority of the rectosigmoid colons dark serosal signal is preserved. A small 7 mm T2 gray gently lobulated lesion is seen along the left posterior lateral aspect on axial T2 oblique images (1001:37). This may represent a small focus of T3 tumor, but is very small accurately characterize. There is a denuded appearance of the visualized rectosigmoid colon with hypervascularity and enhancement suggestive of a chronic colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.MRI findings suggestive of chronic colitis, likely ulcerative. 2.No definitive identifiable tumor is seen. A 7 mm lesion described above could represent T3 tumor but is very small accurately characterize. Several lymph nodes are seen, with a few described above. These are indeterminate as to whether they're related to ulcerative colitis or tumor."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male with history of C4-T1 cervical fusion presents with open wound and exposed spinous process of T1. Evaluate for osteomyelitis. There are postsurgical changes of posterior fusion from C4 to T2 and anterior cervical fusion from C5 to C7 with interbody bone grafts at C5-C6 and C6-7. A fragment of an old pedicle screw is again seen at the right T1 level as identified on the prior CT. There is evidence of wide laminectomies at the C2-3 to C6-7 levels. There is straightening of the cervical spine, which may be due to fusion.  Susceptibility artifact related to hardware limits evaluation. There is a soft tissue defect involving the posterior neck with exposure of the T1 spinous process and surrounding soft tissue edema and enhancement. Foci of susceptibility in the soft tissue adjacent to the T1 spinous process may represent foci of air related to wound dehiscence. There is no evidence of a drainable fluid collection. There is increased T2 and decreased T1 signal with enhancement of the spinous process of T1, which is suspicious for osteomyelitis (best seen on axial series 14, image 17). There is no evidence of discitis, abscess, or epidural collection. There is no evidence of central spinal canal stenosis or cord signal abnormality. There is mild left neuroforaminal stenosis at C3-4 and mild-to-moderate left neuroforaminal stenosis at C4-5.", "output": "Bone marrow signal abnormality involving the T1 spinous process is suspicious for osteomyelitis. There are surrounding inflammatory changes in the adjacent soft tissues. There are suspected subcutaneous foci of air which may be related to the open wound. There is no appreciable drainable fluid collection in the paraspinous soft tissues, with susceptibility artifact from hardware slightly limiting evaluation. No findings to suggest discitis or epidural abscess."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old male with headache, elevated BP and diplopia. Elevate for CVA. There is no evidence of intracranial hemorrhage, mass or edema. Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.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": "Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with shoulder pain. ROTATOR CUFF: There is thickening with intermediate signal abnormality of the supraspinatus tendon indicating moderate tendinosis. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. There is thickening and intermediate signal abnormality of the supraspinatus tendon indicating moderate tendinosis The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of the glenoid labrum, the labrum appears intact.BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps which may represent tenosynovitis. The long head of the biceps tendon appears intact. ADDITIONAL", "output": "Interstitial tearing of the rotator cuff without evidence of a full-thickness tear. Rotator cuff tendinosis and other findings as described above. "}
{"instruction": "Generate impression based on findings.", "input": "41 years Female (DOB:1/4/1975)Reason: hx lumbar med L5-S1 1 month ago. c/o LBP, left leg pain, foot drop. Eval for epidural scar, abnormality or changes History: c/o LBP, left leg pain, foot drop.Referring Attending: EDWIN RAMOS Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is loss of disc space height, disc desiccation and a left lateral recess disc extrusion. The patient status post left hemilaminectomy at this level. Disc material extends into the left lateral recess and compresses the nerve roots at the left lateral recess. In addition there is some soft tissue thickening on top of the disc extrusion at the left lateral recess associated with some contrast enhancement. There is some associated contrast enhancement surrounding the disc extrusion. There is additional contrast enhancement at the left lateral recess. There is contrast enhancement along the left medial paraspinous tissues and the adjacent subcutaneous tissues at the surgical site which is likely postoperative in nature.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "Since the prior exam patient has undergone left hemilaminectomy at L5-S1. There is some soft tissue thickening at the left lateral recess at L5-S1 which affects the nerve roots at the left lateral recess. This could represent postoperative change, disc material or inflammation due to infection. Additionally the left lateral recess disc extrusion has not changed substantially since prior exam."}
{"instruction": "Generate impression based on findings.", "input": " The dominant mass centered in the right retromolar trigone seen previously has markedly decreased in size with patchy non-masslike enhancement seen in this region. The enhancement abuts the right cervical internal carotid artery. Large left level 2 lymph node seen previously is also smaller measuring up to 10 mm today compared to 19 mm previously. Additional enhancing nodule along the left lateral aspect of the base of the tongue in the left retromolar trigone just anterior to the left pterygoid muscle abutting the left angle of the mandible appears non-masslike today compared to the prior exam.Reference right level Ib lymph node is unchanged measuring 9 mm. Right retropharyngeal lymph node abutting the right cervical internal carotid artery is unchanged measuring up to 10 mm. A smaller right level IIb lymph node seen previously measuring up to 8 mm in short axis now measures up to 5 mm in short axis.The right submandibular gland is not well visualized. The imaged brain appears within normal limits. No other areas of suspicious enhancement are identified. Flow-voids in the neck are grossly patent with the exception of the left internal jugular vein flow void which is not well visualized, possibly artifactual.", "output": "1.Marked interval decrease in size of right retromolar trigone/base of tongue mass with minimal patchy non-masslike enhancement likely representing post treatment change although residual tumor is not entirely excluded. 2.Marked interval decrease in size of left level II lymph node measuring up to 10 mm today.3.Stable to decreased size of other reference lymph nodes as described above."}
{"instruction": "Generate impression based on findings.", "input": "Delirium and agitation. History of lupus nephritis. On chronic high-dose steroids. Rule out cerebritis or brain infection. The exam was initially ordered with and without contrast but given the lack of IV access, it was changed to without contrast. The examination is also moderately limited by patient motion, which is most pronounced on the susceptibility-weighted imaging despite being repeated. There is no gross intracranial hemorrhage.There is confluent T2/FLAIR hyperintensity in the left frontal periventricular/deep white-matter associated with ex vacuo enlargement of the anterior body/frontal horn of the left lateral ventricle. This is not significant change since the November 2007 CT scan. In addition, there are symmetric T2/FLAIR hyperintense lesions in the frontoparietal white-matter. There is no diffusion restriction. In addition to dilated perivascular spaces, there are small foci of CSF intensity in the basal ganglia regions and in the frontal periventricular white-matter, especially on the left, which probably represent chronic lacunar infarcts. There is no mass-effect or midline shift and there is no extra-axial fluid collection. The ventricles and other CSF-containing spaces are moderately expanded, reflecting underlying brain volume loss. The major intracranial vascular flow voids are grossly preserved. There is no gross orbital abnormality. There is no large, destructive osseous lesion. There is scattered mucosal thickening in the paranasal sinuses.", "output": "1.The examination is limited by patient motion and by the lack of intravenous contrast given the lack of intravenous access.2.There is no acute infarct. There is no gross intracranial hemorrhage but the hemorrhage-sensitive sequences are markedly limited by motion. With there is no definite sign of cerebritis, the sensitivity of the examination for detecting leptomeningitis is significantly low given the lack of intravenous contrast.3.Left frontal white-matter lesion with associated volume loss most likely represents gliosis related to remote insult, probably ischemic.4.Mild-to-moderate frontoparietal white-matter abnormality is nonspecific but may represent chronic microvascular ischemia. There are also small chronic lacunar infarcts. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Hemorrhage? Infection? Signs and symptoms: Altered mental status. Nonenhanced head CT:Examination demonstrates a well demarcated high density lesion projecting into the left frontal horn and partial involvement of the septum pellucidum. This lesion measures 10.7 x 8.8-mm in size on axial image 12. Differentials for this lesion includes a cavernoma and less likely possibility of a colloid cyst cannot be entirely ruled out. There is no associated edema or any mass effect with this finding and no hydrocephalus is detected. Recommend unenhanced MRI examination for further evaluation.There is no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system and CSF cisterns as well as gray -- white matter differentiation all remain within normal.Calvarium, visualized paranasal sinuses, mastoid air cells, middle ear cavities and orbits are unremarkable.", "output": "1.Well demarcated high density mass measuring 10.7 x 8.8-mm in the left frontal horn with involvement of septum pellucidum as described. Recommend further follow-up with a pre-and post enhanced MRI of brain.2.The non-infused head CT is otherwise unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with ataxia and right arm weakness. Please rule out CVA. There is limited secondary to motion artifact. 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.Sella and orbits are grossly within normal limits. Mucosal thickening of the bilateral maxillary sinuses. Bone marrow signal and extracranial soft tissues are within normal limits.", "output": "No evidence of intracranial hemorrhage, mass, or acute infarct."}
{"instruction": "Generate impression based on findings.", "input": "21 years Male (DOB:8/7/1995)Reason: evaluate structural changes. Abnormalities History: medically refractory epilepsy, increase in night sweating, increase in seizure activityPROVIDER/ATTENDING NAME: PATRICIA OGDEN PATRICIA OGDEN There is interval development of right frontal temporal parietal craniotomy. In addition, there are encephalomalacia involving right frontal lobe, right temporal lobe with associated ex vacuo changes of the right lateral ventricle.There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Interval development of right frontal parietotemporal craniotomy ostomy with underlying encephalomalacia involving right frontal and temporal lobes.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "Status post T10-T11 discectomy, persistent RLE giving way. Compared to 7/30/2014, interval post surgical changes of discectomy and right-sided posterior spinal fusion at the T10-T11 is seen. Susceptibility hardware slightly limits evaluation, however, no residual spinal canal stenosis is appreciated. No epidural collections. There is subtle T2 hyperintensity in the right aspect of the thoracic cord (axial T2 series 9 image 26) which may have been present on the preoperative study but not well appreciable due to the stenosis.There is moderate left T11-T12 neural foraminal narrowing related to disc-osteophyte complex. The vertebral column alignment is anatomic. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.", "output": "1. Interval T10-T11 discectomy and right-sided posterior spinal fusion. No significant residual spinal canal stenosis is appreciated.2. Artifact somewhat limits evaluation, however, subtle T2 hyperintensity in the right aspect of the thoracic cord is suspected (axial T2 series 9 image 26) which may have also been present on the preoperative study.3. Moderate left T11-T12 neural foraminal narrowing."}
{"instruction": "Generate impression based on findings.", "input": "Male; 67 years old. Reason: 67 yo with lung ca with abnl LFT ABDOMEN:LUNG BASES: Stable appearance of the partially visualized left lung base with loculated left basilar pleural effusion with underlying nonspecific atelectasis/consolidation.LIVER, BILIARY TRACT: Mild hepatic steatosis. No focal hepatic lesions. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesions. No pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Mild hepatic steatosis. No focal hepatic lesions. No biliary ductal dilation.2.Stable appearance of the partially visualized left lung base as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "New back pain. Thoracic spine: At T7 and T8 vertebral bodies, there are changes of previous augmented vertebroplasty, where central vertebral body height loss remain not significantly changed nor the minimal T8 retropulsion. The compression fracture along the anterior inferior endplate of T6 is unchanged but there are anterior and central compression fractures at T9, T11 and T12, which are new since October 2015 though without associated marrow edema. There is unchanged focal fat in the left T5 lamina. There is mildly exaggerated kyphosis from the multilevel compression fractures. Multilevel disc desiccation is present. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The distal arch/proximal descending aorta is prominent and there is a small left pleural effusion. The paravertebral soft tissues are unremarkable.Lumbar spine: New central compression fractures involve all the lumbar vertebral bodies, which is most pronounced at L2 with up to 50% height loss in addition to fluid subjacent to the superior endplate and adjacent marrow edema, as well as linear hypointense signal in the posterior aspect of the vertebral body. Mild marrow edema is present superiorly at L1, L3 and L4. Sagittal alignment remains anatomic. There is no retropulsion or osseous expansion. Multilevel degenerative disc disease is not significantly changed and results in shallow ventral indentations of the thecal sac but no significant spinal canal stenosis. Facet arthropathy contributes to mild bilateral neural foraminal stenoses in the mid/lower lumbar spine, most pronounced on the left at L3-L4 and on the right at L4-L5 levels, where it is moderate. The conus medullaris displays normal signal and morphology with its tip lying at upper L2 level. The paraspinal muscles are atrophic. The paravertebral soft tissues are unremarkable otherwise.", "output": "1.Thoracic spine: New insufficiency compression fractures are present at T9, T11 and T12 without marrow edema, marrow replacement or retropulsion. T6-T8 compression fractures are unchanged since October 2015 except for changes of augmented vertebroplasty at T7 and T8. No thoracic spinal canal stenosis or cord abnormality. Incidental small left pleural effusion.2.Lumbar spine: New, since October 2015, insufficiency compression fractures at L1-L5, most pronounced at L2, where there is also fluid subjacent to the superior endplate, which may reflect unstable endplate fragment. There is mild marrow edema at the other levels but no retropulsion or osseous expansion. Multilevel degenerative disease has not changed, causing neural foraminal stenoses most on the left at L3-4 and on the right at L4-L5, but no significant spinal canal stenosis. Unremarkable conus medullaris."}
{"instruction": "Generate impression based on findings.", "input": " Cervical spine:Alignment is normal. The marrow signal is benign. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no significant degenerative changes and there are no stenoses.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. There is no abnormal enhancement. There are no significant degenerative changes and there are no stenoses. Incidental note is made of an anatomic variation of a right azygous vein.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. A 12 mm T2 hyperintense, T1 hypointense, nonenhancing focus within the left kidney is consistent with a simple renal cyst. Other subcentimeter foci with a similar appearance are present in bilateral kidneys, also most consistent with simple renal cysts. Otherwise the visualized intra-abdominal and paraspinal contents are unremarkable. There is no abnormal enhancement. There are no significant degenerative changes and there are no stenoses.", "output": "1.Negative contrast enhanced cervical spine.2.Negative contrast-enhanced thoracic spine.3.Bilateral simple renal cysts, otherwise negative contrast-enhanced lumbar spine."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: 24-year-old male with metastatic Ewing sarcoma, persistent headaches, evaluate for progression of Ewing's, brain abscess or other pathology. Signs and symptoms: Headaches Nonenhanced CT of brain:Examination demonstrate a large extra-axial mass of high density in the right posterior parietal region with associated lytic changes of inner table of the skull (axial images 35 through 38) the mass causes significant mass effect and buckling of the cortex. At this level there is also a large extracranial high-density mass which measures approximately 62 mm times 30 mm in size. This finding is also associated with some irregularity of the outer table of the skull. Considering the provided clinical history of Ewing sarcoma this finding is highly suspected of a metastatic lesion to the calvarium with intracranial and extracranial spread of tumor.There is evidence of associated edema of brain parenchyma adjacent to this finding (axial images 29 through 34). The extra-axial mass has higher density than brain parenchyma and on a few of the images appears like a subdural hematoma. Further evaluation with an enhanced MRI of brain is highly recommended.There is no evidence of parenchymal hemorrhage, hydrocephalus or midline shift.Visualized paranasal sinuses and mastoid air cells are unremarkable.", "output": "Lytic changes of the inner and outer cortex of right parietal bone with associated large high density mass in the extra-axial intracranial space and within the soft tissues of the scalp. Finding is highly suspected of osseous metastatic lesion with both intracranial and extracranial spread. The combination of these masses measures approximately 40 mm in thickness and 85-mm in longus cranial slice cephalad axis (coronal reformatted image 47). There is evidence of mass effect on the brain parenchyma and vasogenic edema. No midline shift or hydrocephalus.Above findings were discussed with Dr. Gornli Jerome pager number 2841 at the time of interpretation."}
{"instruction": "Generate impression based on findings.", "input": "63 year old man with coronary artery disease s/p PCI x 3 referred to evaluate for ischemia.MEDICATIONS: amlodipine, atorvastatin, ticagrelor, metoprolol First Pass PerfusionDuring hyperemia, there is a perfusion defect involving most of the inferior wall. The defect is predominantly associated with the below described myocardial infarction. The remainder of the myocardium is free of obvious ischemia.Viability/ Myocardial ScarThere is transmural myocardial infarction, involving most of the inferior wall. This territory is not viable. The remainder of the myocardium is free of myocardial infarction and is viable.Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 184 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19), the LV mass index is 54 g/m2, and the LV mass is 104 g. There is abnormal septal motion. There is no evidence of underlying myocardial fibrosis (aside from above myocardial infarction), infiltration, or inflammation.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 85 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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. There is a transmural myocardial infarction involving much of the inferior wall. Most of it is non-viable; however, there is a small amount of peri-infarct ischemia present.2. The remainder of the myocardium is viable and free of ischemia.3. Normal LV size with mildly reduced systolic function (LVEF 49%).4. Normal RV size and systolic function (RVEF 54%).When compared to the prior study, the myocardial infarction-related perfusion defect is more evident now and the LVEF is mildly reduced now."}
{"instruction": "Generate impression based on findings.", "input": "Male, 71 years old, with asymmetric left sensorineural hearing loss. The IACs are normally sized and patent. No IAC or CP angle masses are present. The vestibular and cochlear nerves are normal bilaterally. No pathologic enhancement is seen. The fluid filled structures of the inner ears show normal morphology. The brainstem shows normal signal characteristics. On limited intracranial views, there is mild patchy white matter hyperintensity, a non-specific finding. Small hippocampal sulcus remnant cysts are present bilaterally.", "output": "Unremarkable evaluation of the IACs with no specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Egan is a 55-year-old female with recent diagnosis of bilateral breast cancer status post neoadjuvant chemotherapy. She presents today for ultrasound evaluation of both breasts. A targeted right breast ultrasound was performed at the mammographic/MRI areas of concern. - In the right breast 10:00 location, approximately 6 cm from the nipple, there is re-visualization of an irregular hypoechoic mass measuring 16 x 7 x 21 mm, previously measuring previously 19 x 12 mm on ultrasound and 24 x 14 x 15 mm on MRI. A surgical clip is noted in the central aspect of this mass corresponding to the biopsy-proven malignancy at the 10:00 location. - In the right breast 2:00 location, no sonographic correlate is identified to correspond to the MRI findings, at site of biopsy-proven DCIS. No surgical clip is visualized in this region either.", "output": "Interval decrease in size of biopsy proven malignancy in the right upper outer breast. Continued follow-up with surgery is recommended. All results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Left hip pain OSSEOUS STRUCTURES: There is a focus of increased edema within the superior acetabulum best appreciated on series 9 image 5/18. There is otherwise no abnormal marrow signal within the left hip. Cystic changes are also noted in the anterior and superior acetabulum (series 9 image 5/18) which are likely degenerative in nature. Mild osteoarthritis affects the left hip.SOFT TISSUES: There is increased soft tissue edema anterior compartment of the hip, specifically involving the vastus intermedius and anterior capsule. Similar although less prominent increased signal is seen posteriorly affecting the obturator internus muscle. The muscle attachments appear intact.Following contrast administration, there is diffuse enhancement in these areas reflecting inflammation. There is no evidence of an enhancing mass or abnormal marrow enhancement.", "output": "1. Abnormal soft tissue edema and enhancement surrounding the left hip representing nonspecific inflammation which appears most conspicuous within the vastus intermedius muscle.2. Osteoarthritis of the left hip with degenerative marrow edema and cystic changes within the superior acetabulum."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Right shoulder pain, C5-C6 foraminal stenosis. Signs and symptoms: Right shoulder pain. Nonenhanced cervical MRI:Examination at the level of foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C3-C4 demonstrate degenerative disease with resultant significant right neural foraminal compromise and mild central spinal stenosis.C4 C5 demonstrate mild disc disease and extensive facet hypertrophic changes. Constellation of findings results in moderate left and mild right neural foraminal compromise and mild central spinal stenosis.C5-C6 demonstrate moderate disc disease, loss of disc height, mild to moderate bilateral facet hypertrophic changes and mild grade 1 retrolisthesis. Constellation of findings results in moderate central spinal stenosis and with significant right and moderate left neural foraminal compromise.C6-C7 demonstrate mild disc disease and hypertrophic changes of posterior elements. No central spinal stenosis however mild left neural foraminal compromise is noted.C7-T1 demonstrate mild degenerative disc disease and asymmetric extensive right facet hypertrophy. There is no central spinal stenosis however moderate right neural foraminal compromise is detected.The signal intensity and caliber of the cord remains within normal.Upper most visualized thoracic spine and thoracic cord demonstrate no signal abnormality of the cord or central spinal stenosis.", "output": "1.Degenerative changes of cervical spine results in mild central spinal stenosis at C3-C4, C4-C5 and moderate stenosis at C5-C6 levels.2.There are multilevel neural foraminal compromise (some significantly) as detailed per level above.3.There is mild retrolisthesis at C5-C6 secondary to degenerative disease.4.The signal intensity of the cord remains within normal."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 71yr old male with history of MM; pre-auto sct evaluation History: evaluate SKULL: There are a couple of small poorly defined lucencies within the calvarium, which were not clearly seen on the prior study and may reflect myelomatous deposits or venous lakes.CERVICAL SPINE: The bones appear diffusely demineralized but we see no focal myelomatous lesions. There is severe multilevel degenerative disc disease.THORACIC SPINE: The bones appear diffusely demineralized but we see no focal myelomatous lesions. The thoracic spine is kyphotic but there are no frank compression fractures. There is mild multilevel degenerative disc disease.LUMBAR SPINE: Degenerative disc disease affects the lower lumbar spine. There are no focal myelomatous lesions.RIBS: Small lucencies are noted within the left clavicle and a couple of the right ribs, which appear more prominent on the current study than on the prior study and are suspicious for myelomatous lesions.PELVIS: There is a lytic lesion of the right iliac wing, which appears similar to that seen on the prior study. Small lucency in the left pubic bone is slightly more prominent on the current study than on the prior study.UPPER EXTREMITY: There are a few small lucencies in the proximal left humeral diaphysis, which may represent small myelomatous lesions but appear similar to those seen on the prior study. Small lucency in the left proximal radial diaphysis may also represent a small myelomatous deposit but appears similar to the prior study. Mild osteoarthritis affects the right shoulder. No definite myelomatous lesions are seen in the right upper extremity.LOWER EXTREMITY: We see no discrete myelomatous lesions in the bilateral femurs although numerous lesions are seen on the recent MRI exam. Calcifications adjacent to the right greater trochanter appear similar to prior. Poorly defined lucency in the proximal right tibial metaphysis may represent a myelomatous deposit but is unchanged from the prior study.", "output": "Multiple myeloma as described above. A few small lesions appear slightly more prominent on the current study than on the prior study. While this may be simply due to differences in technique, we cannot exclude the possibility of disease progression."}
{"instruction": "Generate impression based on findings.", "input": "Patient is a 60-year-old female with recent biopsy proven left breast cancer who presents for ultrasound-guided biopsy of the additional lesion in the left breast. Upon review the mammogram from outside facility, there is a satellite lesion posterior to the index mass on the mammogram without a sonographic correlate. Repeat ultrasound of the left breast reidentified the index lesion with the clip at 12:00, 1 cm from the nipple. Subsequently, 1 cm lateral and inferomedial to the index mass, in the left breast, 1:00 location, 1 cm from the nipple, there is a 10 x 9 x 5 mm slightly hypoechoic irregular mass with increased flow, which likely corresponds to the posterior satellite lesion on the mammogram. In addition, in the left breast, 2:00 location, 1 cm from the nipple, there is a 6 mm lesion 6 mm inferior and lateral to the index mass and likely corresponding to the findings on the MRI 10/26/2015. These findings were reviewed with Dr. Jaskowiak in the reading room. The 2:00 satellite lesion would be targeted for biopsy and clip placed along the lateral/posterior aspect of the 2:00 mass, towards the 1:00 finding. PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, three 14-gauge core needle (Achieve) specimens were obtained of the lesion. Targeting was judged very good. Two specimens sank to the bottom of the prefilled container of 10% formalin. One specimen floated. The floating specimen was the initial core, towards the 1:00 lesion obtained with open trough technique. Subsequently, firing technique was needed to get through the patient's dense tissue and more accurately target the 2:00 finding. Both subsequent cores sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed near the 2:00 lesion, towards the 1:00 lesion. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Schacht. Dr. Schacht was present during the procedure at all times.", "output": "Successful ultrasound-guided core biopsy of the left breast satellite lesion and clip placement. Pathology is pending at this time.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old female with mental status changes status post fall on face. Evaluate for acute bleed. Extensive areas of low-attenuation in the deep, subcortical, and periventricular white matter consistent with small vessel ischemic disease of indeterminate age. They appear grossly stable when comparing to prior MRI of the brain. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Additionally, there is a mottled appearance to the bones of the skull base and frontal bone that is of uncertain etiology. Given patient's history of malignancy, bone metastasis is a differential consideration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. Extensive small vessel ischemic disease of indeterminate age.2. Mottled appearance of the bones of the skull base and frontal bone is of uncertain etiology. Given patient's history of malignancy, metastatic disease to bone is a differential consideration. Nuclear medicine bone scan may be helpful for further evaluation as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Status post tumor resection. Signs and symptoms: Status post craniotomy. Pre-and post-enhanced brain MRI:Examination demonstrates a large well-demarcated hemorrhagic mass and high convexity right posterior frontal lobe with large internal focus of enhancement. The combination of findings measures at 33 x 43 mm in transaxial dimensions. There is surrounding vasogenic edema and with resultant effacement of adjacent cortical sulci and trace deviation of midline to the left.Two tiny additional enhancing foci are metastatic lesion is also noted in the high convexity left posterior frontal and anterior parietal lobes with a larger lesion measuring only 4.5-mm in size. An additional small superficially located metastatic lesion approximately 4 mm is noted in the right posterior temporal -- occipital junction.Post-enhanced images also demonstrate a small developmental venous anomaly of the left frontal lobe.Calvarium demonstrate a tiny focus of enhancement in the left parietal (axial post enhanced series 1 to zero image 24 measuring approximately 4.5 mm. This finding demonstrate T2 hypointense signal pattern on axial T2 and T2 flair image 24 and could represent an additional metastatic lesion.Unremarkable images through the orbits. Mild extensive chronic sinusitis is noted. Its", "output": "1.Large hemorrhagic partially enhancing metastatic lesion in right posterior frontal measuring 43 x 33-mm in transaxial dimensions.2.Multiple additional subcentimeter metastatic lesions as detailed.3.4.5-mm focus of enhancement in the left parietal bone as detailed."}
{"instruction": "Generate impression based on findings.", "input": "Acute and chronic back pain, rule-out fracture, worsening disk protrusion, cord compression. Thoracic Spine:Vertebral body heights in the thoracic spine are normal without evidence of compression fracture. Alignment is maintained. Patient motion limits evaluation for cord signal abnormalities, however, no definite cord signal abnormality is appreciated. No abnormal enhancement. There are mild degenerative changes with small disk bulges, most prominent at the T10-T11 level, with there is a disk protrusion resulting in mild spinal canal stenosis with effacement of the left greater than right ventral thecal sac. Appearance is unchanged since 6/23/2014. Dorsal thecal sac is preserved.There is no high grade spinal canal or neural foramina stenosis at any level in the thoracic spine.Lumbar Spine:Please note for the purposes of numbering, the most inferior well-defined disk space is labeled L5-S1 consistent with prior numbering.Again seen is mild congenital narrowing of the spinal canal. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a right paracentral disk protrusion which effaces the right lateral recess and not significantly change since prior. There is mild central spinal canal stenosis on a congenital basis and related to prominence of the dorsal epidural fat. There is mild right neural foramina narrowing and minimal on the left.L3-L4: There is disk dessication and mild disk bulge with small central protrusion component versus osteophyte. There is mild spinal canal stenosis, which is predominantly on a congenital basis. There is a small right dorsal annular fissure. There is mild to moderate spinal canal stenosis on the right and mild on the left. Mild facet arthropathy.L4-L5: There is disk dessication and bulge with small left dorsal annular fissure. There is mild right and moderate to severe left neural foraminal stenosis. There is mild facet arthropathy. There is mild central canal stenosis predominantly on a congenital basis.L5-S1: There is transitional anatomy. There is disc dessication and mild disk bulge. There is mild left neural foramina stenosis. No significant right neural foramina narrowing. No spinal canal stenosis.There is edema involving the paraspinous musculature with bilateral superficial fluid collections right larger than left extending along the muscle fascial planes from T12 to L3. There is peripheral enhancement. Collection on the right measures up to 15 mm in thickness and 36 mm in the AP dimension. Smaller fluid collections on the left measure approximately 6 mm in thickness.", "output": "1. Mild degenerative changes in the thoracic spine without significant spinal canal or neural foramina stenosis. There is a small disk protrusion at the left T10-T11 level with mild spinal canal stenosis and not significantly changed since prior. No compression fractures in the thoracic or lumbar spine. 2. Degenerative changes in the lumbar spine not significantly changed since prior. There is mild spinal canal stenosis, which is mostly on a congenital basis. No high-grade spinal canal stenosis is appreciated at any level. There is effacement of the right lateral recess at the L2-L3 level and multilevel neural foramina narrowing, relatively worse at the L4-L5 level where there is moderate to severe left foraminal stenosis.3. Multiple small fluid collections involving the bilateral paraspinous musculature from T12 to L3 levels. There is mild peripheral enhancement. Fluid may be related to inflammatory process with muscle injury/myositis/myonecrosis or perhaps prolonged supine position; however given multiple loculations of fluid and mild peripheral enhancement, abscesses are not excluded. Consider ultrasound-guided aspiration. No evidence of epidural abscess or discitis-osteomyelitis. Dr. Ali discussed findings with Dr. Sheth at 1538 hrs on 3/12/2015."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Memory deterioration; evaluate for CNS disease. Signs and symptoms: As above. Pre-and post enhanced brain MRI:No acute intracranial process and in particular no evidence of acute ischemic stroke.Examination demonstrates prominence of cerebral cortical sulci which are more prominent in bilateral parietal lobes. There is no associated signal abnormality.There are small patchy foci of flair hyperintensity only in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in the right thalamus and bilateral basal ganglia. Findings considering patient's stated age of 88 are highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild degree.There is normal appearing ventricular system and with maintained midline.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits. Minimal patchy opacification of bilateral mastoid air cells and unremarkable paranasal sinuses with the exception of mild left maxillary and coastal thickening.Post enhanced images are unremarkable and demonstrate no detectable abnormal enhancement the brain parenchyma, leptomeninges, calvarium or retro-orbital spaces.", "output": "1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.3.Slight prominence of cortical sulci primarily in the bilateral parietal lobes which likely still within normal range for patient stated age of 88.4.No detectable abnormal enhancement the brain parenchyma, leptomeninges or the calvarium."}
{"instruction": "Generate impression based on findings.", "input": "Female, 12 months old, with new onset generalized tonic-clonic seizures. No evidence of parenchymal edema or mass effect is seen. No structural abnormalities are detected. Mild ill-defined T2 hyperintensity is seen in the periatrial white matter, left side more so than right.The pituitary region is unremarkable. The corpus callosum is fully formed and intact. The brainstem, cerebellar vermis and cerebellar hemispheres are within normal limits. The pattern of white matter myelination is appropriate for age.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. The ventricular system is normal in size and morphology. The medial temporal lobe structures are symmetric and free of pathologic signal abnormality.", "output": "1.Mild periatrial white matter T2 hyperintensity is seen, left side more so than right. This is favored to represent the normal terminal zones of myelination.2.No definite focal parenchymal lesion, structural abnormality or other specific finding to account for the patient's seizures."}
{"instruction": "Generate impression based on findings.", "input": "86 year old male with posttransplant lymphoproliferative disease involving the CNS. History of renal transplant in 2005 presented with PTLD involving the CNS and 2013. There are no diffusion weighted abnormalities. Redemonstrated are stable foci of FLAIR hyperintensity primarily within the periventricular white matter, most prominent involving the left frontal centrum semiovale and left cingulate gyrus with out evidence of mass effect. As before, there is a small focus of susceptibility near the vertex of the left-sided process. Mild ex vacuo dilatation of bilateral frontal horns of lateral ventricles (left slightly greater than right) is stable with maintained midline anatomy. Prominence of cortical sulci likely within normal range for patient's stated age and stable since prior exams. There are no detectable new foci of parenchymal signal abnormality. The signal voids of major intracranial arterial branches are identified.. The visualized paranasal sinuses and the mastoid air cells are clear", "output": "1.No evidence of acute or new findings since prior exams.2.Stable focus of hemorrhagic encephalomalacia in the left frontal centrum semiovale and left cingulate gyrus.3.Stable periventricular chronic small vessel ischemic disease.4.Stable mild ex vacuo dilatation of the lateral ventricles and prominence of cortical sulci"}
{"instruction": "Generate impression based on findings.", "input": "Rule-out AVN versus fracture in the lunate. Prior traumaIMAGE ACQUISITIONS: Ultrahigh routine CT of the right wrist was performed with 0.3-mm reconstruction. No enhancement The osseous structures remain in proper alignment with particular attention placed on the lunate relative to the radius, triquetrum and scaphoid. The shape of the lunate is normal without abnormality. Specifically no evidence of fracture or dislocation. No additional CT findings to suggest AVN, however please note MRI would be more sensitive in this early stage.A small benign-appearing cyst noted in the proximal pole of the scaphoid. Small bone island seen in the distal radius. The remainder of the wrist is otherwise unremarkable. Soft tissues normal.", "output": "No additional abnormality, specifically no CT findings to suggest AVN or fracture."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate stenosis. Signs and symptoms: Worsening left arm pain. Unenhanced cervical MRI:There is generalized small caliber cervical spinal canal which is believed to be a congenital anatomical variation.Foramen magnum is unremarkable.C2 -- C3 demonstrate minimal left neural foraminal compromise and unremarkable otherwise.C3 -- C4 demonstrate mild degenerative disk disease and loss of disk height and no significant hypertrophy changes of posterior elements. Mild degenerative changes at this level in combination with congenitally small canal results in mild central spinal stenosis. There is moderate (R>L) neuroforaminal compromise and without appreciable change since prior exam.C4 -- C5 demonstrate mild degenerative disk disease and minimal bilateral facet degenerative changes. There is mild bilateral neural foraminal and central spinal stenosis without significant change since prior exam. C5 -- C6 demonstrate mild this disease with mild loss of disk height, mild bulging disk and asymmetric (L > R ) uncovertebral hypertrophic changes. New since prior exam is a right paramedian disk protrusion with resulting subtle flattening deformity of the right ventral aspect of the cord. Constellation of changes and including congenitally small canal results in moderate central spinal stenosis, significant left and moderate right neural foraminal compromise. There is no detectable signal abnormality of the cord.C6 -- C7 demonstrate mild disk disease and loss of disk height, shallow broad-based bulging disk, hypertrophic changes of posterior longitudinal ligament along the dorsal aspect of C6 vertebrae, asymmetric left uncovertebral hypertrophic changes. Constellation of changes results in mild central spinal stenosis, moderate left neural foraminal compromise and mild on the right.C7 -- T1 is unremarkable.Uppermost visualized thoracic spine the thoracic cord to T3 level is unremarkable", "output": "1.There is uniform generalized a smaller caliber of the spinal canal believed to present a congenital anatomical variation. This finding in combination with mild degenerative changes resulting in multilevel mild central spinal stenosis. 2.At C5 -- C6 there is a new right paramedian small disk protrusion with resultant flattening deformity of the right ventral cord, moderate central spinal stenosis and neural foraminal compromise. No detectable cord signal abnormality.3.Mild degenerative changes at other levels without significant change since prior exam as detailed per level."}
{"instruction": "Generate impression based on findings.", "input": "Left eye flashes, workup for TIA. No restricted diffusion to suggest acute infarct. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are patchy confluent areas and scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease. Punctate foci of susceptibility consistent with chronic microhemorrhage are noted involving the right frontal lobe and left occipital lobe. There is global parenchymal volume loss which is commensurate with age. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Minimal mucosal thickening is seen in the frontal and maxillary sinuses; paranasal sinuses are otherwise clear. Minimal left mastoid air cell fluid. Bone marrow signal and extracranial soft tissues are within normal limits.", "output": "1. No evidence of acute infarct. No intracranial mass or mass effect.2. Foci of T2/FLAIR hyperintensities in periventricular and subcortical white matter are nonspecific but compatible with mild chronic small vessel ischemic disease.3. Two punctate foci of chronic microhemorrhage are nonspecific but given the peripheral lobar distribution, favor amyloid angiopathy."}
{"instruction": "Generate impression based on findings.", "input": "58 years, Male, Reason: 58 yo M with SB-IPMN please r/o growth or tumor History: 58 yo M with SB-IPMN please r/o growth or tumor. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild loss of signal on phase images suggest steatosis. Common bile duct appears normal. No gallstones. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is prominent. Normal response to secretin administration. Mild atrophy of the pancreatic tail. There are 4 punctate cysts within the tail which do not definitively communicate with the main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter nonenhancing 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.Punctate cystic lesions in the tail of the pancreas are nonspecific and with no definitive communication with the main pancreatic duct. 2.Main pancreatic duct is mildly prominent with mild atrophy of the tail. No suspicious pancreatic lesions.3.Hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are essentially within normal limits. There is trace anterior wedging involving the L1 and L2 vertebral bodies which may be physiologic. Alignment is within normal limits. Bone marrow signal is benign with a focus of T1 hyperintensity at L1 compatible with a small hemangioma.. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disk desiccation with left dorsal annular fissure and small protrusion. Minimal effacement of the left lateral recess. No significant spinal canal or neural foramina stenosis seen. L3-L4: Minimal disk bulge, ligamentum flavum thickening, and facet arthropathy. No significant spinal canal or neural foraminal stenosis is seen. L4-L5: Minimal disk bulge eccentric to the left with mild left neural foraminal narrowing. No significant spinal canal or right neural foraminal narrowing.L5-S1: Disk desiccation with small dorsal annular fissure, and tiny protrusion. No significant spinal canal or right neural foramina stenosis is seen. Minimal left neural foraminal narrowing. There is mild to moderate bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.", "output": "1. Mild degenerative changes in the lumbar spine as detailed above with small multilevel disk bulges and protrusions. No significant spinal canal or neural foramina stenosis at any level.2. Facet arthropathy in the lower lumbar spine which may be contributing to patient's low back pain. 3. Trace anterior wedging at L1 and L2 vertebral bodies which may be physiologic. No edema to suggest recent compression fracture."}
{"instruction": "Generate impression based on findings.", "input": "42 year old female. Status post vaginal hysterectomy. Now has bandemia and abdominal pain. Right CVA TTP, fever and rigors. DM. Evaluate for perinephric abscess. ABDOMEN:LUNG BASES: Mild bibasilar dependent atelectasis. LIVER, BILIARY TRACT: Hepatomegaly. The liver measures 22 cm overall. Periportal edema seen previously has resolved. There are hepatic hypodensities which are subcentimeter in size and unchanged since prior examination, probably benign. SPLEEN: No significant abnormality noted. Splenules at the hilum and lower pole. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The previous examination found left hydronephrosis and hydroureter which has resolved. No specific renal abnormality was identified.RETROPERITONEUM, LYMPH NODES: Multiple borderline enlarged pericaval and paraaortic lymph nodes inferior to the kidneys. BOWEL, MESENTERY: No significant abnormality noted. Normal appendix in the right lower quadrant. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No abscess or ascites. The celiac and superior mesenteric arteries share a common origin, a normal anatomic variant. This is seen best on midline sagittal view.Umbilical Richter's hernia contains nonobstructed bowel.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Large central pelvic multiloculated cystic mass with wall enhancement was seen on the prior exam and is much smaller. The mass measures 8.7 x 12 cm. No gas bubbles. May be further evaluated with transvaginal ultrasound and/or MRI, if indicated. BLADDER: No significant abnormality notedLYMPH NODES: Mildly enlarged left iliac lymph nodes.BOWEL, MESENTERY: No significant abnormality notedqBONES, SOFT TISSUES: Intramuscular cystic lesion at right rectus femoris muscle image 101 of series 3) is stable since the prior exam and does not have characteristics of an abscess. OTHER: No significant abnormality noted", "output": "The multiloculated central pelvic mass seen on the prior exam of 2/21/2010 is much smaller. Interval resolution of left hydroureter and hydronephrosis. Pelvic ultrasound exam may be helpful for further evaluation.  "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Preop stealth brain MRI. Signs and symptoms: Preop MRI. Pre- and post enhanced Stealth brain MRI:Examination demonstrates a right posterior parietal dural based paramedian well-demarcated and intensely enhancing mass consistent with meningioma. It measures 16 x 15 mm in transaxial dimensions which is slightly larger than prior exam from April 2015.Additionally there is a more laterally located right posterior parietal dural based enhancing tumor likely representing an additional focus of meningioma measuring at 12 x 9 mm in transaxial dimensions and without convincing evidence of significant change.Diffuse FLAIR hyperintensity in bilateral posterior parietal without associated mass effect and likely representing gliosis/encephalomalacia.", "output": "1.Dural base right posterior parietal paramedian meningioma measuring 16 x 15 in transaxial dimensions with subtle interval increased size.2.A more laterally located dural base right posterior parietal enhancing meningioma measures at 12 x 9 mm and without convincing change since prior exam.3.Extensive bilateral posterior parietal FLAIR hyperintensity without mass effect and suggestive of post treatment"}
{"instruction": "Generate impression based on findings.", "input": "Cavernous malformation surveillance. There is an unchanged lesion centered in the right cerebral peduncle that measures up to approximately 15 mm. There is circumferential susceptibility effect and central loculated area of intrinsic T1 hyperintensity, as well as patchy enhancement in the lesion. There also appears to be at least one developmental venous anomaly associated with the lesion, but there is no surrounding vasogenic edema. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "A lesion centered in the right cerebral peduncle is unchanged and likely represents a cavernous malformation associated with at least one developmental venous anomaly."}
{"instruction": "Generate impression based on findings.", "input": "Right shoulder pain. ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon at its attachment on the greater tuberosity that measures approximately 1.5 to 2 cm in the AP dimension, with mild (under 1 cm) retraction. There is thickening of the remainder of the supraspinatus tendon indicating tendinosis. There is mild tendinosis of the infraspinatus tendon, but we see no tear. The supraspinatus and infraspinatus muscles appear intact. There is mild edema type signal and cyst formation within the humeral head, posteriorly, perhaps reflecting an overlying tendinosis. There are also cysts more anteriorly within the greater tuberosity. There is minimal tendinosis of the subscapularis tendon distally, otherwise the subscapularis tendon appears normal. The subscapularis muscle appears intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is linear signal intensity traversing the superior labrum posteriorly which may represent a tear, but the clinical significance of this finding is uncertain. The remainder of the labrum appears normal given the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL", "output": "Full-thickness insertional tear of the supraspinatus with minimal retraction and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with progressive knee pain and known Baker's cyst. Evaluate for meniscus tear or ligament tears and degree of degenerative changes. MENISCI: There is linear increased signal abnormality within the anterior horn of the lateral meniscus which extends to the femoral articular surface consistent with a horizontal tear. There is globular increased signal abnormality within the posterior horn of the meniscus consistent with intrasubstance degeneration. Some of the signal extends to the tibial articular surface consistent with undersurface tearing/fraying.There is globular increased signal abnormality within the body of the medial meniscus consistent with intrasubstance degeneration. Some of this signal abnormality extends to the tibial articular surface consistent with undersurface tearing/fraying. The medial meniscus otherwise appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the posterior aspect of the lateral femoral condyle as well as along the weightbearing portion of the lateral femoral condyle above the posterior horn of the meniscus. There is also full-thickness articular cartilage degeneration along the lateral aspect of the lateral tibial plateau, beneath the posterior horn of the meniscus.There is full-thickness articular cartilage degeneration affecting the patellofemoral articulation with portions of the medial and lateral facet of the patella completely devoid of cartilage. There is underlying degenerative subchondral signal abnormality. There is near full-thickness to full-thickness articular cartilage degeneration along the lateral facet of the femoral trochlea with underlying degenerative subchondral signal abnormality. There is tricompartmental osteophyte formation.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Tear of the lateral meniscus as described above.2. Undersurface tearing/fraying of the medial meniscus.3. Small-to-moderate sized joint effusion and Baker's cyst.4. Osteoarthritic changes including full-thickness articular cartilage degeneration and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": " There is new mild increased T2 signal within the paravertebral soft tissues posteriorly from the C4/5 through C 6/7 levels associated with slight increased signal in the interspinous ligament at C6/7 (best seen sagittal STIR technique).Previously identified Modic type I discogenic reactive endplate changes at C6-C7 and to a lesser extent C5-C6 now appear as Modic type II. As before, there is multilevel disk desiccation and loss of disk height. Minimal grade 1 retrolisthesis of C5 on C6 is unchanged. There are no acute fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. Right mastoid fluid is unchanged.C1/2: No significant central canal stenosis or neuroforaminal narrowing, unchanged.C2/3: No significant central canal stenosis or neuroforaminal narrowing, unchanged.C3/4: Posterior disk osteophyte complex eccentric to the right has progressed resulting in increased right anterior hemicord flattening, yet still without intrinsic T2 cord signal abnormality. As before, there is bilateral uncovertebral hypertrophy and mild facet hypertrophy resulting in mild to moderate left neural foraminal and moderate to severe right neural foraminal stenosis, unchanged. There is no significant central canal stenosis.C4/5: Posterior disk osteophyte complex, left facet hypertrophy, and posterior ligamentous hypertrophy resulting in bilateral neuroforamina narrowing, mild to moderate on the right and moderate to severe on the left, unchanged. No significant central canal stenosis.C5/6: Posterior disk osteophyte complex, facet hypertrophy, posterior ligamentous hypertrophy resulting in severe right and moderate left neuroforaminal narrowing, unchanged. There is effacement of the CSF space resulting in mild central canal stenosis, unchanged.C6/7: Posterior disk osteophyte complex, facet hypertrophy, uncovertebral hypertrophy, and posterior ligamentous hypertrophy resulting in mild central canal stenosis and mild to moderate bilateral neuroforaminal narrowing, left greater than right, unchanged.C7/T1: Facet hypertrophy results in mild left neuroforaminal narrowing, unchanged. No significant central canal stenosis.", "output": "1.There is new mild increased T2 signal within the paravertebral soft tissues posteriorly from the C4/5 through C 6/7 levels associated with slight increased signal in the interspinous ligament at C6/7. The differential diagnosis for this would include injury if there is been a recent history of trauma or in absence of this history an inflammatory process of uncertain etiology or significance.2.C3/4: Posterior disk osteophyte complex eccentric to the right has progressed resulting in increased right anterior hemicord flattening, yet still without intrinsic T2 cord signal abnormality. Mild to moderate left neural foraminal and moderate to severe right neural foraminal stenosis is unchanged. 3.C4/5: Bilateral neuroforamina narrowing, mild to moderate on the right and moderate to severe on the left, unchanged.4.C5/6: Severe right and moderate left neuroforaminal narrowing, unchanged. Mild central canal stenosis is unchanged.5.C6/7: Mild central canal stenosis and mild to moderate bilateral neuroforaminal narrowing, left greater than right, unchanged.6.C7/T1: Mild left neuroforaminal narrowing, unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Acute myeloblastic leukemia, not having achieved remission. Altered mental status, unspecifiedClinical question: assess for white matter changes, lesionsSigns and Symptoms: altered mental status The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact. There are falcine calcifications present.", "output": "There is no evidence for acute cerebral infarction, leptomeningeal disease or intracranial mass. Given the patient's age MRI imaging of the brain is within normal limits."}
{"instruction": "Generate impression based on findings.", "input": "History of metabolic myopathy. Bone lesion seen on MRI. Patient with complaint of the thigh muscle cramping/soreness. Evaluate for left femur lesion/calcifications. 2 views of the left femur show a lucent lesion in the mid femoral diaphysis with endosteal scalloping corresponding to the abnormality seen on recent MRI. There may be faint calcifications within the lesion but this is equivocal. We see no frank cortical penetration. The remainder of the femur is unremarkable.", "output": "Lucent lesion in the mid femoral diaphysis as described above. Its appearance on MRI is suggestive of an enchondroma although we cannot confidently see calcification within the lesion on these radiographs. CT may be considered as a more sensitive modality for detecting calcification."}
{"instruction": "Generate impression based on findings.", "input": "66 years Male (DOB:9/1/1949)Reason: Eval for ischemia, bleed History: falls, c/f left sided weakness, subacute change in mental statusPROVIDER/ATTENDING NAME: SHANNON K MARTIN SHANNON K MARTIN The CSF spaces are appropriate for the patient's stated age with no midline shift. The exam is somewhat degraded due to patient motion artifact. Susceptibility weighted imaging is degraded significantly patient motion artifact.There is a cystic focus present medial to the left cerebellar hemisphere measuring 20 x 20 mm axial dimensions which follows spinal fluid on all pulse sequences and most likely represents a small arachnoid cyst.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery appears very small relative to the right vertebral artery.The visualized portions of the paranasal sinuses demonstrate scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Exam is mildly degraded due to patient motion which may obscure more subtle abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female with psoriasis and pain. Evaluate for sacroiliitis. BONE MARROW: No bone marrow signal abnormality is identified. The sacroiliac joints are normal in appearance without findings to suggest sacroiliitis, as clinically questioned.SOFT TISSUES: The imaged musculature is normal in appearance. JOINTS: The sacroiliac joints are normal in appearance without findings to suggest sacroiliitis, as clinically questioned.ADDITIONAL", "output": "1. No evidence of sacroiliitis.2. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Female; 49 years old. Reason: uterine anomaly seen on ultrasound. Need MRI to determine exact anatomy and if also has renal anomaly. 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.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: Ventral abdominal wall hernia containing mesenteric fat. Pelvis:UTERUS, ADNEXA: The uterus demonstrates two horns; morphology is borderline between septate and bicornuate uterus but favor bicornuate uterus. No suspicious adnexal lesions. Numerous subcentimeter T2 hyperintense lesions throughout the uterine wall likely represent adenomyosis. Heterogeneous lesion adjacent to the right uterine wall with larger T2 hyperintense cystic areas is suggestive of a focal adenomyoma, but could also represent a degenerated fibroid (series 19, image 11). There is a mildly T2 hyperintense mass located within the endometrial cavity and right uterine horn that demonstrates gray signal on T1 weighted sequences and measures 3.8 x 2.7 cm, best seen on series 19, image 12. This lesion extends to the level of the lower uterine segment and may also extend into the left uterine horn, but does not transgress the myometrium to the serosal surface. BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.BIcornuate uterus containing soft tissue mass of intermediate signal intensity as described above, which does not appear to extend into the myometrium. Findings are suspicious for endometrial carcinoma.2.Uterine adenomyosis with focal adenomyoma vs degenerated fibroid. 3.No structural renal anomalies identified as clinically questioned. "}
{"instruction": "Generate impression based on findings.", "input": "Other headache syndrome [G44.89], Reason for Study: ^Reason: h/o migraine HA with pulsatile tinnitus and facial numbness, eval for vascular anomaly History: h/o migraine HA with pulsatile tinnitus and facial numbness, eval for vascular anomaly Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is about 16.1 mm tonsilar ectopia through the foramen magnum level indicating Chiari 1 malformation. Ventricle size remains within normal limits.Prominent suprasellar cistern is also shown.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Bilateral Pcom arteries and Acom artery are patent.There is no intracranial arterial aneurysm. No significant arterial luminal stenosis.", "output": "1. Chiari 1 malformation as described above.2. No evidence of acute ischemic or hemorrhagic lesion.3. Normal brain MRA. "}
{"instruction": "Generate impression based on findings.", "input": "Left cranial nerve VI and VII pulse, known multiple sclerosis patient. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal scattered variable sized high signal intensities on FLAIR imaging are identified including left temporal lobe anterior aspect bilateral trigone areas, periventricular white matter, left precentral gyrus, right midbrain posterior aspect, bilateral middle cerebellar peduncles, and left mid to lower pons. These high signal intensity lesions are compatible with multiple sclerosis plaque.Especially the left mid to lower pons and left side middle cerebellar peduncle and left anterior temporal lobe lesions demonstrate periportal irregularity shaped contrast enhancement indicating minimal effective multiple sclerosis plaque. The differential diagnosis of these lesions include high-grade glioma or metastasis but those possibility would be lower.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRI:Multifocal patch high signal intensities on T2 and STIR images were seen on craniocervical junction to the cervical spine. On axial scan, abnormal high signal intensity lesions involve bilateral posterolateral aspect of spinal cord at the level of C1, the lesion involves the central portion of the spinal cord as well. Again, the location and characteristics of this high signal intensity lesions are consistent with multiple sclerosis involvement of the cervical spine.There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement.Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: Disc desiccation no spinal stenosis. Minimal left neural foraminal narrowing. C4-C5: no neuroforaminal narrowing or spinal stenosis. C5-C6: Minimal thickening of the ligamentum flavum, otherwise no neuroforaminal narrowing or spinal stenosis. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.", "output": "1. Multifocal patch high signal intensities on FLAIR imaging as described above, consistent with multiple sclerosis plaque.2. Irregular walled enhancing lesions especially on the left temporal lobe anterior aspect as well as left-sided mid to lower pons and the left middle cerebellar peduncle suggestive possibility of tumefactive multiple sclerosis lesions. Differential diagnosis includes high-grade glioma in metastatic lesions, but the possibility is low.3. Multifocal patch high signal intensity lesions on T2 and STIR images on all cervical spine consistent with multiple sclerosis involvement of C-spine."}
{"instruction": "Generate impression based on findings.", "input": "Seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no evidence of heterotopia or hippocampal sclerosis. There is mild asymmetry of the lateral ventricle, left smaller than right, which can be a developmental variant. 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 potential seizure foci are identified."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with pT2(m)N1a IDC of the R breast s/p mastectomy and axillary lymph node dissection (3/17 total + LNs), ER/PR+, Her-2- in 7/2013. S/p Chemo and XRT. She was on Tam but stopped after one month due intolerable hot flashes. Discussed AI/ovarain suppressio History: with pT2(m)N1a IDC of the R breast s/p mastectomy and axillary lymph node dissection (3/17 total + LNs), ER/PR+, Her-2- in 7/201 RIGHT BREAST:Again seen are postsurgical changes in the right breast which are unchanged. The retropectoral saline implant appears intact. No abnormal sized axillary lymph nodes are identified in the right axillary region.LEFT BREAST:There is unchanged heterogeneity of fibroglandular tissue in the left breast with minimal parenchymal enhancement noted. The retropectoral saline implant appears intact. The previously described enhancing focus in the 5 o'clock position near the implant is is no longer seen. However a more benign round 5 x 4 x 4 mm enhancing focus is identified in the anterior depth of the left breast in the 5:00 position adjacent to the implant which could represent fat necrosis. However this area should be followed in subsequent exams to ensure stability. There are stable prominent left-sided axillary lymph nodes.", "output": "1.The previously described enhancing focus in the 5 o'clock position near the implant is is no longer seen. However a more benign appearing round 5 x 4 x 4 mm enhancing focus is identified in the anterior depth of the left breast in the 5:00 position adjacent to the implant which could represent fat necrosis. However this area should be followed in subsequent exams to ensure stability.2.Stable post-surgical changes in the reconstructed right breast without evidence of malignancy.3.Stable slightly prominent left-sided axillary lymph nodes.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Spastic quadriplegic with history of cerebral palsy and TORCH infection. Evaluate for seizure focus or cerebellar lesion: horizontal nystagmus. There are extensive areas of cystic encephalomalacia within the bilateral parietal and posterior frontal lobes, with associated scattered areas of susceptibility effect, marked thinning and bulging of the body of the corpus callosum, and ex-vacuo dilatation of the lateral ventricles. There are also smaller areas of encephalomalacia and susceptibility effect in the bilateral basal ganglia. There are multiple additional scattered small foci of abnormal susceptibility throughout cerebral hemispheres bilaterally. There is diffuse prominence of the cerebellar sulci, left more than right. There is also patchy T2 hyperintensity in the left cerebellar hemisphere white matter. There is no evidence of acute infarction. There is no intracranial mass lesion or midline shift. The cranium has a microcephalic appearance and there appears to be hypertelorism. There is mild scattered paranasal sinus mucosal thickening.", "output": "1. Areas of chronic hemorrhagic infarction in the bilateral cerebral hemispheres, particularly the frontal and parietal lobes and basal ganglia, as well as multiple scattered cerebral calcifications are compatible with the history of cerebral palsy and of TORCH infection.2. Diffuse left greater than right cerebellar volume loss and patchy signal abnormality in the left cerebellar hemisphere white matter may be related to the supratentorial infarcts with superimposed crossed cerebellar diaschises.  I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Right sided hand and arm weakness, intermittent; h/o fungal sinusitis. There are postoperative findings related to osteoplastic flap reconstruction of the frontal sinuses and endoscopic sinus surgery with resection of the uncinate processes and middle turbinates. There is predominantly low T1 and high T2 signal material within the bilateral frontal sinuses. There is also mild mucosal thickening within the anterior right ethmoid sinuses and subcentimeter retention cysts in the right maxillary sinus and right sphenoethmoid recess. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.", "output": "1. Postoperative findings related to osteoplastic flap reconstruction of the frontal sinuses with what appear to be persistent obstructed secretions in the bilateral frontal sinuses, but no intracranial extension.2. No evidence of acute infarct or intracranial mass."}
{"instruction": "Generate impression based on findings.", "input": "Female, 3 years old, history of bilateral sensorineural hearing loss. Pre-cochlear implantation evaluation. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.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. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.No masslike lesions are seen in the IACs. The vestibules and semicircular canals demonstrate a normal MRI morphology. Cochlear morphology, however, was better assessed on temporal bone CT. Cochlear nerves are evident bilaterally entering the cochlear apertures.", "output": "1.No specific findings are seen to account for the patient's hearing loss. Please note that cochlear morphology was better assessed on dedicated temporal bone CT imaging.2.Cochlear nerves are present bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "Unknown congenital spinal cord tumor, presenting with severe lumbosacral pain, radiculopathy, inability to ambulate. There is clumping, irregularity and predominantly posterior displacement of the cauda equina nerve roots at the L5-S1 level, along with what appear to be linear low attenuation bands around the nerve roots. There is a perineural cyst at the S3 level that measures up to approximately 45 mm in width associated with remodeling of the surrounding bone. There are also subcentimeter perineural cysts in the spinal canal at the S2 level. There is mild degenerative spondylosis, including disc bulges and facet hypertrophic changes with trace effusions, in the lower lumbar spine, which result in up to mild bilateral neural foraminal stenosis at L4-5. Otherwise, there is no significant spinal canal stenosis. There are Schmorl nodes at T11-12 level. Otherwise the vertebral body heights and alignment are intact. There are renal cysts bilaterally. There is a partially-imaged infrarenal aortic aneurysm.", "output": "1. Findings suggestive of arachnoiditis and/or arachnoid cyst and adhesion formation versus inclusion cyst at the L5-S1 level, which may be iatrogenic in nature. Otherwise, evaluation for tumor is limited without contrast.2. Sacral perineural cysts, the largest of which measures 45 mm in width at the S3 level.3. No significant lumbar spinal canal stenosis.4. Partially-imaged infrarenal aortic aneurysm. Dedicated vascular imaging may be useful for further characterization."}
{"instruction": "Generate impression based on findings.", "input": "Lymphoma, follow-up evaluation. Compared to most recent study, there is no significant change in mild enlargement and diffuse enhancement of the bilateral trigeminal nerves particularly in its cisternal segment and right foramen ovale. There is no new parenchymal or meningeal enhancement to suggest progression of disease. There is a stable right frontal approach Ommaya catheter. The ventricles and sulci are stable. There remains a similar extent of confluent T2/FLAIR hyperintensity within the bilateral cerebral white matter. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is an unchanged small left maxillary sinus mucosal retention cyst.CERVICAL SPINE", "output": "1. No evidence of progression of lymphoma in the brain or cervical spine. Cranial nerve enhancement as well as cervical nerve root enhancement is not appreciably changed since 8/4/2016.2. Stable extent of confluent areas of bilateral cerebral white matter signal abnormality, likely posttreatment changes."}
{"instruction": "Generate impression based on findings.", "input": "Acute onset of dizziness, unsteadiness and difficulty with word finding. Images through posterior fossa are unremarkable.Images through supratentorial space demonstrate findings consistent with small vessel disease of indeterminate age. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. Considering provided clinical data an MRI examination is recommended.", "output": "Small vessel disease of indeterminate age."}
{"instruction": "Generate impression based on findings.", "input": "4-year-old female is status post peak versus auto . Nonenhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and gray -- white matter differentiation is unremarkable. There is mild crowding of cerebellar tonsils into the foramina magnum. This finding is best appreciated on sagittal reformatted images. Please correlate with clinical history and follow-up with an MRI may be necessary.Calvarium is intact. No definitive abnormality of soft tissues of the scalp.Limited view of the orbits, mastoid air cells, middle ear cavities and paranasal sinuses are unremarkable.", "output": "1.No evidence of acute posttraumatic findings.2.With the exception of mildly ectopic cerebellar tonsils this non-infused CT examination of brain is unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "Male 30 years old with left knee pain. Evaluate for meniscus tear. MENISCI: The anterior meniscus is slightly diminutive in size but we see no meniscal tear.ARTICULAR CARTILAGE AND BONE: There is a small focus of degeneration involving the cartilage of the femoral trochlea centrally. Mild heterogeneous signal in the cartilage of the patella likely also represents degeneration. There are small cysts within the tibial plateau beneath the root of the posterior horn of the medial meniscus but we see no meniscal tear. There is mild edema in the anterior tibial tuberosity.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is a longitudinal tear of the distal patellar tendon centrally at its insertion on the anterior tibial tuberosity. The tear involves the majority of the thickness of the tendon disrupting the undersurface fibers but sparing the superficial fibers. The tear is approximately 3 cm in longitudinal dimension and 1 cm in width. The remainder of the tendon appears thickened indicating tendinosis. The distal quadriceps tendon appears normal. Fluid in the deep infrapatellar bursa indicates bursitis. There is mild adjacent soft tissue edema.ADDITIONAL", "output": "1.Partial-thickness tear of the distal patellar tendon at its insertion as described above.2.No meniscal tear.3.Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female. Status post cholecystectomy complaining of abdominal pain. Per OSH MRCP patient has cholelithiasis. Please evaluate and confirm diagnosis. Examination is limited due to significant motion artifact and lack of pre-contrast T1 sequences.ABDOMEN:LIVER, BILIARY TRACT: Post-surgical findings of cholecystectomy. Central moderate intrahepatic and marked extrahepatic biliary ductal dilatation with transition point at a 7 mm distal CBD stone near the ampulla (series 11, image 13).Hepatomegaly measuring 19 mm in length.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered small T2 hyperintense foci in the kidneys, incompletely characterized without intravenous contrast, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Postsurgical changes in the small bowel.BONES, SOFT TISSUES: Small ventral hernia containing unobstructed loop of bowel.OTHER: No significant abnormality noted.", "output": "Diffuse biliary ductal dilatation with transition point at an obstructing 7 mm distal CBD stone near the ampulla."}
{"instruction": "Generate impression based on findings.", "input": "15 years Male (DOB:8/3/2000)Reason: Recurrent JPA History: post opPROVIDER/ATTENDING NAME: ELIZABETH M DRUMM ELIZABETH M DRUMM Since the prior exam and heterogeneously enhancing mass located at the right pontomedullary junction associated with a septated multicystic component has remained in general stable. The enhancing component currently measures 46 x 26 mm axial dimensions and on 12/22/2015 measured the same. Please note that the postcontrast study from 12/23/2015 had minimal contrast enhancement likely due to injection. The appearance of the mass is similar to the 12/17/2015 exam where it is multiseptated and heterogeneous on T2 and FLAIR pulse sequences and enhances heterogeneously. The overall dimensions of the lesion also appear stable compared to that exam. There is associated distortion of the adjacent brainstem. The mass effects the right internal auditory canal and hypoglossal canal structures and abuts the right trigeminal nerve. The mass displaces the right trigeminal nerve.There is redemonstration of ventriculomegaly with enlargement of the temporal horns of the lateral ventricles. Biventricular diameter on coronal imaging at the level of foramen of Monro is currently approximately 66 mm and previously was approximately 67 mm. Third ventricular diameter remains at 17 mm.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Since prior exam of 12/17/2015, a posterior fossa neoplasm which is consistent with the patient's diagnosis of pilocytic astrocytoma and is centered at the right half of the pontomedullary junction has not changed substantially in size.2.Since the prior exam ventriculomegaly has remained stable."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male with mental status. Evaluation for cerebral infarction. Extremely limited exam due to patient motion. Area of susceptibility effect corresponding to hyperattenuation in the left inferior parietal lobule seen on CT is compatible with blood product. Additional focus of susceptibility in the left superior cerebellum and several scattered foci in the inferior cerebellum, likely representing chronic blood product.Prominence of the ventricles and sulci compatible with diffuse parenchymal volume loss. The basal cisterns remain patent. There is no definitive parenchymal edema. There is no midline shift or mass effect. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Extensive patchy periventricular FLAIR hyperintensity without restricted diffusion compatible with chronic small vessel ischemic disease. Left frontal scalp lipoma.", "output": "1.The hyperattenuating area of concern on prior CT demonstrates susceptibility effect on MR compatible with trace acute blood product.2.Several additional scattered small foci of susceptibility likely representing chronic blood product.3.Advanced chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old with history of hepatomegaly, evaluate for hepatic venous thrombosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The portal and hepatic veins are seen opacifying with contrast. No correlate for the periportal edema seen on the prior CT is present on this examination.The gallbladder is normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Normal examination. Specifically, no finding to correlate to periportal edema seen on prior CT which may have been related to patient's volume status."}
{"instruction": "Generate impression based on findings.", "input": "History of prostate cancer. Considering active surveillance. 6/19/2015 biopsy demonstrated 3+3 tumor in the right apex medially. PELVIS:PROSTATE:Prostate Size: 3.8 x 6.0 x 6.0 cmPeripheral Zone: In the right apex there is a 4 mm focus of restricted diffusion (series 704/224) associated with T2 weighted hypointensity which may correspond to the patient's prostatic adenocarcinoma.Central Gland: Benign prostatic hyperplasia. Mild medial lobe hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic 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": "1.4 mm focus in the peripheral zone of the right apex may correspond to the patient's prostatic adenocarcinoma.2.No evidence of seminal vesicle invasion, extraprostatic extension or pelvic lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Altered gait, weakness. Evaluate for cervical stenosis. The study is degraded by motion artifact. Given his caveat:The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.C2-C3: No significant spinal canal stenosis or neuroforaminal narrowing. C3-C4: Posterior disc-osteophyte complex without significant spinal canal stenosis. Uncinate hypertrophy with mild neuroforaminal narrowing. C4-C5: Posterior disc-osteophyte complex with mild spinal canal stenosis. Right greater than left uncinate hypertrophy with right and mild left neuroforaminal narrowing. C5-C6: No significant spinal canal stenosis. Uncinate hypertrophy and neuroforaminal narrowing.C6-C7: Mild disc bulge without spinal canal stenosis. No significant neuroforaminal narrowing. C7-T1: No significant spinal canal or neuroforaminal narrowing.", "output": "Multilevel cervical spondylosis most predominant at C4-C5 with mild spinal canal stenosis. "}
{"instruction": "Generate impression based on findings.", "input": "Male 20 years old Reason: Assess for any dominant strictures and CCA History: PSC ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is persistent mild intrahepatic ductal dilatation and a stricture extending from the Klatskin point to the common hepatic duct. The length of the narrowing is approximately 2 cm, previously 2 cm. The distal common bile duct also is irregular with mild narrowing, appearing similar to the prior study. No definite mass lesion is identified.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.", "output": "No significant interval change in mild intrahepatic biliary ductal dilatation with mild narrowing of the common bile duct. "}
{"instruction": "Generate impression based on findings.", "input": " BRAIN: There is no acute infarct, mass effect, or cerebral edema. There are scattered periventricular and subcortical white matter T2 signal abnormalities which are nonspecific, but likely vascular related. There is mild to moderate diffuse lateral and third ventricular prominence with a relatively normal sized fourth ventricle which is likely secondary to greater degree of central parenchymal volume loss, with possible superimposed normal pressure hydrocephalus. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. LUMBAR: The last well formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. There is no osseous marrow signal abnormality. The conus terminates at L2 which is within normal limits.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis. L2-3: No disk herniation or spinal stenosis.L3-4: Minimal disk bulge, bilateral facet arthropathy and ligamenta flava thickening causing mild bilateral neural foraminal stenosis. No spinal canal stenosis.L4-5: Mild disk bulge, ligamenta flava thickening and facet arthropathy causing mild to moderate bilateral neural foraminal stenosis. No spinal canal stenosis.L5-S1: Mild diffuse disk bulge, facet arthropathy and ligamenta flava thickening causing moderate to severe bilateral neural foraminal stenosis. No spinal canal stenosis.", "output": "1.No acute infarct.2.Mild to moderate nonspecific white matter T2 signal abnormalities likely vascular related.3.Mild to moderate cerebral central parenchymal volume loss with possible superimposed normal pressure hydrocephalus.4.Multilevel lumbar spondylosis with bilateral neural foraminal stenosis at L3-4 through L5-S1, worst at L5-S1. No spinal canal stenosis. Please see details above."}
{"instruction": "Generate impression based on findings.", "input": "Male, 52 years old, status post transhiatal esophagectomy 08/17/15 after neoadjuvant chemoradiotherapy, now presenting with left scapular pain radiating to the neck and back. Abnormal T1 hypointensity and STIR hyperintensity is evident within the T1 and T2 vertebral bodies. The intervening disc space also shows abnormal STIR hyperintensity. The vertebral bodies and intervening disc are enhancing with extension of ill-defined enhancement to the anterior and left anterior paraspinal soft tissues where it becomes contiguous with a presumed gastric pull-up. No obvious fluid collection is detected. The left T1-2 and T2-3 neural foramina are encompassed by this process. In addition, there is mild thickening of the left ventral epidural tissues at T1 and T2. However, no high-grade spinal canal stenosis is suspected. No abnormal signal intensity or pathologic enhancement is detected within the spinal cord parenchyma.The remaining vertebral bodies demonstrate normal signal characteristics and are free of pathologic enhancement. Spinal alignment is anatomic. Vertebral body heights are preserved. Scattered mild degenerative findings are seen but there are no areas of associated spinal canal or foraminal stenosis.", "output": "Findings are seen compatible with discitis osteomyelitis at T1-2. Inflammation extends to the anterior and left anterior paraspinal soft tissues where it becomes contiguous with the adjacent gastric pull-up. No frank abscess is identified.There is mild inflammatory thickening of the epidural soft tissues as well but no significant spinal canal compromise is detected. The left neural foramina at T1-2 and T2-3 appear to be encompassed by inflammation as well."}
{"instruction": "Generate impression based on findings.", "input": "Oropharyngeal fibroma status post biopsy. There is a residual focus of subcentimeter mildly nodular mucosal thickening in the region of the right tongue base and glossotonsillar sulcus without extension into the deeper tissues of the tongue. There is no significant lymphadenopathy in the neck. The thyroid and major salivary glands are unremarkable. The major cervical flow voids appear to be patent. There is a 15 mm diameter perineural cyst in the left T1-2 neural foramen, which is unchanged. Other subcentimeter perineural cysts are present within the cervical spine neural foramina at several levels. The temporal bones, imaged intracranial structures, and orbits are grossly unremarkable. There appears to be filler material within the bilateral nasolabial folds. There are bilateral maxillary sinus retention cysts. There has been interval enlargement of left axillary lymph nodes, which measure up to 15 mm.", "output": "1. A subcentimeter lesion in the right oropharyngeal region is compatible with residual fibroma and/or inflammatory changes. 2. Unchanged left T1-2 neural foramen perineural cyst. 3. Interval enlargement of left axillary lymph nodes, which measure up to 15 mm, which is non-specific."}
{"instruction": "Generate impression based on findings.", "input": "History of recurrent cholangitis of unclear etiology, evaluate for biliary stricture. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified. The hepatic vasculature is patent. The gallbladder is surgically absent. There is no intrahepatic biliary ductal dilatation. The common bile duct measures up to 7 mm in diameter. There is slight smooth narrowing of the distal common bile duct measuring down to approximately 2 to 3 mm which remains patent. There is no abnormal enhancement of the bile ducts or secondary evidence of cholangitis.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement. The pancreatic duct is not dilated. There are a few small cystic foci within the body of the pancreas measuring up to 4 mm (series 9, image 17). Though these do not definitively connect to the pancreatic duct, they likely represent side branch IPMNs. ADRENAL GLANDS: There is a 1.3 x 2.5 cm right adrenal nodule which demonstrates loss of signal on out of phase images and is compatible with a benign adrenal adenoma.KIDNEYS, URETERS: Status post right nephrectomy. Left renal cysts, some of which are too small to characterize.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.Smooth slight narrowing of the distal common bile duct without definite stricture, stone, or obstructing lesion. No specific imaging evidence of cholangitis currently.2.Benign right adrenal adenoma."}
{"instruction": "Generate impression based on findings.", "input": "Female, 57 years old, with intractable epilepsy, functional MRI requested for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical stimulation maps along the calcarine sulci.All tested language paradigms produced reliable language related cortical activation. Language is overall left dominant. On two of the three paradigms (word generation and verb generation), a substantial language related activation is seen in the expected location of Wernicke's area on the right. Broca's area is identified within the left inferior frontal gyrus (pars opercularis and pars triangularis). Wernicke's area is identified (bilaterally) along the posterior aspect of the superior temporal gyrus.", "output": "1.Sensorimotor cortical activation maps as expected along the pre- and post-central gyri.2.Primary visual cortical stimulation maps along the calcarine sulci.3.Language is overall left dominant. On two of three language paradigms, however, a substantial contribution is seen from Wernicke's area on the right. The significance of this is uncertain, but it suggests the possibility that some task-specific language processing may reside in the right cerebral hemisphere. "}
{"instruction": "Generate impression based on findings.", "input": "Left ulnar radicular pain, is there nerve impingement? Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis with apex at the C4-C5 level. Alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Disc desiccation and minimal bulge. No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge and dorsal annular fissure. No significant compromise to the spinal canal or neural foramina.C6-7: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina. There is a tiny left-sided perineural cyst which is a frequently seen incidental finding and of doubtful clinical significance.Paraspinous soft tissue structures appear within normal limits. There is a 6 mm right thyroid nodule.", "output": "1. Minimal degenerative changes in the cervical spine without significant spinal canal or neural foraminal stenosis at any level.2. Minor incidental findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Male, 31 years old, with weakness, history of MS. Evaluate for progression. Brain:Numerous round, oval or linear T2 hyperintense lesions are evident predominantly involving the periventricular and juxtacortical white matter of the cerebral hemispheres. No definite involvement of the brainstem or cerebellum is seen.Since the prior examination, a lesion adjacent to the right occipital horn has decreased in size. In addition, a cortically based lesion within the left anterior frontal lobe has also decreased in size. However, two new lesions are seen within the left frontal lobe, one within the superior frontal white matter, and another large lesion situated in the left frontal white matter nearly spanning between the left frontal horn and the peripheral frontal cortex. Both lesions demonstrate a rim of moderate T2 hyperintensity and a core of marked T2 hyperintensity with marked T1 hypointensity.No significant generalized mass effect is seen. No abnormal extra-axial fluid collections are detected. The ventricles remain normal in size and morphology. Brain parenchymal volume is preserved. The cerebellar tonsils descend below the level of the foramen magnum compatible with Chiari I malformation.Cervical spine:One discrete T2 hyperintense lesion is evident within the anterior aspect of the spinal cord centered at C3-4. Elsewhere, cord shows normal morphology and signal characteristics. No epidural abnormalities are seen.The cervical lordosis is straightened but this is likely positional. Sagittal alignment is unremarkable. Marrow signal characteristics are within normal limits. The intervertebral discs are preserved with no significant compromise of the spinal canal or neural foramina.", "output": "1.Numerous lesions are evident within the supratentorial brain compatible with multiple sclerosis. On comparison with the prior examination, two lesions did become smaller. However, two relatively large new lesions also developed.2.A single lesion is identified within the cervical spinal cord which is also compatible with multiple sclerosis. No prior cervical spine imaging is available for comparison.3.Incidental note is made of a Chiari I malformation."}
{"instruction": "Generate impression based on findings.", "input": "Left knee pain and swelling MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is partial-thickness degeneration of the articular cartilage along the patella. A defect noted along the median eminence seen on the prior exam is less prominent currently. However there is a new near full-thickness cleft along the medial facet. Additional near full-thickness cleft is seen inferiorly along the median eminence which was likely present on the prior exam. There is a near full-thickness defect of the femoral trochlear cartilage centrally and inferiorly measuring approximately 8 mm. This appears more prominent on the current exam.There is mild heterogeneity of the lateral tibial plateau suggesting mild cartilage degeneration, which is similar to the prior exam.There is mild heterogeneity of the articular cartilage of the medial femoral condyle above the free edge of the posterior horn of the meniscus suggesting mild degeneration. This appears less prominent on the current exam. There is also increased signal intensity more anteriorly within the articular cartilage of the medial femoral condyle suggesting delamination. There is a small cyst within the medial tibial plateau posteriorly which was present on the prior exam. The surrounding bone marrow edema in this area has resolved. The remaining bone marrow signal is otherwise normal.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Articular cartilage abnormalities and additional findings described above."}
{"instruction": "Generate impression based on findings.", "input": "Male, 2 years old, with altered mental status. Diffuse gyral swelling is suspected given the lack of visualization of fluid in any of the cerebral sulci. On T2 weighted images, there appears to be a diffuse symmetric pattern of hyperintensity involving the cerebral cortex and the immediate subcortical tissues. Areas of more pronounced abnormal signal are suspected within the bilateral insulae and the hippocampi. On diffusion weighted imaging, there is a striking pattern of diffuse white matter hyperintensity with corresponding low signal on the ADC maps involving the cerebral white matter bilaterally and symmetrically, including the corpus callosum. On the top several slices through the brain, similar imaging characteristics may affect the cortex, but at lower levels, it is primarily found in the white matter.The basal ganglia and thalami may also be somewhat T2 hyperintense, but given the extensive background abnormality, these findings are not definitive. T2 hyperintensity seems to involve the midbrain and to a lesser degree the pons. The cerebellum does not appear to be as severely affected as the supratentorial brain, but it too shows some abnormal diffuse T2 signal. On post contrast imaging, there is prominence of the sulcal vasculature which could reflect slow flow or compression effect from edema. No discrete pathologic parenchymal enhancement is detected.No evidence of intracranial hemorrhage is seen. No abnormal extra axial fluid collections are present. The ventricular system is essentially normal in morphology and perhaps slightly smaller than what is typically seen.Pansinusitis inflammation is seen.", "output": "A pattern of extensive T2 signal abnormality is seen involving the bilateral cerebral cortex and immediate subcortical white matter, the insulae and hippocampi. Less convincing is the possibility of involvement of the basal ganglia and thalami. The midbrain is suspected to be affected, with less severe findings noted in the pons and posterior fossa. A fairly striking pattern of restricted diffusion is also demonstrated involving primarily the supratentorial white matter with questionable cortical involvement in the superior most brain.The differential diagnosis for these findings would include hypoglycemic injury, though the findings as present here are not entirely typical of those reported in either the pediatric or adult populations. Additionally, injury related to hyperammonemia or some other abnormality of the urea cycle should be considered. Hypoxic-ischemic injury can be considered, though again the imaging features are not entirely typical. If these possibilities are disproved, consideration might be given to other inborn errors of metabolism."}
{"instruction": "Generate impression based on findings.", "input": "Female, 16 years old, with diagnosis of PRES, lupus, with altered mental status and seizures, on steroid treatment. Previously seen areas of cortical and subcortical T2 hyperintensity along the cerebral watershed zones and the occipitotemporal regions have completely or nearly completely resolved. A few scattered foci of periventricular T2 hyperintensity are seen, along with mild T2 cuffing of the ventricular atria. No diffusion restriction is seen. No evidence of significant parenchymal edema or mass effect is detected. There are no findings to indicate acute or chronic intracranial hemorrhage. Ventricular size and morphology are stable. No pathologic intracranial enhancement is detected.", "output": "Complete or near complete resolution of scattered cortical and subcortical signal abnormality which was compatible with PRES. Small areas of residual periventricular signal abnormality may reflect pre-existing chronic lesions perhaps related to the patient's diagnosis of lupus."}
{"instruction": "Generate impression based on findings.", "input": "Shoulder pain ROTATOR CUFF: The rotator cuff tendons are intact. There is mild increased signal intensity within the distal supraspinatus tendon compatible with tendinopathy.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. No gadolinium is observed in the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The glenoid articular cartilage is intact.The labrum is intact. BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "1. Mild supraspinatus tendinopathy.2. Intact labrum. "}
{"instruction": "Generate impression based on findings.", "input": "66 years Female (DOB:7/25/1949)Reason: please assess if subacute stroke vs degenerative cause for PD symptoms, History: left body tremor at rest, paratonia and weakness left sidePROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. A couple T2 and FLAIR hyperintense punctate foci are present in the brainstem.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Periventricular and subcortical white matter lesions of a mild degree as well as a couple punctate lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female status distal pancreatectomy for IPMN and in mid March 20, 2015 percent for follow-up. ABDOMEN:LIVER, BILIARY TRACT: Common bile duct is prominent measuring up to 12 mm proximally, unchanged. No evidence of choledocholithiasis, strictures, or mass. There is persistent unchanged mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Postoperative changes of distal pancreatectomy. Again noted are multiple subcentimeter outpouchings from the pancreatic duct in the pancreatic body. The reference pancreatic duct outpouching in the pancreatic head measures 14 mm (series 9, image 5), previously measuring 14 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Previously noted saccular left renal artery aneurysm is no longer present; findings compatible with history of aortorenal artery bypass graft.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.Postoperative changes of distal pancreatectomy.2.Stable pancreatic head main duct IPMN. 3.Postoperative changes of left aortorenal artery bypass graft."}
{"instruction": "Generate impression based on findings.", "input": "Worsening mental status, aphasia, and right hemiparesis. Several sequences are degraded by motion.There is restricted diffusion involving the anterior and lateral aspects of the left thalamus as well as an additional punctate focus within the splenium of the left corpus callosum with associated increased T2 signal compatible with acute/subacute ischemic infarctions. There is also mild associated swelling of the left thalamus without associated significant mass effect, although there is mild convexity of its medial margin. Susceptibility weighted images are significantly degraded by motion but demonstrate punctate foci of susceptibility artifact in the bilateral deep gray nuclei as well as within the right temporal occipital region which are compatible with microhemorrhages and which are favored to be chronic, however, recent petechial hemorrhage is not entirely excluded. There is encephalomalacia involving the medial aspect of the left occipital lobe compatible with chronic infarction. Confluent areas of increased T2/FLAIR signal within the periventricular white matter, basal ganglia, and brainstem are nonspecific but compatible with chronic small vessel changes. The ventricles and sulci are within normal limits for age. The basal cisterns remain patent. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits.There is dilation of the left horizontal portion of the cavernous internal carotid artery which bulges into the cavernous sinus and left middle cranial fossa as characterized on recent CTA. The occlusion of the left posterior cerebral artery is better visualized on recent CTA. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1.Acute/subacute infarction involving the left thalamus with additional punctate acute/subacute infarct involving the left splenium of the corpus callosum.2.Chronic left occipital lobe infarction.3.Occlusion of the left posterior cerebral artery as well as left cavernous internal carotid artery fusiform aneurysm more fully characterized on CTA from 8/18/2016.4.Moderate chronic small vessel ischemic changes.5.Scattered punctate foci of susceptibility artifact compatible with microhemorrhages, favor chronic though recent petechial hemorrhage associated with left thalamic infarction is not entirely excluded."}
{"instruction": "Generate impression based on findings.", "input": "Female, 57 years old, with multiple sclerosis and worsening weakness. Assess for MS lesions and meningioma. Brain:Numerous T2 hyperintense lesions are seen prominently within the periventricular white matter but also to a lesser degree in the juxtacortical white matter and the brainstem. Several of these lesions show evidence of enhancement including two lesions along the left lateral ventricle, a lesion in the left lower parietal lobe, a lesion in the right parietal lobe, a lesion along the posterior medial right temporal lobe, and lesions in the brainstem.Evidence of frontal craniotomy is seen with encephalomalacia and gliosis of the left orbital gyri. A fairly homogeneously enhancing mass is present centered within the left suprasellar cistern measuring up to 28 x 17 mm in the axial plane and up to 16 mm craniocaudally. The lesion probably invades the left cavernous sinus and partially encases the left ICA. It also projects into the prepontine cistern and contacts the basilar artery. The lesion encroaches upon the sella and exerts mass effect upon the pituitary gland and pituitary stalk. The left optic nerve and chiasm are not clearly visualized and may be embedded within the tumor.No evidence of restricted diffusion is seen. No significant parenchymal edema or mass effect is detected. A focus of susceptibility within the left cerebellum without edema is compatible with chronic microhemorrhage. Generalized parenchymal volume loss is seen with prominent sulci and ventricles. A focally prominent CSF space along the right parietal lobe may represent an arachnoid cyst.C-spine:Multiple T2 hyperintense lesions are seen within the spinal cord including anteriorly at the cervico medullary junction, centrally and left laterally at C2, left laterally at C3-4, left laterally at C5-6 and anteriorly at C7. As assessed on sagittal images, several additional lesions are seen in the thoracic region. None of these lesions shows definite corresponding enhancement.The cervical lordosis is reversed but spinal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality or enhancement is seen.C2-3: Right uncovertebral hypertrophy. Minimal right foraminal narrowing. C3-4: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C5-6: Facet hypertrophy on the right. Posterior disc-osteophyte complex formation with a large component in the right paracentral region. This causes effacement of the ventral thecal sac and some flattening of the ventral cord with a mild generalized spinal canal stenosis. Mild right foraminal narrowing. C6-7: Right facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C7-T1: Unremarkable.", "output": "1.Numerous white matter lesions are evident within the brain compatible with the diagnosis of multiple sclerosis. Several of these lesions show evidence of enhancement compatible with active inflammation.2.A left suprasellar mass is again seen compatible with history of meningioma. This lesion likely invades the left cavernous sinus and at least partially encases the left ICA. The lesion exerts mass effect upon the pituitary gland and pituitary stalk. The left optic nerve and chiasm may be embedded within the lesion. Sequelae of left frontal approach surgery are seen perhaps related to this lesion.3.Multiple lesions are evident within the cervical and partially visualized thoracic spinal cord, but without clear evidence of enhancement.4.Degenerative disc disease is seen most severely affecting the C5-6 level where there is a right paracentral disc osteophyte which mildly impinges upon the cord."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are breast MRI (8/7/2015) performed at Northwestern Memorial Hospital .For comparison,mammogram and ultrasound 7/17/2015 and 7/27/2015 are available. MRI: There is mild parenchymal background enhancement. There is an enhancing spiculated mass in the left breast upper-outer quadrant 2:00 position, consistent with biopsy-proven cancer. Clip artifact noted within it. The mass measures approximately 17 x 14 x 10 mm (previous study measured 15 x 13 mm on ultrasound 7/27/2015). There is an eccentric thickened left axillary node which is most likely reactive.No abnormal enhancement in the right breast or right axilla.", "output": "Biopsy-proven unifocal left breast mass as described. Most likely reactive lymph node noted in the left axillary region. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Multiple sclerosis. Lumbar stenosis. MRI thoracic spine: There is redemonstration of fairly extensive patchy T2 hyperintense foci of the spinal cord with areas of volume loss. Lesions are most prominent at the left aspect of the T4-T5 level, right aspect of the T5-T6 level, left aspect of T9-T10 and right aspect of T10-T11. On post enhanced images there is no convincing evidence of an enhancing plaque. 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 paravertebral soft tissues are unremarkable.MRI of lumbar spine: The vertebral column is straightened but otherwise within normal limits in alignment. The vertebral body heights are preserved. There is disc desiccation at L4-L5 and L5-S1 and to a lesser degree at L3-L4 as before. Conus is in normal position.There is no significant spinal canal or neural foraminal stenosis at L1-L2 or L2-L3. At L3-L4, there is a disc bulge eccentric to the right with minimal narrowing of the right neural foramen as before. Otherwise no significant spinal canal or neural foraminal stenosis.At L4-L5, there is disc bulge eccentric to the right which contacts the right L4 nerve root extraforaminally. Otherwise no significant spinal canal or neural foraminal stenosis.At L5-S1: There is central and left paracentral disc protrusion which partially effaces the left lateral recess and contacts the left S1 nerve root similar to 11/30/2015. Disc herniation at this level is significantly improved when compared to 5/2/2015. Mild left neural foraminal stenosis similar to prior. Central spinal canal and right neural foramen remain patent.No suspicious enhancement. The paravertebral soft tissues are unremarkable. Again noted is a leiomyomatous uterus.", "output": "1. Patchy T2 hyperintensity throughout the thoracic cord consistent with known demyelinating disease. No new lesion or enhancement within the extensive background of T2 signal abnormality is definitively appreciated.2. Degenerative changes in the lumbar spine are not significantly changed since 11/30/2015. Please see above for more details."}
{"instruction": "Generate impression based on findings.", "input": " There are no foci of restricted diffusion. No susceptibility abnormalities visualized.A small circumscribed area of high signal in T2 and FLAIR with abnormal enhancement is again seen in the left inferior cerebellar lobe, which is intra-axial and peripherally located, measuring up to 7 mm in transaxial view. There is no surrounding edema. The lesion is unchanged since the previous study.The cerebellar tonsils extend 5 mm below the level of the foreman magnum, unchanged from the previous study. The cerebellar tonsils are rounded in configuration. There is moderate crowding at this level.The ventricles and basal cisterns are unchanged in volume and configuration. No midline shift or herniation. The skull and extra-axial soft tissues are unremarkable.", "output": "1. Continued stability of a subcentimeter FLAIR hyperintense enhancing lesion in the inferior left cerebellar hemisphere, peripherally located, now over a course of 2.5 years. This is nonspecific but continued follow up is recommended to exclude low grade neoplasm. Differential includes inflammatory processes.2. Slightly low lying cerebellar tonsils, unchanged since the previous study."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with history of paresthesias. Evaluate for structural lesions. Brain: There are no areas of restricted diffusion to suggest an acute ischemic infarction. There is no evidence of acute intracranial hemorrhage. There are minimal curvilinear and punctate foci of increased T2/FLAIR signal within the frontal and parietal periventricular and subcortical white matter bilaterally. The corpus collosum appears spared. The ventricles and sulci are symmetric. The basal cisterns are intact. The visualized paranasal sinuses and mastoid air cells are clear. Flow voids are appreciated in the major intracranial vessels.Lumbar spine: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. THere is mild facet arthropathy at L4-5 and L5-S1. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.There is a partially imaged large fluid filled structure only seen on axial series within the anterior aspect of the pelvis which likely represents a distended bladder. Additionally, there is a large T2 hypointense structure with adjacent septated cystic structure only partially imaged on sagittal series. These findings may represent normal structures, although dedicated imaging is recommended for confirmation and to exclude any pathologic process.", "output": "1. Curvilinear and punctate foci of increased T2/FLAIR signal within the frontal and parietal periventricular and subcortical white matter bilaterally have the morphology of benign perivascular spaces, although signal abnormality persists on FLAIR imaging. Another diagnostic consideration is a demyelinating process such as multiple sclerosis, however this appearance is not classic and thus these findings are ultimately nonspecific.2. Mild facet arthropathy of the lower lumbar spine.3. Nonspecific and partially imaged findings in the pelvis as above for which dedicated pelvic imaging is recommended. Ultrasound would be an appropriate first choice for this imaging."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Syncope and collapseClinical question: r/o acute ischemiaSigns and Symptoms: dysarthria, right sided weakness There is diffusion restriction involving the right inferior parietal lobule, portions of the precentral gyrus, the midportion and posterior aspect of the right superior and middle temporal gyri as well as the posterior half of the right insular cortex and a small patchy area of the right frontal lobe centered in the precentral gyrus in an area measuring 24x74mm axial dimensions.There is encephalomalacia present in the left middle frontal gyrus.There is encephalomalacia involving the central portions of the right SCA territory of the right cerebellar hemisphere.There is cerebellar atrophy presentThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are foci of T2 hyperintensity in the pons and thalami.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.Images are degraded due to artifacts related to patient motion.", "output": "1.Acute infarction involving the right MCA territory as detailed above.2.Encephalomalacia is present in the left frontal lobe and right cerebellar hemisphere as detailed above.3.Cerebellar atrophy.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Lesions in the pons and thalami of a moderate degree are likely related to old lacunar infarcts.6.Images are degraded due to artifacts related to patient motion. This may obscure more subtle abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "Stage IV T2N2bM0 squamous cell carcinoma of the left lateral tongue, on IRB 121712 clinical trial, 1 month post TFHX ending 9/16/16. There are post-treatment findings without evidence of measurable mass in the left oral tongue, which measures up to approximately 40 mm. There has been interval decrease in size of the necrotic left cervical lymphadenopathy. In particular, there is a cystic or necrotic left level 2B lymph node measures 25 x 32 mm in axial cross-section, previously 43 x 47 mm. The lymph node tumor appears to slight infiltrate into the adjacent left parotid gland. A left level 1 lymph node measures 5 x 6 mm in axial cross-section, previously 12 x 13 mm. The left lateral retropharyngeal lymph node is asymmetrically prominent and measures 3 x 4 mm in axial cross-section, previously 4 x 8 mm. There is a right level 2A lymph node with a rounded morphology, which measures 7 x 10 mm in axial cross-section, which is not enlarged by size criteria. There is no significant right cervical lymphadenopathy. There is a cystic right thyroid nodule that measures up to 9 mm. There are small maxillary sinus retention cysts. There are also secretions in the left sphenoid sinus. The orbits and imaged intracranial structures are unremarkable. There is a small posterior disc-osteophyte complex at C5-C6 that mildly indents the spinal cord.", "output": "1. Post-treatment findings without measurable residual left oral tongue mass.2. Interval decrease in size of the metastatic left cervical lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with alcoholic cirrhosis. Evaluate for HCC. Reviewed head CT and confirmed with neuroradiology that MRI is safe given prior AVM surgery. There are no metallic objects or clips on recent head CT. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Subcentimeter T2 hyperintense focus in hepatic segment 7 (axial series 6 image 9) shows no significant enhancement on arterial phase and progressive enhancement in the portal venous and delayed phases (axial series 10 images 288, 391). No suspicious lesions with washout are identified.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Subcentimeter T2 hyperintense focus in hepatic segment 7 most likely represents a small hemangioma. Small size of lesion may make visualization of typically seen interrupted peripheral nodular enhancement difficult; lesion seen filling in with contrast on venous and delayed phases.2.No suspicious hepatic lesion with washout visualized."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Bleed/mass. Signs and symptoms: Headaches, nausea and vomiting. Nonenhanced CT of head:Images through posterior fossa demonstrate ectopia of cerebellar tonsils consistent with Chiari malformation. The inferior pole of cerebellar tonsils are beyond the field of study. There is complete effacement of subarachnoid space at the level of foramina magnum with deformity of cerebellar tonsils. Follow-up with an MRI is recommended.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci and ventricular system remain within normal limits.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable.", "output": "1.Chiari malformation with resultant deformity of cerebellar tonsils and total effacement of subarachnoid space at the level of foramen magnum . CT examination of brain is otherwise unremarkable.2.Recommend follow-up with an MRI examination of brain and including CSF flow study at the level of foramen magnum."}
{"instruction": "Generate impression based on findings.", "input": "Disturbance of skin sensation, sarcoidosis, history of neurosarcoid, new left No evidence of acute ischemic or hemorrhagic lesion on this scan.Subtle enhancement of the slightly thickened optic chiasm, optic tract especially left and hypothalamus was again demonstrated, no change since prior scan.Otherwise no abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Bilateral maxillary sinus opacifications.", "output": "No evidence of acute ischemic or hemorrhagic lesion.No change of subtle enhancement of optic chiasm, left optic tract and hypothalamus since prior exam."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis B. HCC and cholangiocarcinoma status post resection. ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy with compensatory left hepatic lobe hypertrophy. Status post cholecystectomy. Mild common bile duct prominence, unchanged. No intrahepatic biliary ductal dilatation. No focal liver lesion.Patent hepatic vasculature.SPLEEN: Normal splenic size without a focal lesion.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Right hepatectomy without a suspicious liver lesion."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Call is headache numbness in all. Signs and symptoms: Headache. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates normal anatomical development of brain and right normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination of brain. This signal void of major intracranial arterial branches are identified and unremarkable. Post-enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series. Images through the calvarium demonstrate multiple foci of marrow signal replacement with diffuse enhancement and highly suspected of metastatic disease. None of the lesions demonstrate extension of enhancement beyond the calvarium into the epidural space or into the soft tissues of the scalp.Pre-and post enhanced complete spine MRI:Examination of the cervical spine demonstrate normal anatomical alignment of the vertebral column.There is uniform diffuse marrow signal changes of vertebral bodies of C2, C3 with mild diffuse enhancement. There is no detectable fixation enhancement beyond the vertebral bodies into the epidural space or the perivertebral soft tissues. This findings also are similar in signal and pattern of enhancement to the findings of the calvarium and suggesting metastatic disease.There is normal signal intensity and caliber of the cervical cord without abnormal enhancement.There is mild degenerative changes of cervical spine however without evidence of spinal stenosis or clinically significant neural foraminal compromise.The perispinal soft tissues also remain within normal and without abnormal enhancement.Examination of thoracic spine also demonstrate normal anatomical alignment the vertebral column.There are uniform marrow signal replacement involving vertebral bodies of T1 and T2 with evidence of involvement of the posterior elements of both levels (worse at T11). This finding demonstrate uniform diffuse enhancement and suggestive of metastatic disease. There is minimal extraosseous spread of enhancement from the spinous process of T1.Normal signal intensity of the rest of the vertebral column and without abnormal enhancement.Normal signal intensity and caliber of thoracic cord without abnormal enhancement.No spinal stenosis or neuroforaminal compromise at any level.Examination of lumbosacral spine also demonstrate diffuse marrow signal and replacement with enhancement of the L1 vertebrae without extraosseous spread of enhancement.Patchy foci of matter signal replacement with enhancement is also present in the vertebral body of L2, L3, 5 and S3 as well as the spinous process of L3. There is mild compression deformity of the superior endplate of L1.There is normal signal intensity and morphology of cauda equina without abnormal enhancement.There is no evidence of spinal stenosis or neural foraminal compromise.There is however a centrally located disk protrusion at the specialty with resultant mild flattening deformity of the thecal sac. There is also a large central and leftward disk protrusion at the L4 -- L5 level resulting in left lateral recess compromise.There is a tiny annular fissure at L5 -- S1 in the left paramedian location best appreciated on sagittal T2 series 38 image 11.", "output": "1.Pre--and post enhanced brain MRI demonstrating unremarkable intracranial content and without abnormal enhancement. Multiple foci of calvarial marrow signal replacement with enhancement are noted and highly suspected for metastatic disease.2.Pre-and post enhanced MRI of the cervical spine demonstrate uniform marrow signal changes of C2 and C3 vertebral bodies with mild diffuse enhancement suggestive of metastatic disease. Mild degenerative changes of the cervical spine without spinal stenosis or neural foraminal compromise. Normal signal intensity and caliber of cervical cord without abnormal enhancement.3.Pre-and post enhanced MRI of thoracic spine demonstrate marrow signal replacement with mild diffuse enhancement involving vertebral bodies and the posterior elements of T1 and T2 as detailed. Unremarkable exam otherwise.4.Pre-and post enhanced MRI of lumbosacral spine also demonstrate foci of marrow signal replacement with enhancement involving vertebral bodies of L1, L2, spinous processes of L3, body of L4 and L5 as well as S3 as detailed. Normal signal intensity of cauda equina and without abnormal enhancement. A small central disk protrusion at L2 -- 3 and a central and leftward disk protrusion at L4 -- L5 resulting in left lateral recess compromise."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: History of HNC. Signs and symptoms: Multiple brain metastases per last CT. Pre and post enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrate multiple enhancing (some hemorrhagic) metastatic lesions in bilateral cerebral and cerebellar hemispheres.The largest supratentorial metastatic lesion is epicentered in the left caudate nucleus and measures at 21 x 15 mm in transaxial dimensions.The largest right hemispheric metastatic lesion in the posterior parietal lobe measures at approximately 23 x 10 mm in transaxial dimensions. The largest metastatic lesion in the posterior fossa is in the anterior right cerebellum measuring at 29 x 21 mm.Although there is surrounding vasogenic edema of all metastatic lesions and mass effect remains regional and without evidence of midline shift, effacement of basal cisterns, quadrigeminal plate cistern or the foramen magnum. Additionally examination demonstrates a focus of enhancement in the left posterior parietal bone measuring approximately at 12 x 8 mm in transaxial dimensions (axial post enhanced series 10 image 29).Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.", "output": "1.Multiple enhancing metastatic lesions (some hemorrhagic) in supra and infratentorial brain parenchyma as detailed/measured above.2.There is no evidence of midline shift or hydrocephalus.3.There is a single nonspecific focus of enhancement in the left parietal bone measuring at 12 x 8 mm and could represent a metastatic focus however possibility of benign lesion cannot be entirely excluded."}
{"instruction": "Generate impression based on findings.", "input": "right leg pain, postoperative status of L5S1. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is evidence of right L5 laminectomy.Anterior epidural fat appears to be obliterated with soft tissue signal intensity which may indicate postoperative changes (granulation tissue), however, there is no evidence of adjacent nerve root compression.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Diffuse bulging of disc which abuts thecal sac, otherwise unremarkable. L5-S1: Evidence of right L5 laminectomy with soft tissue signals within the anterior epidural fat which may represent postoperative changes such as granulation tissues. No evidence of neural foraminal narrowing or nerve root compression on this scan.", "output": "1. Postop (L5 right laminectomy) changes at the level of L5S1 as described above.2. Diffuse bulging of disc, L45.Comment: if clinically indicated Gad enhanced L spine MRI can be considered for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Memory problems and headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive mucosal thickening and fluid within the left maxillary sinus. There is also mild right maxillary sinus mucosal thickening.", "output": "1. Findings suggestive of acute left maxillary sinusitis.2. No evidence of intracranial hemorrhage, mass, or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Detrick is a 31 year old female with a family history of breast cancer in her sister (diagnosed at the age of 29. She has a history of bilateral breast reduction. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with mass. Evaluate for pseudotumor status post metal on metal hip Metallic artifact reduction protocol was used. Despite this, evaluation of the hip and surrounding tissues is limited by metallic susceptibility artifact from the patient's left total hip arthroplasty. Large collection of near-fluid signal intensity extending from the posterior aspect of the intertrochanteric region of the proximal femur through the soft tissues posterior to the greater trochanter to the lateral skin surface of the hip. The posterior component of this collection measures approximately 13.0 cm x 7.0 cm in transverse dimension and 7.5 cm in craniocaudal dimension. It is surrounded by a low signal intensity rim which could either represent hemosiderin or metal particle deposition. The collection also extends anterior to the hip joint into the iliopsoas muscle forming a collection that is approximately 4.0 cm x 3.5 cm in transverse dimension and 7.5 cm in craniocaudal dimension. There is also a lobulated collection of near fluid signal intensity within the supra-acetabular left ilium measuring approximately 4.0 cm in greatest dimension and correlates to a geographic lucent lesion on prior radiographs. On the fat suppressed T2 weighted images there is thin increased signal intensity within the intertrochanteric region of the femur along the lateral aspect of the femoral component that may represent the same disease process or simply artifact. The gluteus medius and gluteus minimus tendons can be followed to their insertions on the greater trochanter. Severe osteoarthritis affects the right hip and severe degenerative arthritis affects the visualized lumbar spine", "output": "Left total hip arthroplasty with adverse soft tissue reaction and focal osteolysis as described above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 56 years old, with history of metastatic adenoid cystic carcinoma of the palate diagnosed in 2004, with newly found metastatic disease to the lung/pleura. The visualized aerodigestive and sinonasal mucosal surfaces are free of mass lesions and pathologic enhancement. The skull base is intact and in particular, there is no evidence to suggest perineural disease spread. The soft tissues of the neck are only partially visualized on the field-of-view of this examination, but no evidence of pathologic adenopathy is seen in the regions assessed. Likewise, partial visualization of the intracranial structures shows no evidence of metastatic disease.", "output": "No evidence of active disease involving the skull base, upper aerodigestive tract, or upper neck."}
{"instruction": "Generate impression based on findings.", "input": "Biopsy proven DCIS in the right breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is suspicious nonmass enhancement extending primarily anterior and posterior to the posterior biopsy site in the right inner breast. Extent of nonmass enhancement is 4.9 x 1.6 x 1.1 cm. Non-mass enhancement extends to within 5 mm of the pectoralis posteriorly. The anterior extent of nonmass enhancement extends 2.7 cm anterior to the posterior biopsy clip, similar to the extent of residual calcifications visible on post biopsy mammograms. Thin peripheral enhancement is seen surrounding each of the 2 biopsy sites. Inconclusive of the anterior biopsy site, AP measurement is 7.3 cm back to the most posterior area of nonmass enhancement near the chest wall.Elsewhere in each breast, a few scattered enhancing foci are present, though none are uniquely suspicious in appearance or kinetics. There is also a normal sized intramammary lymph node in the far posterior depth of the central inferior left breast.No abnormal lymph nodes are identified in either axillary region.", "output": "Nonmass enhancement in the right inner breast measures 4.9 cm AP and extends to within 5 mm of the pectoralis. For needle localization prior to breast conservation, the anterior extent of calcifications or anterior biopsy clip could be localized. The posterior-most extent of calcifications/enhancement may be difficult to localize based on its position near the pectoralis. Given the enhancing foci elsewhere and her dense breasts, an MRI follow up in 1 year to establish stability is recommended. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Severe neck pain. History of trauma. Postcontrast images are requested after paraspinous edema seen on earlier noncontrast study. Examination is limited to post contrast sequences and demonstrates moderate degree of enhancement in the left paraspinous musculature, maximal at the left C4-C5 level but extending craniocaudally from approximately the upper C3 to the C6-C7 levels. There also appears to be mildly increased enhancement in the right lower cervical paraspinous soft tissues.Degenerative changes including multilevel facet arthropathy, particularly on the left are noted. There is no evidence of discitis osteomyelitis or clear evidence of septic arthritis involving a particular facet joint.There is no abnormal enhancement within the spinal canal. There are also no enhancing bony lesions.", "output": "Examination limited to post contrast sequences demonstrates enhancement in the left paraspinous soft tissues corresponding to the paraspinous edema noted on earlier noncontrast cervical spine study. Differentials again include inflammation related to prior trauma or inflammation related to facet arthropathy. Infection is not excluded although there is no discrete fluid collection to indicate abscess."}
{"instruction": "Generate impression based on findings.", "input": "Pain. Question of hindfoot mass. Markers denote the site of the patient's pain.There is thickening and increased T2 signal within the plantar aponeurosis approximately 2 cm distal to the calcaneal attachment. On postcontrast imaging there is enhancement within the aponeurosis and surrounding soft tissues.There are areas of low T1 and high T2 signal within the bone marrow of the mid-talus and talar dome compatible with non-specifc edema. Bone marrow signal is otherwise within normal limits. The tendons of the ankle appear intact.", "output": "Probable plantar fasciitis. "}
{"instruction": "Generate impression based on findings.", "input": "Recurrence of pain following relief of symptoms for approximately 8 months following vertebroplasty at L5 and RF ablation of metastatic renal cell carcinoma with painful compression fracture of L2. There are postoperative findings related to vertebroplasty of a compression at L5 and RF ablation of metastatic renal cell carcinoma with compression fracture of L2. There has been interval increase in size of an intermediate T1 and high T2 signal lesion in the left posterior vertebral and pedicle of L2, resulting in marked spinal canal stenosis, in which the cauda equina nerve roots are compressed. There is no significant interval change in the treated L5 vertebra with mild loss of height and high T2 signal surrounding the cement. There is also no significant interval change in the L1 compression fracture with approximately 50 % loss of height. There is a probable small hemangioma in the T6 vertebral body. There are mild superior endplate depressions at T3 and T5. The rest of the vertebral body heights are intact and the alignment is unchanged. There are mild degenerative spondylitis changes in the lumbar spine without associated significant spinal canal or neural foraminal narrowing. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The right kidney is absent.", "output": "Postoperative findings related to vertebroplasty of a compression at L5 and RF ablation of metastatic renal cell carcinoma with compression fracture of L2, with interval increase in size of tumor involving the eft posterior vertebral and pedicle of L2, which results in marked cauda equina nerve root compression. Otherwise, no significant interval change in the L1 and L5 compression fractures, as well as the mild superior endplate depressions at T3 and T5. Assessment for tumor is otherwise limited without contrast."}
{"instruction": "Generate impression based on findings.", "input": "4 y/o male with headaches. Evaluation of ventricular size s/p Chiari I decompression There is no evidence of intracranial hemorrhage, mass or edema. The lateral, third, and fourth ventricles are enlarged, compatible with hydrocephalus. The ventricles appear larger when compared to the MRI dated 6/18/2009.There is evidence of an occipital decompression with post-surgical changes. There is fluid present in the post-surgical bed. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. Enlarged lateral, third, and fourth ventricles. Hydrocephalus consistent with prior history of Chiari I malformation. 2. Post-operative changes as described above."}
{"instruction": "Generate impression based on findings.", "input": "History of prematurity, global developmental delay, and chronic head banging. Evaluate for structural abnormality. No abnormal signal is seen on the T2, FLAIR or diffusion weighted images. Myelination is within normal limits for age. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.", "output": "Normal unenhanced brain MR."}
{"instruction": "Generate impression based on findings.", "input": "Status post TACE RFA. Assess for treatment response. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with fibrotic changes.Segment 6 ablation cavity measuring 5.0 x 4.6 cm without evidence of marginal recurrent or residual disease. Mild intrinsic T1 weighted signal intensity.No suspicious arterial enhancing or washing out liver lesion.Cholelithiasis without evidence of acute cholecystitis. No intra or extrahepatic biliary ductal dilatation. The portal and hepatic veins are patent.Trace perihepatic ascites.SPLEEN: Splenomegaly, measuring 18 cm in AP dimension. Trace perisplenic ascites.PANCREAS: Multiple small peripancreatic and porta hepatis lymph nodes, nonspecific in the setting of chronic liver disease. No pancreatic ductal dilatation or focal lesion. No peripancreatic inflammatory changes.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple small peripancreatic and porta hepatis lymph nodes, nonspecific in the setting of chronic liver disease. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Posttreatment changes from segment 6 radiofrequency ablation without evidence of residual or recurrent disease. No new suspicious liver lesion.Cirrhosis with trace ascites and splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "45 years Female (DOB:8/25/1970)Reason: please do dr javed MS protocol, dx MS, SLE as well as strokes History: progression weaknessPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple periventricular and subcortical T2 and FLAIR small hyperintense lesions identified in the periventricular and subcortical white matter. Additionally there are patchy T2 and FLAIR hyperintense lesions in the brainstem. There is no associated abnormal enhancing lesion within the brain parenchyma. There is a developmental venous anomaly present in the left frontal lobe.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Multiple periventricular and subcortical white matter lesions are present. These are nonspecific. These are usual for age 45. Demyelinating disorder is one explanation for this. Other explanations include vasculitis and vascular related lesions.2.Patchy lesions in the brainstem are present. These are nonspecific. There could be vascular related or related to demyelination or vasculitis."}
{"instruction": "Generate impression based on findings.", "input": "Left oropharyngeal, status post treatment. Persistent left facial and ear pain. There are treatment effects in the left upper neck. The left oropharyngeal mass is no longer discretely measurable. There is persistent fatty atrophy of the adjacent left tongue and there are stigmata of left vocal cord paralysis. There is also atrophy of the left facial expression muscles. There no significant cervical lymphadenopathy. The skull base and temporomandibular joints appear to be intact. The thyroid and salivary glands are unremarkable. The orbits are unremarkable, but there is a small right lateral periorbital skin nodule. There is an aberrant right subclavian artery. There is bilateral mastoid fluid.", "output": "1. Post-treatment findings in the neck and denervation changes involving multiple left cranial nerves, but no evidence of gross measurable tumor, including perineural tumor.2. Fluid in the bilateral mastoid air cells may represent mastoiditis."}
{"instruction": "Generate impression based on findings.", "input": "Recent craniotomy for posterior fossa tumor resection and history of NF2. There are recent postoperative findings related to suboccipital craniotomy with a small amount of expected fluid in the surgical bed. There interval decrease in size of a cystic component in a heterogeneously enhancing tumor within the medulla. The cystic component now measures up to 8 mm, previously 12 mm, and the tumor overall measures up to 31 mm, previously 33 mm. There is decreased effacement of the foramen of Magendie. Other stigmata of neurofibromatosis type 2 are otherwise unchanged, including small bilateral vestibular schwannomas, small intracranial meningiomas, and a left optic nerve sheath meningioma. There is no evidence of acute infarct. There is no abnormal intracranial enhancement. There is no ventriculomegaly. There is no midline shift or herniation. The major cerebral flow voids are intact. There are scattered foci of enhancement in the scalp, which correspond to the sites of the previously inserted stereotactic frame screws. There is mucosal thickening and fluid within the left maxillary sinus, as well as scattered mucosal thickening elsewhere within the paranasal sinuses. There is also a small amount of bilateral tympanomastoid fluid, which is nonspecific.", "output": "1. Recent postoperative findings related to suboccipital craniotomy for subtotal resection of an ependymoma within the medulla with decreased effacement of the foramen of Magendie.2. Other stigmata of neurofibromatosis type 2 are otherwise unchanged, including small bilateral vestibular schwannomas, small intracranial meningiomas, and a left optic nerve sheath meningioma. 3. Findings suggestive of acute sinusitis."}
{"instruction": "Generate impression based on findings.", "input": "Subarachnoid hemorrhage [430], Reason for Study: ^Reason: eval for bleeding History: s/p SAH, failing EVD clamping trials Motion artifacts degraded exam quality.No evidence of new ischemic infarct on the scan.Previously seen minimal subdural hematomas on tentorium, posterior fossa and left hemisphere appears to be slightly reduced or no change since prior scan.The interpeduncular fossa subarachnoid hemorrhage has been reduced in its extent since prior scan. On gradient echo image, there is evidence of susceptibility artifacts on the surface of corresponding area indicating possible hemosiderin deposition.Ventricle size is stable with right frontal approached ventriculostomy tube which is clamped.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 new acute ischemic or hemorrhagic lesion on this scan.2. Interval decrease of interpeduncular fossa subarachnoid hemorrhage extent with hemosiderin deposition on the surface of corresponding area.3. No change of ventricle size since prior scan.4. No abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other intervertebral disc degeneration, lumbosacral region Other spondylosis with myelopathy, lumbar regionClinical question: Evaluate pathology of new left LE weaknessSigns and Symptoms: New LLE weaknessComments: H/o spinal stenosis Cervical laminectomy 2006 | Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation present in the lower lumbar spineAt L5-S1 there is a left lateral recess disc extrusion present which impresses upon the nerve roots at the left lateral recess and displaces them and further extends into the left neural foramen where it encroaches on the left-sided exiting nerve roots. There are endplate reactive changes present at this level which are heterogeneous signal on T1 and T2. The disc extrusion was also present on the prior exams dating back to 2006. The endplate reactive change has progressed since 2006. Loss of disc space height at this level has progressed compared to 2006 is not significantly different than 2015.At L4-5 there is loss of disc space height associated with diffuse disc bulge and are shown effacement of the fat at the lateral recess bilaterally but worse on the right lateral recess versus the left lateral recess. Some disc material extends into the right neural foramen where it encroaches on the right-sided exiting nerve roots. There are endplate reactive changes present this level with large Schmorl's nodes. The disc bulge was also present on the prior exams dating back to 2006. The endplate reactive change has progressed since 2006. Loss of disc space height at this level has progressed compared to 2006 is not significantly different than 2015.At L3-4 there is redemonstration of a diffuse disc bulge which was also present on exams dating back to 2006. There is narrowing of the neural foramina present bilaterally with partial effacement of the fat surrounding the exiting nerve roots within the neural foramina. Endplate reactive changes are present at this level with Schmorl's nodes which has progressed since the 2006 exam.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.There are degenerative changes present in the lower lumbar spine which have been present dating back to 2006. There is associated encroachment of the left-sided exiting nerve roots at L5-S1 and right-sided exiting nerve roots at L4-5 with a mild degree of spinal stenosis at L4-5 which was also present in 2006. Endplate reactive changes and loss of disk space height have progressed since 2006."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male patient with left knee pain. Evaluate for medial meniscus repair and healing of trochlear microfracture. MENISCI: There is increased T2 signal within the body and posterior horn of the medial meniscus and the medial meniscus is diminutive in size, these findings are compatible with prior meniscal tear and meniscectomy. There is no new tear in the medial or lateral menisci.ARTICULAR CARTILAGE AND BONE: There is inhomogenous increased T2 signal intensity in the articular cartilage of the trochlea, compatible with history of microfracturing with production of fibrocartilage. There are no focal chondral defects identified.LIGAMENTS: Again seen is a chronic partial tear of the anterior cruciate ligament. The posterior cruciate ligament, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1.Findings consistent with prior surgery in the medial meniscus without new meniscal tear identified.2.Inhomogeneity of the femoral trochlea compatible with prior microfracturing and production of fibrocartilage. No focal chondral defect is identified.3.Chronic partial tear of the anterior cruciate ligament."}
{"instruction": "Generate impression based on findings.", "input": "Multiple myeloma, pelvic pain The examination is limited by patient motion artifact.Although we see no dominant focal myelomatous lesion, there is diffuse intermediate signal intensity of the marrow on both T1 and T2 sequences. This finding is nonspecific but could reflect myelomatous involvement. There is similar signal abnormality affecting the proximal femora and lower lumbar spine with a compression deformity of L4 noted. For further details regarding the spine, please refer to the accompanying lumbar MRI exam report. There is no evidence of fracture within the pelvis or proximal femora. The hip joints, sacroiliac joints, and pubic symphysis appear normal. The visualized soft tissues of the pelvis are unremarkable as well.", "output": "Although there is no dominant focal bone marrow lesion evident, there is diffuse intermediate signal intensity of the visualized marrow which is nonspecific in nature but could reflect myelomatous involvement. Other findings are described above."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Critical cervical stenosis requiring surgery. Signs and symptoms: Weak grip. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column.Unremarkable signal intensity of the vertebral column other than changes related to degenerative disease.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative degenerative disease and unremarkable otherwise.C3-C4 demonstrate moderate disc disease and loss of disc height, mild bulging disc and mild ligamentum flavum hypertrophy. Constellation of changes results in moderate central spinal stenosis, severe right and moderate left neural foraminal compromise.C4-C5 demonstrate mild disc disease and loss of disc height, shallow bulge of disc and moderate ligamentum flavum hypertrophy. Constellation of changes results in flattening and posterior displacement of the cord and severe central spinal stenosis with moderate right neural foraminal compromise.C5-C6 demonstrate mild degenerative disc and hypertrophic changes of posterior elements without spinal stenosis and mild right neural foraminal compromise.C6/C7 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C7-T1 demonstrate mild disc disease and mild bilateral facet and ligamentum flavum hypertrophy. There is no spinal stenosis however moderate right and mild-to-moderate left neural foraminal compromise is present.There is no evidence of signal abnormality of cervical or upper most visualized thoracic cord.", "output": "1.Degenerative changes at C3-C4 results in moderate central spinal stenosis and with severe right and moderate left neural foraminal compromise.2.Degenerative changes at C4-C5 resulting in severe central spinal stenosis an moderate right neural foraminal compromise.3.Normal signal intensity of the cervical and upper most visualized thoracic cord.4.Mild degenerative changes at other levels however without central spinal stenosis as detailed per level above."}
{"instruction": "Generate impression based on findings.", "input": "73 year old male with CAD (unclear history), cardiomyopathy, HTN, hyperlipidemia. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 117 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). There is global hypokinesis. There is late gadolinium enhancement present along the mid-wall and epicardial boundary circumferentially along the base and mid ventricle to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is atypical for myocardial infarction and also for cardiac amyloidosis. No evidence of myocardial iron overload. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 155 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 79 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThe esophagus is patulous. 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. Mild left ventricular dilation with mildly reduced systolic function (LVEF 43%). 2. There is late gadolinium enhancement present along the mid-wall and epicardial boundary circumferentially along the base and mid ventricle to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is atypical for myocardial infarction and also for cardiac amyloidosis.3. Normal right ventricular size with mildly reduced systolic function (RVEF 49%).4. Mild dilation of the main pulmonary artery.5. Patulous esophagus noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Other epilepsy, not intractable, without status epilepticus [G40.802], Reason for Study: ^Reason: please re-evaluate s/p lupus cerebritis with seizures History: Lupus cerebritis, temporal lobe epileptiform discharges Previously seen mass like lesions with peripheral enhancement and susceptibility artifacts at the right frontal lobe and left basal ganglia have been significantly reduced in size and changed MR characteristics. Specifically, the right frontal lobe lesion shows gyriform cortical encephalomalacia with enhancement and the left basal ganglia lesion only shows focal enhancement. Both lesions do not show surrounding edema. And both lesions show susceptibility artifacts indicating prior intralesional hemorrhages. There are remained FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter which again have been significantly decreased in their extent.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no other abnormal enhancing lesion.Constellation of above findings indicate interval improvement of multifocal brain lesions likely related to patient's SLE. Continuous enhancement of both right frontal and left basal ganglia lesions may indicate sustained inflammatory reactions. The ventricles, sulci and cisterns are symmetric and unremarkable. 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.Multiple enhancing nodules within the right parotid gland indicating benign lesions such as pleomorphic adenoma, unchanged.", "output": "1. Significant interval reduction of peripheral enhancement, surrounding edema and mass effects of both right frontal lobe and left basal ganglia lesions since prior scan since prior scan.2. Remained enhancement of above lesions may indicate sustained inflammatory reactions.3. No evidence of acute ischemic or hemorrhagic lesion on this scan. "}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with a history of right adrenal mass ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a wedge-shaped hypodense area within the left lobe liver likely representing focal fatty infiltration. MRI of the liver may be obtained for further evaluation.3.1 x 2.1 cm hypodense mass in the left lobe liver image number 55, series number 10 highly suspicious for metastatic disease.SPLEEN: Nonspecific 1.2-cm hypodense lesion in the spleen on image number 34, series number 10. Metastatic disease cannot be excluded.PANCREAS: No significant abnormality notedADRENAL GLANDS: There is an 18 by 16.5 by 22-cm mass superior to the right kidney. The mass indents and possibly invades the liver, IVC and the right kidney. This mass likely represents an adrenocortical carcinoma arising from the right adrenal gland. Left adrenal glands unremarkable.KIDNEYS, URETERS: Left kidney is unremarkable. Right suprarenal mass likely representing adrenocortical carcinoma inmates the right kidney. Venous collaterals posterior and lateral to the right kidney.RETROPERITONEUM, LYMPH NODES: IVC filter is in place. Retroperitoneal adenopathy. An index retrocaval lymph node measures 1.9 by 1.4 cm on image number 72, series number 10.IVC is invaded by the large mass. Major retroperitoneal vessels are displaced laterally and anteriorly by the mass.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Right suprarenal mass concerning for adrenocortical l carcinoma. The mass invades the IVC, right kidney and possibly liver.Left lobe lesion in the liver highly suspicious for metastatic disease. Focal fatty infiltration in the liver likely secondary to invasion of the IVC.Metastatic adenopathy.Nonspecific hypodense lesion in the spleen. Metastatic disease cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old woman with history of myelofibrosis on clinical trial, please measure spleen size. ABDOMEN:LIVER, BILIARY TRACT: The right hepatic lobe is relatively atrophied. Scattered T2 hyperintense hepatic cysts are stable.Patient is status post cholecystectomy. Additional perihepatic surgical clips are noted. There is mild, stable intrahepatic biliary ductal dilatation.The portal vein is thrombosed chronically with extensive collateralization and large splenorenal shunts.SPLEEN: The spleen is markedly enlarged but stable measuring 22.6 cm in craniocaudal dimension (12/19) and 16.3 x 11.5 cm in axial dimension (13/30). Small foci of heterogeneous T1 and T2 signal are again noted. Additionally, there are scattered foci of susceptibility artifact compatible with iron deposition.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple and hemorrhagic/proteinaceous renal cysts noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Marked splenomegaly similar in size to prior exams.2.No additional significant change from priors with persistent portal vein thrombosis and collateral shunting."}
{"instruction": "Generate impression based on findings.", "input": "Chronic back pain with signs of nerve impingement. There is multilevel degenerative spondylosis. At T12-L1, there is loss of disc space height and fatty endplate signal in the T12 vertebral body, but no significant spinal canal or neural foraminal stenosis. At L1 through L4, there is no significant spinal canal or neural foraminal stenosis either. At L4-5, there is a disc bulge, mild facet hypertrophy bilaterally, and ligamentum flavum thickening with mild neural foraminal stenosis, but no significant spinal canal narrowing. At L5-S1, there is a disc bulge, mild facet hypertrophy bilaterally, and ligamentum flavum thickening with mild neural foraminal stenosis, but no significant spinal canal narrowing. The vertebral column alignment is within normal limits. The vertebral body heights are preserved, aside from a Schmorl node in the inferior T11 vertebral body. There is no evidence of tumors. The imaged portions of the spinal cord display normal signal and morphology. The paravertebral soft tissues are unremarkable.", "output": "Degenerative spondylosis, with mild bilateral neural foraminal narrowing at L4-5 and L5-S1, but no significant spinal canal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Biceps pain LIGAMENTS: No significant abnormality noted.TENDONS: No significant abnormality noted. Specifically, the biceps tendon is intact.ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL", "output": "No evidence of internal derangement of the right elbow. Specifically the biceps tendon appears normal."}
{"instruction": "Generate impression based on findings.", "input": "Smoldering multiple myeloma. Assess for myelomatous involvement. THORACIC SPINE: There is multilevel degenerative cervical spondylosis that is better assessed on the recent cervical spine MRI, including minimal anterior subluxation of C7 relative to T1. Otherwise, the thoracic sagittal alignment is preserved. The vertebral body heights are preserved. Mild multilevel degenerative disc desiccation and height loss are most pronounced at T10-T11, where a small posterior central disc protrusion mildly narrows the spinal canal. There is also a small right foraminal disc protrusion along with right facet arthropathy resulting in mild T10 and T11 right neural foraminal stenosis. There is no other significant spinal canal stenosis. The vertebral bone marrow signal is unremarkable, accounting for mild degenerative signal anteriorly and T5-T6 and T10-T11. The spinal cord displays normal signal and morphology. There is no abnormal contrast enhancement. Apparent contrast enhancement in T7-T8 disc probably represents intrinsic T1 shortening rather than real enhancement. The esophagus is patulous. The paravertebral soft tissues are unremarkable.LUMBAR SPINE: There is a leftward convex curvature. Sagittal alignment is relatively preserved. The vertebral body heights are preserved. While the intrabody herniation in the inferior L1 has not changed, new intrabody herniations have developed at L2-L3 associated with mild subjacent contrast-enhancing marrow edema. This is associated with increased right-sided L2-L3 disc height loss and increased posterolateral, paracentral disc bulge resulting in left subarticular recess stenosis and moderate left neural foraminal stenosis while the mild right neural foraminal stenosis is unchanged. Otherwise, the vertebral bone marrow signal remain heterogeneous but without significant focal lesion. Focal contrast enhancement subjacent to the superior L3 endplate on the right correlates with small focal T2-hyperintensity, which is unchanged since the prior examination. The other levels show unchanged disc desiccation and height loss. The mild central and left paracentral canal stenosis at L3-L4 are unchanged, as well as the mild bilateral neural foraminal stenoses. Lower lumbar facet osteoarthritic changes along with small joint effusions are present. There is no significant spinal canal stenosis. The conus medullaris displays normal signal and morphology and its tip lies at lower L1 level. Heterogeneous pelvic marrow signal is not significantly changed from the prior MRI of May 17, 2016 and probably reflect posttreatment findings.", "output": "1.Thoracic spine: No definite myelomatous involvement in the thoracic spine. Mild multilevel degenerative spondylosis but no significant spinal canal stenosis or cord compression. Apparent contrast enhancement in T7-T8 disc probably represents intrinsic T1 shortening rather than real enhancement. 2.Lumbar spine: No definite myelomatous involvement in the lumbar spine. Multilevel degenerative spondylosis is most pronounced at L2-L3, where increased posterolateral, paracentral disc bulge results in left subarticular recess stenosis and moderate left neural foraminal stenosis. There has not been significant change of the multilevel spondylosis otherwise. 3.Heterogeneous pelvic marrow signal is not significantly changed from the prior MRI of May 17, 2016 and may reflect treatment effects. Please refer to the recent pelvis MRI for additional details.4.The esophagus is patulous, which may be associated with gastroesophageal reflux. "}
{"instruction": "Generate impression based on findings.", "input": "66-year-old woman with history of Crohn's and left-sided abdominal pain. Patient is status post ileocecectomy and hysterectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: Spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Patient is status post ileocecectomy. There is a short segment of concentric small bowel wall thickening involving approximately 5 cm of the neoterminal ileum (series 5, images 14-17) with mild postcontrast enhancement. There is mild fatty proliferation surrounding the neoterminal ileum. The small bowel and colon are otherwise normal. There is no evidence of obstruction.BONES, SOFT TISSUES: Postsurgical artifact noted in the ventral mid abdomen.OTHER: The patient is status post hysterectomy.", "output": "1. Thickwalled neoterminal ileum (located in right hemipelvis and involved segment seen directed towards the left, area of involvement measures approximately 5 cm) with decreased distensibility and mild postcontrast enhancement, suspicious for acute on chronic inflammation."}
{"instruction": "Generate impression based on findings.", "input": " The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. There is a aneurysm proximal to the left ophthalmic artery origin likely involving the left distal cavernous internal carotid artery, which measures approximately 4 mm in height and 4 mm at the base, and projects medially.MRA NECK", "output": "1. No significant stenosis in the intracranial circulation or the extracranial circulation in the neck.2. 4 mm left distal cavernous ICA aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "Left knee instability MENISCI: There is maceration of the lateral meniscus with only a small remnant of the anterior horn remaining. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is severe full-thickness cartilage loss of the medial compartment of both the femoral condyle and tibial plateau. There is associated degenerative marrow edema in the underlying subchondral bone. There is moderate thinning of the articular cartilage of the medial compartment with areas of near full-thickness degeneration as well. There is heterogeneity and partial-thickness loss of the medial patellar facet and associated femoral trochlea. The articular cartilage of the lateral patellar facet is preserved.LIGAMENTS: The anterior cruciate ligament is absent. PCL is intact. The MCL is intact. The lateral collateral ligament complex is performed. EXTENSOR MECHANISM: There is increased signal and thickening of the distal portion of the patellar tendon with osteophyte formation of the anterior tibia. The quadriceps tendon is intact.ADDITIONAL", "output": "1. Ruptured ACL.2. Maceration of the lateral meniscus.3. Severe osteoarthritis of the lateral compartment with moderate changes noted in the medial and patellofemoral compartment.4. Rupture of the lateral collateral ligament complex.5. Large joint effusion and Baker's cyst containing small foci of low signal intensity which likely reflect a combination of synovitis and/or debris/loose bodies. 6. Thickening and increased signal of the distal portion of the patellar tendon which may reflect partial tearing or tendinosis."}
{"instruction": "Generate impression based on findings.", "input": " There are postsurgical findings related to right neck dissection and resection of the posterior right hemimandible with hardware fixation and flap reconstruction of the right-sided pharyngeal soft tissues. There are also radiation effects in the nasopharyngeal region with mild swelling and mucositis, as well as edema in the right retromolar trigone region, but no measurable residual tumor within the right nasopharynx. There is also no significant cervical lymphadenopathy. There are denervation changes in the right tongue. There is a small area of high T2 signal and enhancement in the soft tissues posterior to the right mandibulectomy margin. The thyroid and remaining salivary glands appear unchanged. The imaged intracranial structures are unremarkable.", "output": "Post-treatment effects in the right nasopharyngeal region and right neck without definite measurable residual or recurrent locoregional tumor. A small area of high T2 signal and enhancement in the soft tissues posterior to the right mandibulectomy margin may be inflammatory in nature."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Kim is 38-year-old BRCA2 positive woman with personal history of left breast invasive carcinoma status post mastectomy and right breast lumpectomy for DCIS. She developed liver metastasis in 2013. She submitted outside studies for review which include mammograms (2/22/2016; 2/24/2026) and MRI (2/23/2016) performed at M.D. Anderson Cancer Center. There are no comparisons study available. MAMMOGRAM 2/22/16: The patient is status post left mastectomy and therefore right mammograms are submitted. Three standard and spot magnification views of the right breast were obtained. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There are postsurgical/posttreatment changes in the upper outer quadrant. Calcifications are noted in upper outer quadrant. These persist on the spot magnification views and appear amorphous and a loosely grouped to segmental distribution. No suspicious masses identified in the right breastMRI 2/23/16:Axial T1, and fat saturated axial and sagittal postcontrast as well as diffusion weighted sequences were submitted. There is moderate heterogeneous fibroglandular elements in the right breast. Minimal background enhancement is present. There is no suspicious mass or non mass enhancement. Specifically, there are no abnormal findings and distribution of the calcifications seen on mammogram in the upper outer quadrant.There are postsurgical changes of left mastectomy and reconstruction. There is no suspicious enhancement in the mastectomy bed or chest wall.No gross axillary lymphadenopathy.MAMMOGRAM 2/24/2016:Static images from right breast stereotactic biopsy targeting the calcifications in the upper-outer quadrant were submitted. Targeted and is appropriate. Biopsy marking clip was applied. Postbiopsy mammograms demonstrate the clip to be in good position in the upper outer quadrant of the right breast, along with postbiopsy changes, about 1 cm displaced from some residual calcifications. Specimen radiograph showed calcifications.Pathology report is not available at this time.", "output": "Status post stereotactic biopsy of low suspicion right breast calcifications. Correlation with biopsy pathology is recommended. A benign result could be considered concordant based on the low level of suspicion and negative MRI. Status post previous left mastectomy with reconstruction and previous right lumpectomy. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of fracture History: assess previous fracture. BONE MARROW: Linear T2 hyperintense signal with the bilateral sacral wings compatible with bilateral insufficiency fractures. Otherwise bone marrow signal is diffusely T1 hypointense compatible with red marrow likely secondary to chemotherapy given patient's history. SOFT TISSUES: Diffuse fatty muscle atrophy. Diffuse muscle edema. JOINTS: No significant abnormality noted.ADDITIONAL", "output": "Bilateral sacral insufficiency fractures and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "70 years, Male, vision loss out of proportion to exam. Evaluate for CNS pathology including optic nerves, chiasm. Vision loss left greater than right eye. Brain: No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. There is a punctate focus of susceptibility in the left temporal white matter as well as in the the right anterior pons/midbrain junction consistent with chronic microhemorrhages and are nonspecific in distribution. There are patchy areas of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic disease. Multiple lacunar infarcts are evident involving the posterior right frontal centrum semiovale and corona radiata as well as the right thalamus. No hydrocephalus. No extra-axial collections. There is mild global parenchymal volume loss. Sella is grossly unremarkable. Major flow-voids are preserved. Paranasal sinuses and mastoid air cells are grossly clear. No lesions involving the calvarium.Orbits: There is no mass within the bilateral orbits. No lesion involving the orbital apices, cavernous sinuses, parasellar region, or optic chiasm. There is motion degradation on multiple sequences which limits assessment of signal abnormality involving the optic nerves. There is question of volume loss involving the bilateral optic nerves.", "output": "1. There is no evidence of intracranial mass or mass effect. Note examination is limited to noncontrast sequences due to patient's severe renal insufficiency and is also motion degraded. 2. Examination quality is inadequate for assessment for optic nerve signal abnormality. There is however no intraorbital mass or mass effect on the optic nerves or chiasm. There is suggestion of volume loss involving the bilateral optic nerves.3. Chronic small vessel ischemic disease with multiple lacunar infarcts as described above. There are also two small foci of chronic microhemorrhage in a nonspecific distribution."}
{"instruction": "Generate impression based on findings.", "input": " BRAIN: There are numerous T2 hyperintense lesions within the supratentorial white matter. Some have resolved or decreased in size while others have increased in size or occurred in the interval since the prior exam; with the most prominent new lesion located in the deep right frontal white matter extending into the genu of the corpus callosum. Many of these new lesions enhance and many of the larger lesions have associated T1 hypointensity. There are no posterior fossa lesions identified. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are two unchanged punctate foci susceptibility effect within the right parietal lobe. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mild mucosal thickening within the left maxillary sinus.CERVICAL SPINE: There are several ill-defined T2 hyperintense lesions throughout the cervical spine without associated cord expansion. These appear grossly decreased in signal intensity and number while an enhancing lesion at the C3 level has resolved. There are however two new bilateral enhancing T2 hyperintense lesions at the C6 level. There is minimal unchanged myelomalacia at the level of C4. 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 paravertebral soft tissues are unremarkable.", "output": "1.Numerous intracranial lesions isolated to the supratentorial compartment. Some have resolved or decreased in size, while some are new or have increased in size. 2.Numerous cervical spinal cord lesions. Some have resolved or decreased in size, while there are two new enhancing lesions at the C6 level. There is also unchanged mild myelomalacia at C4. "}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with right patellofemoral syndrome and chondromalacia. Prior arthroscopy with chondroplasty many years prior. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is a partial-thickness articular cartilage fissuring along the medial facet of the patella. There is thinning and irregularity of the articular cartilage along the medial facet of the patella which may represent postsurgical changes versus articular cartilage degeneration or a combination of both. There is subchondral bone marrow signal abnormality within the patella, likely degenerative in etiology. There is relative sparing of the articular cartilage of the medial and lateral compartments.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Partial-thickness articular cartilage fissure along the medial facet of the patella. Thinning and irregularity of the articular cartilage along the medial facet may reflect postsurgical changes versus articular cartilage degeneration as described above.2. Small to moderate size joint effusion. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Neck pain with C6 inflammation, right arm pain, 1 year follow up eval for changes. There are multiple unchanged vertebral segmentation anomalies, including congenital fusion of C3 through C6 with a \"wasp-waist\" morphology and a dysmorphic dens. There are also postoperative findings at C1-2 posterior fusion with cerclage wire and screws. There is an apparent punctate focus of high T2 signal in the spinal cord at the C2 level with associated mild volume loss. The cervical vertebral column alignment is unchanged. There is a mild posterior disc-osteophyte complex and ligamentous hypertrophy at the level of C6-C7 that results in mild spinal canal narrowing and moderate right neural foramen narrowing. There is also a mild posterior disc-osteophyte complex at C2-3 with mild right spinal canal and moderate right neural stenosis. There is a partially-imaged cystic space superior to the cerebellar vermis, which appears flattened.", "output": "1. Unchanged postoperative findings at C1-2 and multilevel vertebral segmentation anomalies.2. A posterior disc-osteophyte complex and ligamentous hypertrophy at the level of C6-C7 results in mild spinal canal narrowing and moderate right neural foramen narrowing.3. A posterior disc-osteophyte complex at C2-3 results in mild right spinal canal and moderate right neural stenosis.4. A partially-imaged cystic space superior to the cerebellar vermis may represent an arachnoid cyst. A brain MRI may be useful for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Wedge-shaped abnormalities on CT scan. HCV Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with left and caudate lobe hypertrophy and mild diffuse fibrotic changes. Fibrosis and atrophy of the anterior segment of the right hepatic lobe without a focal lesion or biliary ductal dilatation.No suspicious liver lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder. The vessels are patent.SPLEEN: Splenomegaly measuring 19.7 cm in craniocaudal dimension with numerous Gamna-Gandy bodies.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Extrarenal pelvis bilaterally.RETROPERITONEUM, LYMPH NODES: Upper abdominal collateral vessel formation.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Cirrhotic liver with fibrotic changes of the anterior segment of the right hepatic lobe without a suspicious lesion."}
{"instruction": "Generate impression based on findings.", "input": "89-year-old female with mental status changes and recent falls. There is no evidence of intracranial hemorrhage, mass or edema. Previously described left posterior parietal stroke appear stable without evidence of hemorrhage or interval acute cortical stroke. Multiple areas of patchy hypodensity in a periventricular distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for new acute ischemia, MRI may be considered.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": "Nonhemorrhagic cortical stroke in the left posterior parietal region without interval change."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Multiple sclerosis. Please perform multiple sclerosis protocol. Signs and symptoms: Multiple sclerosis progression. Pre and post enhanced brain MRI:Examination is performed utilizing dedicated Dr. Javed's multiple sclerosis protocol.Precise comparison difficult due to significant technique difference between the 2 exam. Current exam is performed utilizing dedicated multiple sclerosis protocol and prior study is a routine brain MRI examination.Within this limitation there is no detectable demyelinating disease in the posterior fossa.Images through the supratentorial space demonstrate findings consistent with mild chronic demyelinating disease. No detectable abnormal enhancement.Examination demonstrates mild interval progression of disease since prior exam. Several tiny new lesions are identified however none without evidence of enhancement. Note should be made that 2 mm slices on current exam could conceivably demonstrate larger number of lesion compared to prior study.Cortical sulci and ventricular system are within normal and with maintained midline.The signal void of major intracranial arterial branches are identified.", "output": "1.Negative diffusion weighted series.2.Mild chronic changes of demyelinating disease only in the supratentorial space with subtle interval progression since 2013 as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "HCV cirrhosis, HCC screening ABDOMEN:LIVER, BILIARY TRACT: Slightly nodular hepatic morphology without arterially enhancing lesions. The hepatic vasculature is patent. No biliary duct dilation. The gallbladder is normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Duodenal diverticulum.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "1.No arterially enhancing lesions to suggest HCC."}
{"instruction": "Generate impression based on findings.", "input": "History of renal carcinoma and vertebral compression fractures. Thoracic spine: The expansile, lobulated metastatic lesion involving the left side of the T3 vertebra is overall slightly smaller, with almost complete resolution of the mass-effect on the thecal sac. In the axial plane, the mass along with its left paraspinal component measures 5.7 cm x 5.4 cm compared to 6.7 cm x 6.0 cm, previously. Obliteration of the left T2-T3 and T3-T4 neural foramina persists. The T7-L3 posterior fixation hardware, which is composed of bilateral transpedicular screws at T7, T8, T11, T12, L2 and L3 and dual posterior rods remain grossly unchanged. The metastatic, expansile lesion involving T9 and the smaller T10 vertebral body lesion are also improved with almost complete resolution of the mass-effect on the thecal sac at T9. The mild right T9 vertebral body compression fracture is unchanged or minimally increased. Vertebral body heights across the fused segment also remain preserved. The thoracic spinal cord shows normal signal and shape.Lumbar spine: There is an expandible cage is present in the right corpectomy defect at L1. Epidural extension of tumor at this level has virtually resolved. There is no significant change in a subcentimeter enhancing lesion in the inferior L5 vertebral body. There is no significant spinal canal stenosis at any of the lumbar spine levels. The L2 through L5 vertebral body heights are preserved. The metastatic, expansile lesions involving the right sacral ala are slightly smaller with less impingement on the epidural fat and nerve sleeves of the right first and second sacral nerves. Another lesion involving the left iliac crest is better defined and perhaps slightly larger and now contains foci of central T2-hyperintensity and peripheral T2-hypointensity. There are changes of previous left nephrectomy. The right adrenal mass is not completely imaged, while the left adrenal mass is not significantly changed in size, but shows central T2-hyperintensity, which may reflect necrosis.", "output": "1.The expansile metastatic lesions at T3 and T9 are overall smaller with almost complete resolution of the mass-effect on thecal sac. Also, the smaller T10 vertebral body lesion has regressed since January 2016. Mild right sided T9 vertebral body compression fracture is unchanged or minimally increased.2.The minimally expanded metastatic lesion at L1 vertebral body is slightly improved, with no significant impingement upon the lumbar spinal canal.3.A metastatic lesion involving the right sacral ala is also slightly smaller, with less impingement on the sacral neural foramina, while the left iliac crest metastatic lesion appears to be slightly larger, but may also feature treatment effects. 4.The left adrenal mass now demonstrates necrosis, while the right adrenal lesion is not completely imaged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " There is chronic loss of white matter volume with associated gliosis bilaterally, most notable involving frontoparietal and parietal lobes, associated with ex vacuo dilatation of the lateral ventricles as well as thinning of the corpus callosum. 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. Fluid is present within a few paranasal sinuses as well as pooling within the nasopharynx, consistent with intubation. There is no abnormal enhancement within the brain.", "output": "1.There is chronic loss of white matter volume with associated gliosis bilaterally, most notable involving frontoparietal and parietal lobes, associated with ex vacuo dilatation of the lateral ventricles as well as thinning of the corpus callosum from remote ischemia.2.No Chiari malformation."}
{"instruction": "Generate impression based on findings.", "input": "Fatigue, paresthesias and urinary frequency. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or mass effect. There are a few unchanged scattered nonspecific punctate foci of T2hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are subcentimeter probable retention cysts in the maxillary sinuses.", "output": "Few unchanged scattered nonspecific punctate foci of T2hyperintensity in the cerebral white matter."}
{"instruction": "Generate impression based on findings.", "input": "Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: Evaluate for L MCA territory ischemia History: dysarthria Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal scattered bihemispheric susceptibility lesions are seen, unchanged since prior scan suggesting chronic petechial hemorrhage or mineralization.Multifocal lacunar infarcts involving bilateral basal ganglia, thalami, and pons are again seen, unchanged.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate complete occlusion of left MCA M1 segment. Otherwise, unchanged right ACA A2 occlusion, significant luminal stenosis of the left ACA P segment and irregularity of bilateral PCA P2 segments.No evidence of intracranial arterial aneurysm.", "output": "1. No evidence of acute ischemic or new hemorrhagic lesion on the scan.2. Multifocal susceptibility lesions on bilateral hemisphere, brainstem and cerebellum are again seen, unchanged.3. No evidence of abnormal enhancement.4. Left MCA M1 segment and right ACA A2 segment occlusions as well as multifocal intracranial arterial luminal stenosis indicating intracranial arthrosclerotic changes are again seen, unchanged since prior scan."}
{"instruction": "Generate impression based on findings.", "input": " BRAIN: There is a large confluent region of T2 hyperintensity within the right frontal and parietal subcortical and deep white matter centered around the central sulcus. There is mild associated T2 hyperintensity of the corticospinal tracts extending into the internal capsule posterior limb. There is no associated mass effect, susceptibility effect, diffusion restriction, or enhancement. There is no evidence of intracranial hemorrhage acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. SPINE: There is abnormal T2 hyperintensity extending the length of the spinal cord but most prominent in the cervical region extending from C2 through C7 where there is cord expansion. There is a 3-mm rounded focus of intramedullary enhancement within the conus at the L1 level. 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 conus terminates at L2. The paravertebral soft tissues are unremarkable. The bladder is distended.", "output": "Large confluent focus of signal abnormality involving the right frontal and parietal white matter as well as signal abnormality throughout the spinal cord, most prominent within the cervical cord where there is cord expansion. These findings are most compatible with a demyelinating process such as ADEM. Follow-up is recommended to ensure improvement. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Possible persistent tendonitis versus FCU tendon tear at the level of the forearm and into the wrist History: pain with activity Bone marrow signal intensity is normal. The signal intensity of the musculature is normal on the T1 and fat suppressed T2-weighted images. However, there is slight increased signal intensity of the abductor pollicis longus and extensor pollicis longus muscles as well as of the brachioradialis, flexor carpi radialis and palmaris longus muscles following contrast administration. The clinical significance of this finding is uncertain. The flexor carpi ulnaris muscle and tendon appear normal. Please note that this study is not optimal for evaluation of the tendinous and ligamentous structures of the elbow, but we see no elbow joint effusion. Additionally, we see no soft tissue masses.", "output": "Minimal enhancement of a few of the anterior and posterior compartment muscles as described above, which is of questionable clinical significance. We see no abnormality of the flexor carpi ulnaris muscle or tendon or other specific findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Male, 37 years old, with left-sided numbness, burning lesion noted on outside MRI. An oval, T2 hyperintense and mildly diffusion restricting lesion is evident within the white matter adjacent to the posterior body and atrium of the right lateral ventricle. The lesion measures 29 x 23 mm on axial images and has not significantly changed in overall size. On postcontrast images, this lesion demonstrates incomplete ring enhancement with the open end of the ring oriented away from the ventricle. The pattern of enhancement is similar to that seen on the prior examination, though it is somewhat better defined on today's study.The lesion exerts only mild local mass effect. The right lateral ventricle is of smaller caliber than the left but this is felt to be due to anatomic variation rather than the lesion as this asymmetry involves the entire ventricle.Multiple additional small foci of T2 hyperintensity are seen elsewhere in the periventricular regions. These are most notable in the left periatrial white matter.No evidence of any intracranial hemorrhage or significant susceptibility artifact is seen. No abnormal extra-axial collections are detected. Parenchymal enhancement is otherwise unremarkable.Single and multi voxel spectroscopic assessment of the dominant right periventricular lesion shows mildly to moderately reduced NAA, and mildly elevated choline. Portions of the lesion show significant lipid resonances along with a smaller quantity of lactate. No unusual resonances are identified. Normal-appearing tissue immediately adjacent to the lesion shows normal spectra or only mild alterations of the expected metabolite patterns.On perfusion imaging, relative CBV is reduced over a majority of the dominant lesion with only small scattered areas of elevated relative CBV along the periphery of the lesion.", "output": "A lesion is redemonstrated in the periventricular white matter along the right lateral ventricle which shows little significant interval change. Lesion location and morphology, and particularly the incomplete ring pattern of enhancement, along with the presence of additional smaller white matter lesions on the left, are most suggestive of a demyelinating process.The MR spectroscopic pattern of this lesion, while nonspecific, is compatible with a significant inflammatory process such as demyelination. The pattern is not supportive of a high-grade neoplastic process, and no specific features of either bacterial or fungal infection are seen. Perfusion imaging is reassuring for a benign process as a majority of the lesion demonstrates reduced rCBV. Alternate diagnostic considerations, including low-grade neoplasm or infection, are considered less likely at this time."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified abnormalities of gait and mobility, evaluate for hemorrhagic lesion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter and in the pons. There is no abnormal intracranial enhancement. The ventricles and cortical sulci are mildly prominent compatible with mild volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal mucosal thickening in the anterior ethmoidal air cells. The skull, and scalp soft tissues are grossly unremarkable. There is a left lens implant.", "output": "1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Scattered bilateral cerebral and pontine white matter hyperintensity including pons may relate to mild chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with cirrhosis. Evaluate biliary tree for obstruction. Total bilirubin of 35.9 mg/dL. ABDOMEN:Limited exam due to patient's body habitus, ascites, and respiratory motion artifact.LIVER, BILIARY TRACT: Cirrhotic pathology of the liver. Small simple cyst of the posterior right hepatic lobe. No normal flow void is identified in the left portal vein, and there is an incomplete flow void within the main pulmonary vein (axial series 5 image 29). No definite intra or extrahepatic biliary ductal dilatation is identified, however the exam is limited due to the patient's body habitus, ascites, and respiratory motion artifactSPLEEN: Splenomegaly measuring 21.3 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Suboptimal evaluation due to lack of intravenous contrast and artifacts related to ascites and body habitus. No definite intrahepatic biliary ductal dilatation. The lack of a normal left portal vein flow void and incomplete flow void of the main portal vein are concerning for thrombus, however further evaluation with postcontrast imaging is recommended. Additionally, parenchymal lesions cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "Enlarged orbital muscles: proptosis. Orbits: There is interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior rectus muscle. There is mild protosis bilaterally, right more than left, which appears to be attributable to diffuse prominence of the orbital fat. Otherwise, the bilateral globes, lacrimal glands, and optic nerves bilaterally are intact. There is no evidence of orbital mass lesions.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are nonspecific punctate foci of T2 hyperintensity in the right parietal lobe white matter. The brain, brainstem, and cerebellum otherwise appear unremarkable. There is no abnormal meningeal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. Interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior rectus muscle, which may be related to evolution of an inflammatory process, such as sarcoidosis. Otherwise, mild protosis bilaterally, right more than left, appears to be attributable to diffuse prominence of the orbital fat.2. Mild thickening of the pituitary infundibulum may represent an inflammatory process as well, such as sarcoidosis.3. No evidence of intracranial hemorrhage, mass, or acute infarct. Punctate foci of T2 hyperintensity in the right parietal lobe white matter are nonspecific, but may represent chronic small vessel ischemic disease, for example. "}
{"instruction": "Generate impression based on findings.", "input": "History of olfactory groove meningioma resection on 2/25/15: surveillance. There are postoperative findings related to recent bifrontal craniotomy with areas of confluent T2 hyperintensity and scattered foci of susceptibility along the margins of the resection cavity. There is an enhancing mass in the posterior aspect of the resection cavity, adjacent to the anterior cerebral arteries, that measures up to approximately 20 mm. There is also unchanged enhancement tumor along the left planum sphenoidale that measures up to 10 mm in thickness, adjacent to the left optic nerve. The ventricles are unchanged in size and configuration. There is no evidence of acute territorial infarction.", "output": "Postoperative findings related to olfactory groove meningioma resection with no significant interval change in size of the residual tumor in the posterior aspect of the resection cavity and along the left planum sphenoidale. "}
{"instruction": "Generate impression based on findings.", "input": "Inflammatory myositis The exam is limited by motion artifact and by patient's body habitus.Left: The muscles of the thigh are normal in caliber and signal. There is no abnormal enhancement following contrast administration. The marrow signal of the femur is normal.Right: The muscles of the thigh are normal in caliber and signal. There is no abnormal enhancement following contrast administration. The marrow signal of the femur is normal.", "output": "Normal appearance of the thigh musculature."}
{"instruction": "Generate impression based on findings.", "input": "Reason: S/P uterine artery embolization History: uterine fibroids, s/p uterine artery embolization. PELVIS:UTERUS, ADNEXA: Enlarged uterus with innumerable heterogeneous T2 hypointense enhancing masses compatible with fibroids has decreased compared to prior. Previous reference largest left subserosal mass measures 11.7 x 7.7 x 12.9 cm (series 1001 image 44, series 1201 image 12), previously 14.6 x 8.7 x 15.9 cm. Previous referenced largest right subserosal mass measures 7.5 x 6.4 x 7.1 cm, previously 8.8 x 8.0 x 9.8 cm. The largest fibroids, which previously enhanced homogeneously, no longer demonstrate enhancement. Some of the smaller fibroids continue to demonstrate enhancement.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": "Interval decrease in size and enhancement of uterine fibroids compatible with some treatment response. "}
{"instruction": "Generate impression based on findings.", "input": "66 years Male (DOB:2/5/1950)Reason: rule out stroke History: L facial droop, dysarthriaPROVIDER/ATTENDING NAME: JAMES J. WALTER DAVID G. BEISER MRI of the brainPatchy foci of diffusion restriction are present in the right centrum semiovale, body of the caudate nucleus and lateral aspect of the precentral gyrus with some punctate foci of diffusion restriction in the right parietal lobe. There is associated T2 and FLAIR signal hyperintensity with the diffusion restriction.The right medullary veins and cortical veins are asymmetrically larger compared to their left sided counterparts.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The right MCA is occluded at its origin.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, left middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is ACA triplication with a median artery. There is fetal origin of the left PCA. The left P1 segment is small. The right PCOMA is not readily visualized. The right vertebral artery is small.", "output": "1.Right MCA occlusion at its origin.2.Subacute infarction along the right MCA territory as detailed above3.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Low back pain [M54.5], Reason for Study: ^Reason: Back pain and h/o multiple myeloma and pathologic fracture History: Low back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multi-level vertebral body compression fractures including L2, L3 and L4.The L2 shows about 50% and L3 shows about 30% of height loss with minimum retropulsion of fractured fragment. The L3 vertebral body shows signal void area which corresponds to injected PMMA.The L4 shows focal 20% (mainly posterior fragment) height loss with high signal intensity on STIR images, minimal or no retropulsion is seen.The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L2-L3: diffuse bulging of disc, minimal bilateral neuroforaminal narrowing is seen. no evidence of spinal stenosis. L3-L4: diffuse bulging of disc with bilateral ligamentum flavum thickening results moderate spinal canal stenosis. L4-L5: diffuse bulging of disc with bilateral ligamentum flavum thickening results moderate spinal canal stenosis.. L5-S1: no neuroforaminal narrowing or spinal stenosis.", "output": "1. Multi-level compression fractures including L2, L3 and L4 as described above.2. Post PMMA injection status of L3.3. Multi-level various degree degenerative changes of lumbar spine as described above."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Personal history of malignant neoplasm of other and unspecified parts of oral cavity and pharynxClinical question: h/o HNC, please compare to previous measurements Brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Neck:The patient is status post left submandibular gland removal.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.The right jugular digastric node measures 11 x 8 mm axial dimensionsThere is a 7 x 9 mm axial dimension right retropharyngeal node of Rouviere present it previously measured 9 x 5 mm axial dimensions.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the right submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are degenerative changes in the cervical spine with endplate and uncovertebral osteophytes at C4-5 and C5-6 with only mild narrowing of the spinal canal .", "output": "1.Compared to the prior exam the patient's examination has not changed. There are number of lymph nodes in the right suprahyoid neck which are stable and compared to the previous exam and do not meet size criteria for adenopathy.2.There is no evidence for brain metastases or perineural spread.."}
{"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 \u201ctime-out\u201d form was completed.he patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 18 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\u2019s 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: 26 seconds", "output": "Successful image guided injection of the right hip followed by MR arthrogram; MRI report to follow."}
{"instruction": "Generate impression based on findings.", "input": " There are unchanged postoperative findings related to left parietal craniotomy for resection of a left frontal lobe mass with associated susceptibility effect in and adjacent to the resection cavity compatible with chronic blood products. Additional small scattered areas of susceptibility artifact, for example in the left frontal lobe, may be related to development of cavernous malformation from prior radiation treatment. Since current exam was performed in 3T MRI, those lesions appear to be more conspicuous than prior exam performed in 1.5T on Mar 2016. Considering the difference in magnet strength, there is no significant interval difference in terms of numbers and distribution. There is a persistent extra-axial fluid collection subjacent to the craniotomy flap. There is unchanged confluent T2 hyperintensity without associated mass effect within the left frontal white matter, in the region of the treatment bed. However, there is no enhancement in the region of the resection cavity. There is no evidence of acute infarct likely related to gliosis. 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 and paranasal sinuses are unremarkable.", "output": "1. MRI of the brain with and without contrast is negative for tumor progression. 2. A few scattered areas of gradient susceptibility may be related to chronic hemosiderin deposition versus developing cavernous malformations from prior radiation treatment, unchanged since prior scan considering the difference in examining magnet strength."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: New daily headaches. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.There is normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal parenchymal, leptomeningeal or calvarial enhancement. Unremarkable images through the orbits and including axial fat sat post enhanced series.There is complete opacification of the larger right chamber sphenoid sinus with intense mucosal enhancement and consistent with chronic sinus disease. Mild bilateral maxillary sinus mucosal thickening consistent with chronic sinusitis is also present. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.", "output": "1.Unremarkable pre-and post enhanced brain MRI.2.Complete opacification of larger right chamber of sphenoid and bilateral maxillary mucosal thickening consistent with chronic sinusitis."}
{"instruction": "Generate impression based on findings.", "input": "Locally recurrent endometrial cancer, now noticing \"tingling\" at vertex and pain at back of head when laying down. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal scattered cerebral white matter T2 hyperintensity, which is nonspecific. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a subcentimeter probable hemangioma in the let frontal bone. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "No evidence of intracranial metastases."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old man with history of cirrhosis, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in morphology with increased parenchymal signal on opposed phase images. No focal hepatic lesions are identified. The portal vein is occluded and the SMV is not visualized. There is evidence of nonocclusive thrombus in the portal collateral vasculature (series 1001, image 59).The gallbladder is distended with a gallstone at the neck. No evidence of cholecystitis.SPLEEN: The spleen is mildly enlarged. Numerous splenic varices are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Subcentimeter hyperintense T2 foci in the kidneys likely represent cysts. The kidneys are otherwise normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted of the partially visualized small bowel and colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Cirrhotic morphology of the liver without suspicious focal hepatic lesion.2.Portal vein occlusion, SMV occlusion, collateralization with thrombus, and mild splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Male, 5 years old, with history of tectal plate juvenile pilocytic astrocytoma, status post biopsy and subtotal resection with third ventriculocisternostomy at an outside hospital, status post laser ablation in 5/15, with progressive growth of the lesion, status post repeat ablation. T1 postcontrast imaging was acquired before and after laser ablation of the tectal plate lesion. Preablation images demonstrate positioning of the right frontal approach laser probe within the heterogeneously enhancing tumor. Post ablation images demonstrate increased confluent enhancement which appears to completely encompass the original lesion. A right frontal approach Ommaya catheter is in place with its tip terminating in the region of the right caudate. The lateral and third ventricles remain dilated similar to prior.", "output": "Expected findings status post laser ablation of the tectal plate tumor."}
{"instruction": "Generate impression based on findings.", "input": " Hand, foot, and tongue sensorimotor areas mapped to their expected locations along the pre- and post-central gyri. Language activity is left dominant but with some mild contribution from the right. Dominant Wernicke's area activity is present on the left along the superior temporal sulcus, with mild activity on the right. Less robust but detectable Broca's area activity activity is seen in the inferior frontal lobe, left side more than right. There is strong secondary language within the left middle frontal gyrus on all tested paradigms.", "output": "1.Language activity is left dominant but with some mild contribution from the right hemisphere as well. 2.Sensorimotor activity maps as expected along the pre- and post-central gyri. "}
{"instruction": "Generate impression based on findings.", "input": " There is exaggeration of cervical lordosis with persistent 4-mm retrolisthesis of C3 on C4. There is incomplete fusion of C5-6 vertebral bodies. The bone marrow signal is within normal limits. The imaged cord shows normal caliber and signal intensity. There is multilevel disk desiccation and loss of disk height at C3-4, C4-5 and C6-7.C2-3: No disk herniation or spinal stenosis.C3-4: 4-mm retrolisthesis of C3 on C4 with ligamenta flava thickening causing mild spinal canal stenosis, and moderate left and mild right neural foraminal stenosis.C4-5: No disk herniation or spinal stenosis.C5-6: Incomplete fusion of C5 and C6 with no significant disk/endplate degenerative changes or spinal stenosis.C6-7: No disk herniation or spinal stenosis. C7-T1: No disk herniation or spinal stenosis.", "output": "No significant interval change in multilevel cervical spondylosis as detailed above with moderate spinal canal stenosis at C3-4."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with knee pain for months with sharp pain and catching and giving out with stairs, fast walking and twisting. History of prior lateral release and scope and history of arthritis. MENISCI: There is a complex tear of the posterior horn of the medial meniscus with both horizontal and vertical components. The anterior horn of the medial meniscus appears normal. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is subchondral bone marrow edema within the medial femoral condyle and medial tibial plateau compatible. There is generalized thinning of the articular cartilage along the medial femoral condyle and medial tibial plateau with areas of full-thickness intermediate signal intensity defects extending to the subchondral bone with associated bone marrow edema. There is generalized thinning of the articular cartilage of the patella.LIGAMENTS: There is edema surrounding the medial collateral ligament compatible with sprain. The lateral collateral ligament appears normal. The anterior and posterior cruciate ligaments appear normal. EXTENSOR MECHANISM: The extensor mechanism appears normal.ADDITIONAL", "output": "1. Complex tear of the posterior horn of the medial meniscus with both vertical and horizontal components.2. Subchondral bone marrow edema within the medial femoral condyle and medial tibial plateau. There is a moderate joint effusion about the knee.3. Medial collateral ligament sprain.4. Articular cartilage thinning and degeneration as described above."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with breast cancer, in need of evaluation. Patient participating in ISPY2 study. MRI #1 for ISPY2. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a heterogenously enhancing mass at the 5:00 position, posterior depth in the left breast, which demonstrates heterogeneous intrinsic signal, with areas of distinct high and low T2 signal, suggesting recent biopsy, and consistent with biopsy-proven breast cancer. The mass measures 3.4 x 3.6 x 2.8 cm (AP X ML X CC), without significant associated nonmass enhancement. No definite associated clip artifact is noted. No additional suspicious enhancing lesions are seen within the left breast.No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "1.Enhancing left breast mass consistent with biopsy-proven breast cancer as detailed above.2.No abnormal enhancement in the right breast.3.No evidence of axillary lymphadenopathy.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Suprasellar tumor. The study is very limited by artifact related to dental braces. The diffusion and gradient/SWI images are nondiagnostic.The patient did have a right frontal craniotomy and subfrontal approach to the mass. Small, heterogeneous collection overlying the right frontal lobe causes no significant mass effect.There is a large, lobulated, well-circumscribed suprasellar mass (separate from the pituitary gland). The mass measures in the coronal plane 3.7 cm x 3.3 cm. Anterior posteriorly, it measures 2.2 cm on the sagittal plane. The mass is heterogeneously T2 hyperintense and shows intense but heterogeneous contrast enhancement. The mass is heterogeneously T1-hypointense relative to gray matter with focus of intrinsic T1 shortening in the dependant part of the cystic component of the mass (which happen to be more intensely T2 bright as well and are new since the previous, preop MRI). These focus might be related to layering postbiopsy hemorrhage and measures axially 3 x 17 mm. The mass is associated with compression of the third ventricle and splaying of the thalami superiorly. There is also edema-like signal along the adjacent left optic tracts. It also stretches the optic chiasm from posteriorly. It laterally displaces without circumferentially encasing the supraclinoid internal carotid arteries as well as the A1 segments. It causes similar mass effect on the tip of the basilar artery and the P1 segments. Compared to the preoperative examination, the very anterior-inferior part of the mass has been resected. The remainder of the mass has not changed. Intracranial major vessels remain patent. There is incidental posterior left frontal developmental venous anomaly.The paranasal sinuses and the mastoid air cells remain clear.", "output": "1.Large suprasellar mass is most compatible with a craniopharyngioma. The mass has relationship to adjacent structures as described above.2.Since the examination of August 9, 2015, the mass has been partial resection as described above.3.Dependent, layering focal T1/T2 hyperintensity within the mass is new and may represent minimal intralesional hemorrhage."}
{"instruction": "Generate impression based on findings.", "input": "Male, 59 years old, with memory decline. Numerous scattered foci of T2 hyperintensity are seen within the white matter of the cerebral hemispheres. These are primarily juxtacortical, and to a lesser degree periventricular in distribution. No significant involvement of the basal ganglia, brainstem or cerebellum is seen.There is no evidence of restricted diffusion. No parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or abnormal extra-axial fluid collections are noted. The lateral ventricles may be slightly prominent. The cerebral sulci in general are of normal caliber, though the sylvian fissures appear mildly prominent.", "output": "1.Numerous, likely chronic, scattered small white matter lesions are seen in the cerebral hemispheres, largely juxtacortical in location but with mild involvement of the periventricular regions as well. The basal ganglia, brainstem and cerebellum are spared. The distribution is somewhat atypical for small vessel ischemic disease though correlation with risk factors is suggested. Other considerations would include sequelae of prior inflammation, demyelination or vasculitis.2.No definite acute intracranial abnormality is seen nor are there any other specific findings which would account for the patient's memory decline. The lateral ventricles appear to be slightly prominent and there may be some prominence of the sylvian fissures suggesting a component of mild parenchymal volume loss."}
{"instruction": "Generate impression based on findings.", "input": "Female, 54 years old, with weakness, numbness, cramping and tremor. Brain:No definite parenchymal signal abnormality is seen. Brain morphology is within normal limits. No evidence of edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. There are no abnormal extra-axial fluid collections. The ventricular system is normal in size and morphology.C-spine:Alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow replacement seen.The visualized spinal cord shows normal signal intensity and morphology throughout. No focal lesions are detected. No epidural pathology is suspected.C2-3: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. C4-5: Unremarkable. C5-6: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. Slight effacement of the ventral thecal sac but no significant spinal canal stenosis. No significant spinal canal stenosis. C6-7: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. Slight effacement of the ventral thecal sac but no significant spinal canal stenosis. Mild left foraminal narrowing. C7-T1: Unremarkable.", "output": "1.Unremarkable evaluation of the brain with no focal lesions or additional specific findings to account for the patient's symptoms.2.Mild degenerative findings in the cervical spine without high-grade spinal canal or foraminal stenosis. No focal cord lesions are seen."}
{"instruction": "Generate impression based on findings.", "input": "15-year-old female with diffuse midfoot sprain/swelling who is unable to walk. Evaluate for stress fracture. Patchy increased STIR signal within the talus with associated T1 hypointensity. Findings consistent with bone contusion. There is mild soft tissue edema at the dorsum of the ankle and a subtalar joint effusion. No evidence of a fracture line or malalignment.", "output": "Findings consistent with talar contusion."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: AVM. Signs and symptoms: Follow-up AVM post treatment. Nonenhanced brain MRA:The measurement of AVM demonstrate no significant change in the size of the patient's high convexity left frontal AVM.The AVM measures approximately 15 mm in cranial cephalad axis similar to prior study. It measures 9 mm on transverse axis compared to prior study remeasurement of approximately 11.4 mm. Enlarged caliber of left anterior cerebral artery similar to prior exam and indicating feeding pedicle.The lesion however on brain MRI demonstrated decreased size of AVM.", "output": "1.Left hemispheric AVM measuring approximately 15 x 9 mm in size compared to prior exam re-measurements of 15 x 11.4 mm.2.Unremarkable brain MRA otherwise."}
{"instruction": "Generate impression based on findings.", "input": "52 yo female with C2 cavernoma. Right lower extremity numbness. Focus of increased T2 signal with hemosiderin rim in the ventral left cervical cord at the C2 level measures 5 x 6 x 8 mm and not appreciably changed allowing for differences in measurement technique. T2 hypointensity is again noted to extend inferiorly down to the C3-C4 level in the left ventral aspect of the cord. T1 hyperintensity as well as mild enhancement are also unchanged.Cervical spine alignment is anatomic. Vertebral body heights are normal. Mild multilevel degenerative changes are again seen with central disk protrusion at the C3-C4 level with mild associated flattening of the ventral cord similar to prior. No associated cord signal abnormality. There is mild to moderate left neural foramina stenosis on the left at C3-C4 related to facet arthropathy and uncovertebral hypertrophy. Mild disc bulge at C6-7 also unchanged without significant spinal canal or neural foraminal stenosis. T1 hyperintense focus at the T2 vertebral body compatible with hemangioma.", "output": "1. No appreciable change in left ventral C2 cavernous malformation across multiple prior studies dating back to 6/29/2012.2. Mild multilevel degenerative changes including central disc protrusion at C3-4 with mild spinal canal stenosis and mild to moderate left neural foraminal stenosis is also not significantly changed."}
{"instruction": "Generate impression based on findings.", "input": "50 years Female (DOB:1/13/1966)Reason: 3 t scanner optic nerve sheath meningioma left and right History: vision loss left more sever than rightPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is optic nerve sheath enhancement appreciated within the intracanalicular portions and orbital apex portions of the optic nerves which appears worse on the left side. There is eccentric dural thickening compressing the left optic nerve, however, some enhancement of the left optic nerve along its intracanalicular portion may also be represent or some compression of the optic nerve. Differentiation may not be possible due to spatial resolution limitations of this exam. The suprasellar cistern is intact .Some mucosal thickening is present in the maxillary sinuses.", "output": "1.Optic nerve sheath enhancement within the intracanalicular and orbital apex portions of the optic nerves encasing the optic nerves. 2.Findings suggest either left optic nerve enhancement or compression. Differentiation may not be possible due to spatial resolution limitations of this exam. "}
{"instruction": "Generate impression based on findings.", "input": "57-year-old woman with recurrent right breast triple negative invasive ductal carcinoma gr 3, recently switched her care from OSH to University of Chicago. Patient submitted outside study for review. Submitted for review are breast MRI (11/2/2015) performed at Advocate Lutheran General Hospital. No comparisons are available. BREAST MRI: There are scattered fibroglandular tissue in both breasts. Mild amount of background parenchymal enhancement is seen bilaterally.RIGHT BREAST: Posttreatment/postsurgical changes are seen in the right breast which include architectural distortion, periareolar skin thickening, and small volume of the right breast. Additional scattered foci of susceptibility artifact are seen and may be related to surgical clips from prior lumpectomy as well as post biopsy changes.Within the central breast at the lumpectomy site near the 12:00 location, there is a spiculated heterogeneously enhancing mass, with susceptibility artifact noted at the anterior aspect of mass, consistent with the biopsy-proven recurrent cancer. The mass measures approximately 3.4 x 2.7 cm in AP and transverse dimension, respectively. There is is loss of the fat planes between the mass and the pectoralis muscle posteriorly, with associated tenting/pulling of the pectoralis muscle, and pectoralis muscle involvement cannot be excluded. Also in the right breast in the subareolar region, there is a an irregular enhancing mass measuring 1.2 x 0.9 cm in AP and transverse dimension, respectively, suspicious for malignancy.There is an enhancing focus in the right subpectoral region, measuring approximately 5 mm, indeterminate, and could be a lymph node. Given the location, this area may be difficult to evaluate on ultrasound and may not be amenable to ultrasound-guided biopsy.LEFT BREAST: There is no discrete enhancing mass or suspicious morphology in left breast. No suspicious findings in the left axilla.OTHER: There is a T2 bright lesion in the right hepatic lobe which is incompletely characterized and statistically could represent a cyst or hemangioma. Further evaluation with a triphasic CT scan of the abdomen with contrast or MRI of the liver with contrast could be obtained for further evaluation as clinically indicated. It could also be evaluated on PET.", "output": "(1) Spiculated heterogeneously enhancing mass in the right central breast with possible pectoralis involvement measuring up to 3.4 cm consistent with the biopsy-proven recurrent cancer.(2) Additional irregular enhancing mass measuring up to 1.2 cm in the right retroareolar region, suspicious for malignancy.(3) Small right subpectoral lymph node. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": " Cervical spine alignment is within normal limits without sagittal subluxation. Vertebral body heights are grossly maintained without wedge compression deformities. Bone marrow signal is somewhat heterogenous without suspicious focal lesions. There is mild-moderate loss of disc height at C4-C5 and C5-C6. The cervical discs are desiccated. There is mild flattening of the mid cervical spinal cord most pronounced at C4-C5. There are no definite cord signal abnormalities.There is redemonstration of patchy increased T2 signal within the pons appearing grossly similar to 4/7/2015 MRI. A mildly prominent lymph node is present within the right upper mediastinum.C2-C3: No significant central canal or foraminal stenosis.C3-C4: No significant central canal or foraminal stenosis.C4-C5: Small posterior disc osteophyte complex with superimposed left paramedian disc protrusion resulting in mild flattening of the left ventral cord and mild central canal stenosis. Mild left foraminal stenosis.C5-C5: Small posterior disc osteophyte complex and uncovertebral osteophytes. No significant central canal stenosis. Mild right neuroforaminal stenosis.C6-C7: Small posterior disc osteophyte complex. Thickening of the ligamentum flavum. Mild flattening of the left ventral cord. Mild-moderate central canal stenosis. Mild left foraminal stenosis.C7-T1: No significant central canal or foraminal stenosis.", "output": "1.Degenerative changes of the cervical spine most pronounced at C4-C5 and C6-C7 where there is foraminal narrowing and mild-moderate central canal stenosis.2.Abnormal signal within the pons likely reflecting chronic small vessel ischemic changes appearing grossly similar to 4/7/2015 MRI.3.Mildly prominent nonspecific upper mediastinal lymph node. In the appropriate clinical setting, could be further evaluated with CT chest."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate left hip for acetabular labral tear, CAM lesion, Pincer lesion. History: Left hip and groin pain with flexion ACETABULAR LABRUM: Increased signal intensity traverses the anterior superior labrum at approximately the 2 o'clock position, indicating a tear. The posterior labrum appears intact. The superior labrum appears intact. ARTICULAR CARTILAGE AND BONE: We see no fluid-filled articular cartilage defects. There is minimal prominence of the anterior aspect of the femoral head/neck junction with a borderline alpha angle of 55 degrees. We see no morphologic features of pincer-type impingement. The bone marrow signal intensity is within normal limits.SOFT TISSUES: The imaged musculature of the left hip is normal in appearance. ADDITIONAL", "output": "1. Tear of the anterior superior labrum.2. Minimal prominence of the anterior femoral head/neck junction with a borderline alpha angle of 55 degrees."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old male with history of T-cell lymphoma and chronic osteomyelitis. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There are numerous geographic lesions with serpentine and sclerotic borders within the distal femur, proximal tibia, and proximal fibula likely representing avascular necrosis appearing similar to prior.Within the proximal tibia in an area of superimposed AVN, there is a large irregular heterogeneous area of signal abnormality consisting of decreased T1 and increased T2 signal abnormality with avid enhancement after contrast administration. This lesion breaks through cortex laterally and extends into the soft tissues where there is extensive increased T2 signal abnormality (image 14 of series 1001). There is periosteal reaction about the proximal tibia. Marked edema type signal abnormality about the subcutaneous fat of the proximal lateral lower leg.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Large heterogeneous lesion within the proximal tibia in the background of chronic AVN. There is new cortical breakthrough laterally as well as a small soft tissue component. While osteomyelitis is a diagnostic consideration, the lesion does not appear as fluid, but actually enhancing soft tissue. Given this, a malignant lesion must be entertained. Further evaluation with nuclear medicine could be useful or consider tissue sampling.2. Avascular necrosis of the distal femur and proximal tibia/fibula appearing similar to prior."}
{"instruction": "Generate impression based on findings.", "input": "Female, 88 years old, with altered mental status and seizure, nonfocal exam. No restricted diffusion is seen. Moderately extensive confluent periventricular T2 hyperintensity is noted without mass effect. There is no evidence of parenchymal edema. No acute intracranial hemorrhage or abnormal extra-axial fluid collections are detected. The ventricles and sulci are prominent compatible with underlying volume loss. A focus of susceptibility is seen in the right pons indicating chronic microhemorrhage. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected. Focal thickening of the right parietal bone is noted likely indicating a benign osteoma. The osseous structures are otherwise unremarkable.", "output": "1.Moderately advanced chronic small vessel ischemic disease.2.Global parenchymal volume loss.3.No evidence of acute ischemia or any other definite acute intracranial abnormality."}
{"instruction": "Generate impression based on findings.", "input": " The study is somewhat degraded by respiratory and vascular motion.The common carotid arteries are patent. The internal carotid bulbs are prominent in length bilaterally, likely a normal variant. The vertebral arteries are patent. The origin of the right vertebral artery is not well visualized. There is no flow-limiting stenosis or aneurysm.", "output": "The cervical arterial circulation is unremarkable within limitations of artifact."}
{"instruction": "Generate impression based on findings.", "input": "Female, 9 years old, with increased seizure frequency (left leg stiffening). The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of enhancement is within normal limits.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 medial temporal lobe structures are symmetric and free of signal abnormality. The corpus callosum is fully formed and intact. The pituitary gland is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed and unremarkable. The pattern of white matter myelination is mature.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.", "output": "Unremarkable evaluation with no acute findings or structural abnormalities to account for the patient's seizures."}
{"instruction": "Generate impression based on findings.", "input": "History of Crohn's disease with worsening perianal pain. Evaluate for perianal abscess/fistula. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Most contracted urinary bladder.LYMPH NODES: No pelvic lymphadenopathy. Small inguinal lymph nodes.BOWEL, MESENTERY: The visualized small and large bowel is normal in caliber without wall thickening or abnormal enhancement. Colonic diverticulosis.BONES, SOFT TISSUES: Again seen are inflammatory changes along the left gluteal cleft within a thin communication to the rectum at approximately the 5 o'clock position, without a drainable fluid collection and similar to the prior study. A seton appears to be in place.No focal suspicious osseous lesion. Lower lumbar facet joint degenerative changes. Degenerative disk disease.OTHER: No significant abnormality noted.", "output": "Stable appearance of the inflammatory changes along the left gluteal cleft with a thin communication with the rectum at approximately the 5 o'clock position. No drainable fluid collection. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Martin is a 40-year-old female with a family history of breast cancer in sister (diagnosed at the age of 33) and paternal grandmother. Known BRCA2 mutation. She is enrolled in a recent breast cancer screening study for high risk individuals. There is scattered fibroglandular tissue in both breasts. Minimal background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram. "}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with a history of metastatic small cell lung cancer s/p chemoradiation and surgery (off chemo since June 2015) presents with an abnormal PET and weakness, evaluate for brain metastases. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are and sulci are prominent compatible with volume loss, which is advanced for age. Extensive patchy areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter which are grossly similar to the prior examination. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is trace mucosal thickening involving the paranasal sinuses and mild opacification of the left mastoid air cells. Note is made of a right lens implant. Subtle postsurgical changes are noted in the left parietal scalp at the vertex. No discrete underlying lesion is evident. Adjacent calvarium is intact.", "output": "1. No evidence of intracranial metastatic disease. No evidence of acute infarct or intracranial mass effect. 2. No significant change in extensive signal abnormality involving the supratentorial white matter which may reflect posttreatment related leukoencephalopathy and/or chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Paresthesias involving both arms, brisk reflexes, up going left toe. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis, alignment is otherwise maintained.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or left neural foramina. Mild uncovertebral hypertrophy on the right with minimal right neural foraminal narrowing.C4-5: There is prominent uncovertebral osteophyte with mild to moderate right neural foraminal stenosis. No significant compromise to the spinal canal or left neural foramen.C5-6: Uncovertebral hypertrophy and mild disc bulge with effacement of the ventral thecal sac. Dorsal thecal sac is preserved without significant spinal canal stenosis at this level. There is minimal right neural foraminal narrowing. C6-7: Mild uncovertebral hypertrophy with minimal narrowing of the right neural foramen. No spinal canal or left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "Mild degenerative changes in the cervical spine, as detailed above. No significant spinal canal stenosis at any level or cord signal abnormality. There is up to moderate right neural foraminal stenosis at the C4-C5 level."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old with history of lung and pancreatic cancer found down at home. Multiple areas of ischemic infarcts noted on recent noncontrast MRI. MRI brain:No foci of abnormal enhancement in the brain. Stable appearance of the very small subdural hematoma overlying the right parietal lobe. Ventricles are normal in size and configuration. No evidence of mass effect, midline shift, or herniation. MRI cervical spine:No abnormal enhancement in the vertebral bodies, epidural space, or cervical spinal cord. Multilevel spondylitic changes are seen which were better evaluated on the noncontrast MRI performed on the same day; see separate report for further details. There is asymmetrically enhancing soft tissue at the right lung apex which may reflect posttreatment change and better assessed with chest CT.MRA brain:Atherosclerotic irregularity of the cavernous internal carotid arteries without significant stenosis. There is an intact circle of Willis. Partial fetal morphology of the right posterior cerebral artery. Left dominant vertebrobasilar system with narrowing and irregularity of the distal extracranial right vertebral artery. No significant intracranial aneurysm. No high-grade steno-occlusive disease in the anterior circulation.MRA neck:The carotid artery origins are widely patent. There is mild atherosclerotic irregularity of the right carotid bulb without significant associated stenosis. There is mild narrowing of the left internal carotid artery beginning at the bulb and extending to the more cranial cervical segment. The right vertebral artery is narrowed at its origin with improved caliber in its mid cervical segment. The left vertebral artery is normal in caliber and contour throughout.", "output": "1. Postcontrast images of the brain show no evidence of intracranial metastatic disease. Please refer to separate brain MRI report for additional findings including small infarcts and trace right parietal subdural hematoma.2. Postcontrast images of the cervical spine show no abnormal enhancement in the vertebral bodies, epidural space, cervical spinal cord. Please refer to separate noncontrast cervical spine MRI report for details of multilevel degenerative changes.3. Mild multifocal irregularity involving the nondominant right vertebral and left proximal cervical internal carotid artery likely related to atherosclerotic disease. No high-grade stenosis in the intracranial or extra cranial circulation the neck."}
{"instruction": "Generate impression based on findings.", "input": "76 year old female status-post fall. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity in a periventricular and subcortical white matter distribution is consistent with small vessel disease, age indeterminate. Right frontal encephalomalacia. Left middle carotid artery appears slightly dense which in light of lack of adjacent ischemic changes may simply represent atherosclerotic calcifications, however if, there is clinical concern for acute ischemia, an MRI may be considered. Vascular calcifications affect the cavernous carotid bilaterally.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": "Diffuse hypodensity in a periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with history of right flank pain and possible dominant polycystic kidney disease. Study is limited due to lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Multiple nonenhancing small simple cysts, slightly increased in size compared to prior.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts of varying sizes have increased when compared to prior. Some of these cysts contain internal high T1 signal abnormality likely representing a hemorrhagic or proteinaceous component.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small left T12 perineural cyst. Bilateral Tarlov cysts.", "output": "Limited exam due to lack of IV contrast. Findings compatible with polycystic kidney disease with enlarging bilateral renal cysts without suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "55 years, Male, Reason: H/O NHL with spinal stenosis and back pain in need of MRI of pelvis. Please compare to prior. History: Back pain, spinal stenoisis, NHL. PELVIS: MalePROSTATE, SEMINAL VESICLES: Bilateral hydroceles.BLADDER: No significant abnormality notedLYMPH NODES: Overall decreased size of multiple pelvic lymph nodes. Reference left external iliac node measures 1.9 x 1.2 cm (9/25), previously 4.1 x 3.0 cm. Reference left femoral node measures 2.1 x 1.5 cm (9/33), previously 3.3 x 2.2 cm. Reference left inguinal node measures 3.4 x 2.9 cm (9/72), previously 5.1 x 4.1 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild edema in the right paraspinal musculature is unchanged.OTHER: No significant abnormality noted", "output": "Improved lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": " The exam is markedly limited due to motion artifact and susceptibility artifact due to braces.BRAIN: The ventricles and sulci are more prominent than expected for the patient's age indicating volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or abnormal intracranial enhancement within the visualized structures. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. The DWI sequence is nondiagnostic due to artifact the SWI are near nondiagnostic.MRA/MRV:Within the limitations described above, the following observations are made. There is no gross stenosis or occlusion within the vertebral arteries, basilar artery and proximal PCAs. The more distal anterior cerebral arteries and visualized A1 branches appear normal. Portions of the M1 segments of the MCAs appear normal but there are areas not visualized secondary to artifact. There is no gross evidence of high-grade stenosis or large aneurysm within these visualized arteries.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. There is no evidence of venous thrombosis.", "output": "1.Limited MRA due to susceptibility motion artifacts. Within this limitation there is no gross stenosis or occlusion within the visualized arteries. Recommend repeat MRA once braces are removed.2.Normal MRV.3.Limited evaluation of the brain parenchyma is normal without gross evidence of ischemia however, within limitations of nondiagnostic DWI."}
{"instruction": "Generate impression based on findings.", "input": "Female, 27 years old. Status post ACL reconstruction, possible medial and lateral meniscectomies in 2004 at OSH. Pain. MENISCI: There is branching signal abnormality within the posterior horn of the medial meniscus extending to both the tibial and femoral articular surfaces, indicating a complex tear. The tear does not appear to fill with fluid, and it is possible that this is a chronic healed tear. There is mild extrusion of the body of the medial meniscus. There is blunting of and abnormal signal within the posterior horn of the lateral meniscus, likely representing a combination of prior surgery and tearing. There is also vertically oriented signal abnormality within the anterior horn of the lateral meniscus extending to the tibial articular surface, indicating a tear of uncertain chronicity.ARTICULAR CARTILAGE AND BONE: There is tricompartmental cartilage degeneration with multiple sites of full thickness degeneration, most notably along the weightbearing portion of the medial femoral condyle. There are multiple sites of subchondral edema that are presumably degenerative.LIGAMENTS: The patient has undergone ACL reconstruction. The graft appears intact, although there is bowing of the intraarticular portion of the graft and increased signal within the anterior fibers which may represent impingement. The PCL is intact. There is thickening of and edema along the proximal fibers of the MCL, which could represent a sprain in the proper clinical context. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1.Surgical changes of ACL reconstruction with possible impingement of the anterior portion of the graft.2.Medial and lateral meniscal tears and probable postsurgical changes as described above. Please note, we cannot determine the chronicity of these tears.3.Tricompartmental osteoarthritis.4.Possible sprain of the medial collateral ligament.5.Large joint effusion."}
{"instruction": "Generate impression based on findings.", "input": "Cervical lymph node enlargement. Neck Mass. CT of the soft tissues of the neck with infusion:Images through the skull base, cavernous sinuses, paranasal sinuses and petrous bones are free of malignancy and unremarkable.Previously noted right tonsillar mass is no longer identified. There is no evidence of any measurable mass. Very minimal soft tissue thickening however still is present.A necrotic right-sided lymph node is again identified. This finding measures 23.5-mm x 21.5-mm (axial image 38 of 82) in transaxial dimension. The measurement of this node on the prior examination was 22.9-mm times 20.9-mm.This node is at the level of the right carotid bifurcation and appears to partially encase right internal carotid artery, right carotid bifurcation and possibly of the proximal right external carotid artery. The overall appearance of this finding (although not typical), its location and relation with carotid and lack of any interval change since prior examination also raises the possibility of a thrombosed carotid aneurysm. Extreme close proximity of this finding with the carotid warrants further evaluation in particular with an MRI.There is no evidence of any new lymphadenopathy.Limited images through the mediastinum are intact.Limited images through the apices of the lungs are unremarkable. 100 cc of Omnipaque 350 was utilized for the above study.", "output": "1.No evidence of a mass in the soft tissues of the neck. Previously noted soft tissue mass in the right tonsil is no longer identified.2.Unusual appearance of the right cervical lymph node with very close proximity and encasement of the carotid as detailed above. This finding demonstrates no interval change since prior study. Its overall unusual appearance, close proximity to the carotid, no appreciable interval change since prior exam warrants further evaluation with an MRI examination to entirely exclude possibility of a vascular abnormality (aneurysm).3.A message was left on Dr. Joyner office number regarding the findings on this patient."}
{"instruction": "Generate impression based on findings.", "input": "Female, 20 years old. Dorsal radial wrist pain There is moderate fluid within the radiocarpal joint. A bilobed cystic structure is located dorsally centered on the radiocarpal joint, measuring proximately 6 x 3 x 4 mm (series 501, image 13; series 801, image seven). Additionally some focal intermediate signal along the dorsal aspect of the radiocarpal joint may reflect synovitis.The osseous structures are unremarkable, with normal cortical thickness and marrow signal. The visualized muscles and tendons are normal. The ligaments and triangular fibrocartilage complex are intact.", "output": "1.Small cystic structure centered on the dorsal radiocarpal joint as described above.2.Additional focal intermediate signal within the dorsal radiocarpal joint may reflect synovitis."}
{"instruction": "Generate impression based on findings.", "input": "History of BRCA mutation, status post lumpectomy at outside hospital in March 20, 2015 with calcifications near the medial margin, dense breasts, evaluate for residual disease and contralateral breast There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Seroma/hematoma cavity in the left upper outer quadrant posterior depth measures 31 x 16 x 24 mm best seen on the T1-weighted sequence. Area of thick irregular enhancement (measuring 7 mm in thickness) is seen along the anterolateral margin of the seroma cavity which could represent area of fat necrosis versus residual disease.3 lobulated homogeneously enhancing similar morphology masses are identified two in the left breast and one in the right breast as follows:Left breast 1:00 position measuring 8 x 12 x 13 mm (bilobed)Left breast 7:00 position measuring 9 x 7 x 8 mmRight breast 3:00 position measuring 7 x 5 x 6 mm.No abnormal lymph nodes are identified in either axillary region.", "output": "1. Area of irregular thick enhancement along the anterolateral aspect of the seroma cavity could represent area of fat necrosis versus residual disease.2. Three similar most likely benign morphology masses in both breast as described above for which MR directed ultrasound is recommended. If the masses are not seen on ultrasound, six-month follow-up MRI is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with right index finger pain, concern for collateral ligament disruption. There is increased signal intensity within the proximal fibers of both the medial and lateral collateral ligaments of the proximal interphalangeal joint on the short TE images compatible with injury. However, we see no frank disruption of the ligaments on the T2-weighted images. These findings are most compatible with sprain. There is a small proximal interphalangeal joint effusion. Mild osteoarthritis affects the distal interphalangeal joint. The metacarpophalangeal joint is unremarkable. There is a small amount of fluid within the tendon sheath of the flexor apparatus as it passes under the metacarpal head and volar to the proximal interphalangeal joint, but the tendons otherwise appear normal. We see no findings to suggest pulley disruption. There is a small cyst in the head of the metacarpal, but otherwise the bone marrow signal is within normal limits.Small subchondral cysts are also noted within the interphalangeal and metacarpophalangeal joints of the thumb as well as at the proximal interphalangeal joint of the middle finger.", "output": "Sprain of the collateral ligaments of the proximal interphalangeal joint of the index finger without frank disruption, and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "19 year old man with history of palpitations, referred for cardiac MRI to evaluate for structural heart disease. Left VentricleThe left ventricle is mildly dilated with low normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 109 ml/m2 (normal range: 74+/-15), the LVEDV is 210 ml (normal range 142+/-34), the LV end systolic volume index is 45 ml/m2 (normal range 25+/-9), the LVESV is 87 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 86 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Wall thickness is normal without evidence of asymmetric hypertrophy. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1025 ms in the basal septum, which is within normal limits. There is no myocardial iron overload.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 124 ml/m2 (normal range 82+/-16), the RVEDV is 238 ml (normal range 142+/-31), the RV end systolic volume index is 62 ml/m2 (normal range 31+/-9), and the RVESV is 119 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely, and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial 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. The sinus of Valsalva measures 26 x 26mm. The ascending aorta is 22 x 23mm. There is no evidence of coarctation or aneurysmal disease of the aorta.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 biventricular dilation with low normal systolic function. (LVEF 56%, RVEF 50%). 2. No evidence of late gadolinium enhancement to suggest underlying myocardial fibrosis, infiltration or inflammation. 3. Mild aortic regurgitation.4. Normal dimensions of the aortic root and ascending aorta. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " There is a punctate focus of diffusion restriction in the right external capsule compatible with an acute ischemic infarct. No mass effect or midline shift. There are additional foci of T2/FLAIR hyperintensity in the bilateral basal ganglia and left thalamus without diffusion restriction, likely representing old lacunar infarcts. There is T2/FLAIR hyperintensity in the pons, in addition to a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions on FLAIR and T2 images. There is a punctate focus of signal loss on susceptibility imaging in the left corona radiata, which most likely represents a punctate focus of microhemorrhage. In isolation, this is of limited clinical significance.There is no evidence of intracranial hemorrhage, extra-axial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are normal in position. Flow-voids are present within the major vessels indicating patency. Trace mucosal thickening of the ethmoid air cells and scattered opacification of the right mastoid air cells. The visualized paranasal sinuses and mastoid air cells are otherwise clear. Calvarium and extracranial soft tissues are grossly unremarkable.", "output": "1. Punctate focus of diffusion restriction in the right external capsule is compatible with acute ischemic infarction. No mass effect or midline shift.2. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Female 55 years old Reason: metastatic breast cancer History: forgetfulness. There is no abnormal intracranial enhancement suggest metastatic disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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 intracranial metastatic disease, hemorrhage, or infarct."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with right medial knee pain and swelling for 3 months. MENISCI: Note is made of blunting and linear increased signal abnormality which extends to the femoral articular surface of the posterior horn of the medial meniscus consistent with a complex tear, which extends to the body of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the medial compartment. There is focal near full-thickness articular cartilage degeneration along the posterior aspect of the weightbearing portion of the medial femoral condyle above the posterior horn of the meniscus with underlying subchondral signal abnormality, likely degenerative in etiology. There is a partial-thickness articular cartilage fissure along the lateral facet of the patella. There is near full-thickness to full-thickness focal articular cartilage degeneration affecting the patellar cartilage, centrally, with underlying subchondral signal abnormality, likely degenerative in etiology.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Tearing of the medial meniscus as described above.2. Small knee joint effusion.3. Articular cartilage degeneration and fissuring as described above."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old woman with history of chronic pancreatitis, questionable stone and ventral duct which could not be removed during ERCP on 9/21/2015. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. There is no intrahepatic biliary duct dilatation. The gallbladder and common bile ducts appear normal.SPLEEN: The spleen appears normal.PANCREAS: The pancreatic parenchyma is mildly atrophic. No solid masses are identified. Segments of the pancreatic duct are irregularly dilated measuring up to 7 mm in the body. A 20 x 9mm cystic lesion in the pancreatic head (series 8, image 19) appears to communicate with the pancreatic duct. Additionally, there are additional small foci of increased T2 signal which communicated with the pancreatic duct (series 4, images 19 and 20). No pancreatic duct stone is identified.After administration of secretin, a bolus is seen filling the duodenum, however the pancreatic duct does not changed in size.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: Subcentimeter T2 hyperintense foci in the kidneys bilaterally are likely cysts. The kidneys are otherwise normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon appear normal.BONES, SOFT TISSUES: Bilateral Tarlov cysts noted.OTHER: No significant abnormality noted.", "output": "1.Irregular pancreatic duct dilatation compatible with given history of chronic pancreatitis.2.Preserved exocrine function but decreased pancreatic duct compliance also compatible with chronic peritonitis.3.Probable side branch IPMN documented in the pancreatic head without suspicious features.4.No obstructing mass or stone identified."}
{"instruction": "Generate impression based on findings.", "input": "73 years Female (DOB:4/17/1943)Reason: r/o stenosis History: back painPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is some multilevel disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is minimal facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a minor disc bulge at this level. There is mild facet hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "There are some mild degenerative changes present lumbar spine but no significant compromise to lumbar spinal canal or neural foramina."}
{"instruction": "Generate impression based on findings.", "input": "71 year old female with breast cancer on Doxorubicin with new diagnosis of heart failure with reduced ejection fraction. Coronary angiogram demonstrated moderate coronary artery disease including a 100%, small distal LAD occlusion. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function . The overall LV ejection fraction is 20%, the LV end diastolic volume index is 123 ml/m2 (normal range: 65+/-11), the LVEDV is 228 ml (normal range 109+/-23), the LV end systolic volume index is 98 ml/m2 (normal range 18+/-5), the LVESV is 183 ml (normal range 31+/-10), the LV mass index is 31 g/m2 (normal range 67+/-11), and the LV mass is 57 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is subendocardial late gadolinium enhancement of the inferior and septal apex that is consistent myocardial infarction and less likely suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. T1 mapping, T2 stir not performed as scan was done on 3T scanner. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function . The overall RV ejection fraction is 34%, the RV end diastolic volume index is 111 ml/m2 (normal range 69+/-14), the RVEDV is 207 ml (normal range 110+/-24), the RV end systolic volume index is 74 ml/m2 (normal range 22+/-8), and the RVESV is 138 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately 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 to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve not well visualized.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild 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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge bilateral pleural effusions. 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. The left ventricle is severely dilated with severely reduced systolic function (LVEF 20%). There is global hypokinesis with regional variation.2. The right ventricle is mildly dilated with moderately reduced systolic function (RVEF 34%). 3. There is subendocardial late gadolinium enhancement of the inferior and septal apex is consistent myocardial infarction of the distal LAD territory.4. Mildly dilated left atrium, moderately dilated right atrium. 5. At least mild-moderate mitral regurgitation.6. Large bilateral pleural effusions. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Worsening dizziness. There is no significant interval change in the enhancing mass that extends from the left cerebellopontine angle to the porus acusticus and is associated with the left vestibular nerve. The mass measures up to 19 mm. There is intact fluid signal within the inner ear structures.", "output": "No significant interval change in the left vestibular schwannoma."}
{"instruction": "Generate impression based on findings.", "input": "Renal cell carcinoma with hemorrhagic brain metastasis, status post resection. Postoperative surveillance and planning for radiation. Please note limited sequences were obtained for treatment planning protocol. Again seen are postsurgical changes of left frontal craniotomy for tumor resection and hematoma evacuation. There is evolution of postoperative blood products with T1 hyperintensity now seen in the previously seen extra-axial collection beneath the left frontal craniotomy. There is a 18 x 15 mm lesion involving the superior aspect of the resection cavity which is hyperintense on the post gadolinium 3-D T1 weighted images and demonstrates a rim of susceptibility effect and favored to represent a hematoma. Similar lesion was present on prior MRI from 1/20/2015. There is edema in the left frontal lobe which is decreased since prior. There is also decrease in associated mass-effect including rightward midline shift and decreased effacement of the left lateral ventricle.No new lesion or new mass-effect is seen on the postcontrast sequence. No hydrocephalus. Postsurgical changes related to posterior wire fixation at C1-C2 level noted.", "output": "Examination limited to sequences for treatment planning demonstrates evolution of postsurgical changes including hemorrhage within the left frontal lobe. 18 x 15 mm lesion along the superior aspect of the resection cavity probably represents a hematoma. Please note however for surveillance of metastatic disease, complete brain MRI including pre-gadolinium T1-weighted sequence should be considered."}
{"instruction": "Generate impression based on findings.", "input": "Sacral pain, prostate cancer There is diffusely homogeneous appearance of the marrow signal intensity were likely relating to post radiation change. There is no evidence of osseous metastatic disease. There is a mild amount of increased signal intensity of the right vastus lateralis and adductor musculature but no abnormal enhancement following contrast administration. A mild amount of nonspecific increased signal intensity is also present in the right paraspinal musculature. There is mild fatty edema of the paraspinal musculature.Bladder diverticula are noted. There is a prominent right-sided 9 mm iliac chain lymph node. The prostate is enlarged.", "output": "No evidence of osseous metastatic disease or sacral lesion."}
{"instruction": "Generate impression based on findings.", "input": "History of RCC and duodenal carcinoid tumor status post Bilroth II on September 10, 2015, now with GJ tube secondary to delayed gastric emptying with high gastric residuals ABDOMEN:LIVER, BILIARY TRACT: Small layering sludge in gallbladder. No secondary signs of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: 1.6 cm pancreatic body cystic focus (punctate wall calcification better seen on earlier CT imaging), most likely a sidebranch intraductal papillary mucinous neoplasm. Pancreatic duct normal in size. No pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Dominant left simple renal cyst measuring up to 13 cm in longitudinal dimension, additional smaller renal cysts also seen. Mild fullness of left mid to lower renal collecting system without significant change from prior CT imaging. Absent right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous gastrojejunal tube seen entering gastric body with tip located beyond ligament of Treitz in left upper quadrant jejunum. Collapsed stomach. Gastroenteric anastomosis unremarkable.BONES, SOFT TISSUES: Ventral abdominal postsurgical sequela including adjacent scarring. Deep to this area is a 1.3 x 0.8 cm focus of enhancing nodularity, persistent to increased enhancement seen in delayed phase, may reflect postsurgical sequela such as scarring or fat necrosis but attention on follow-up recommended to exclude interval increasing size. T9 vertebral body T2 and T1 hyperintense focus most likely a vertebral body hemangioma. Partially imaged aneurysmal ascending thoracic aorta.", "output": "Gastroenteric anastomosis unremarkable, no evidence of bowel obstruction. Deep to region of ventral abdominal postsurgical changes is 1.3 cm focus of enhancing nodularity as above, likely reflecting postsurgical scarring or fat necrosis but attention on follow-up suggested.1.6 cm pancreatic body cystic lesion, most likely a sidebranch IPMN.Gallbladder sludge."}
{"instruction": "Generate impression based on findings.", "input": "Female, 57 years old. Right shoulder pain, continued pain despite injections and physical therapy, evaluate for rotator cuff tear. ROTATOR CUFF: There is a full-thickness near-complete to complete tear of the supraspinatus tendon with retraction of the tendon to the level of the glenohumeral joint. There is moderate atrophy of the supraspinatus muscle. There may be mild degeneration and/or fraying of the anterior fibers of the infraspinatus tendon, but the majority of the tendon appears to extend to the greater tuberosity. Mild increased signal intensity within the tendon suggests tendinosis. The infraspinatus muscle appears normal. The teres minor muscle and tendon appear normal. There is thickening and increased signal intensity within the distal subscapularis tendon indicating moderate tendinosis with additional linear foci of high signal intensity at its insertion indicating partial thickness insertional tearing. The subscapularis muscle appears normal. Small cysts are noted in the greater and lesser tuberosities likely reflecting the aforementioned rotator cuff pathology.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint with a small amount of fluid in the joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is increased signal intensity within the superior labrum suggestive of tearing. The inferior labrum appears intact. There is a small amount of fluid in the glenohumeral joint but no large effusion.BICEPS TENDON: There is increased signal intensity within the biceps tendon particularly at its transition from the rotator interval to the intertubercular groove indicating moderate tendinosis and partial-thickness tearing.", "output": "1.Near-complete/complete tear of the supraspinatus with retraction and additional rotator cuff pathology as described above.2.Osteoarthritis of the acromioclavicular joint.3.Tendinosis and partial-thickness tearing of the tendon of the long head of the biceps and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Syringomyelia and syringobulbia Arnold-Chiari syndrome without spina bifida or hydrocephalusClinical question: Syrinx, yearly eval for changes/sizeSigns and Symptoms: yearly eval of syrinx Cervical spine:There is redemonstration of an 8 mm x 6 mm axial dimensions syrinx extending from the C5-6 disc space level down to the upper thoracic spine and centered at C7 which previously measured approximately 7 x 5 mm axial dimensions and extended from the C5-6 disc level. On the 2013 exam it measured 4.5 x 6 mm axial dimensions.The patient is status post Chiari decompression.The cervical vertebral bodies are appropriate in overall alignment and height. 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.MRI thoracic spine:The syrinx extends down to the C6-7 disc space level on the current exam and previously extended down to approximately the same level.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots.", "output": "Compared to prior exams over the past 2 years the patient's syrinx is currently larger in axial dimensions at the C7 vertebral level. The superior and inferior extent of the syrinx appears approximately the same."}
{"instruction": "Generate impression based on findings.", "input": " The corpus callosum is diffusely atrophic and the lateral ventricles are symmetrically enlarged suggesting periventricular leukomalacia. There is a 14 x 11mm porencephalic cyst in the white matter deep immediately adjacent to the body of the left lateral ventricle and approximately 6 x 5 mm paraventricular porencephalic cyst near the frontal horn of the right lateral ventricle. Increased FLAIR signal seen around the CSF spaces is suggestive of gliosis. Punctate areas of susceptibility artifact are noted in the occipital horns and walls of the lateral ventricles and in the right choroid plexus. There is no mass or mass effect. There is no diffusion abnormality to suspect acute stroke. The basal cisterns remain patent. Normal flow-voids are demonstrated in the major intracranial vascular structures. The craniocervical junction is normal. The orbits are unremarkable. There is mucosal thickening in the maxillary sinuses. The adenoids are enlarged with partial effacement of the nasopharyngeal airway.", "output": "Periventricular leukomalacia with associated porencephalic cysts and staining of the lateral ventricles suggestive of remote injury involving intraventricular hemorrhage. "}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other specified hearing loss, right earClinical question: assess for retrocochlear pathologySigns and Symptoms: asymmetric SNHL of right ear; h/o facial trauma one year ago The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils are low lying.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.No abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally. The acetabular aqueducts do not appear enlarged. There is no evidence for dehiscent some of the superior semicircular canal.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.", "output": "MRI of the brain and IACs are within normal limits. No abnormal lesions are identified within the internal artery canals. "}
{"instruction": "Generate impression based on findings.", "input": " The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement appreciated. There is no diffusion restriction appreciated. No extra-axial fluid collection is identified.There is a single punctate focus of signal hyperintensity on T2 and FLAIR MRI in the right frontal lobe white matter which is unchanged from the previous study. This is nonspecific and likely of little clinical significance.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mucosal thickening of the paranasal sinuses.", "output": "1.No evidence for brain metastases."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old female with hypertension now with progressive lower extremity weakness x 1 day. Generalized weakness x 2 weeks. No objective neuro findings on exam. Question acute ischemia. Question subdural hematoma. Patient has very poor gait. Patchy areas of deep subcortical and periventricular white matter hypodensity likely represent moderate small vessel ischemic disease, age indeterminate by CT. However, if there is concern for an acute stroke, an MRI is recommended for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift. Prominence of the sulci and ventricles indicates mild to moderate corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Small vessel ischemic disease, age indeterminate. If there is concern for an acute stroke, an MRI is recommended for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Seizure activity. Signs and symptoms: Seizure activity. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is noted. Diffuse patchy areas of periventricular and subcortical low attenuation are nonspecific however in the presence of risk factors of diabetes, hypertension and hyperlipidemia he may represent advanced to small vessel disease of indeterminate age. Follow-up with an MRI is recommended. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.", "output": "Findings concerning for advanced to small vessel disease."}
{"instruction": "Generate impression based on findings.", "input": " CERVICAL SPINE: Redemonstrated is a small caliber syrinx of the cervical cord without significant interval change in size or extent since prior study. The largest transaxial dimension of the syrinx measuring approximately 1.5 mm at the C6 level is unchanged. There is mild straightening of the cervical spine. The vertebral body and disc heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE: Redemonstrated is a mildly expansile syrinx of the mid to lower thoracic cord extending from T6 to L1 similar to the prior exam. The syrinx at T8 measures 3.9 x 3.9 mm (AP x TR), previously 3.5 x 3.8 mm. The syrinx at T11 measures 3.9 x 3.5 mm (AP x TR), previously 3.9 x 3.5 mm. The cord terminates at upper L2 level. The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disc heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.", "output": "1. Stable appearance of syrinx in the cervical and mid to lower thoracic cord, without significant interval change in size and extent from prior exam.2. No significant spinal canal or neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": " BRAIN: There is an area of restricted diffusion in the left paramedian pons, with associated T2/FLAIR signal abnormality, compatible with acute infarct. There tiny foci of susceptibility in the right thalamus and right parietal lobe, compatible with chronic microhemorrhages. Mild to moderate scattered periventricular and subcortical T2/FLAIR signal abnormality, likely reflecting chronic microvascular ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There is no evidence of flow-limiting stenosis or aneurysm in the anterior circulation. There is at least moderate stenosis involving the left V4 segment. The right vertebral artery, bilateral PCAs, basilar artery, and cerebellar arteries are patent.MRA NECK: Exam is limited by suboptimal contrast timing. Noncontrast \"Inhance\" sequence demonstrates a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are slightly narrowed, with additional atherosclerotic mild narrowing of the left subclavian artery. The left vertebral artery is narrow throughout its course, likely reflecting a combination of hypoplasia and atherosclerotic disease. There is moderate stenosis involving the left V4 segment.", "output": "1.Left paramedian pontine acute infarct. No acute intracranial hemorrhage is evident.2.Moderate stenosis is suspected involving the left V4 segment, although this is not well assessed. The basilar artery is patent. The left vertebral artery is diffusely small in caliber, likely related to a comminution of hypoplasia and atherosclerotic disease. Further delineation with CT angiography can be considered if clinically indicated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old man with radial nerve pain. Evaluate for site of compression. ELBOW:LIGAMENTS: No significant abnormality noted.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Bone marrow signal intensity is within normal limits. No abnormalities of the articular cartilage are evident.SURROUNDING STRUCTURES: No abnormal soft tissue masses or abnormalities are evident.ADDITIONAL", "output": "No significant findings are seen to account for the patient's radian nerve pain. Normal examination of the elbow and forearm."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: CervicalgiaClinical question: h/o MCV, evaluate for ligamentous injury to cervical spine The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level.At C4-5 there is loss of disc space height, disc desiccation, endplate osteophytes and uncovertebral osteophytes associated with mild posterior ligamentous hypertrophy. There is effacement of the spinal fluid ventral and posterior the spinal cord at this level. There is a right paramedian disc protrusion present at this level which encroaches on the right hemicord and right-sided exiting nerve root at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At C5-6 there is loss of disc space height, disc desiccation, endplate and uncovertebral osteophytes and a disc bulge associated with some effacement of spinal fluid ventral and posterior the spinal cord and encroachment of the exiting nerve roots within the neural foramina bilaterally due to osteophytes and disc material.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.", "output": "1.There are multilevel degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C4-5 and C5-6 and encroachment of the right-sided exiting nerve roots at C4-5 and bilaterally at C5-6."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old male with a possible radial MCP collateral injury. Evaluate grade in degree. Presents with pain and swelling. LIGAMENTS: The radial collateral ligament appears intact. The ulnar collateral ligament appears intact.TENDONS: The flexor and extensor tendons appear intact. BONES: There is increased bone marrow signal abnormality within the volar aspect of the head of the first metacarpal which may reflect a combination of resolving bone contusion or degenerative change. There is no linear signal abnormality to suggest an acute fracture. No additional bone marrow signal abnormality is identified.ADDITIONAL", "output": "Findings consistent with a resolving bone contusion versus degenerative change affecting the volar aspect of the first metacarpal head. The radial collateral ligament appears intact."}
{"instruction": "Generate impression based on findings.", "input": "Male 28 years old; Reason: instability ankle History: pain and swelling TENDONS: A small amount of circumferential fluid is noted around the posterior tibial tendon, which may conceivably represent mild tenosynovitis, however this is equivocal. Best seen on the axial T2 sequence, there is fluid signal around the peroneus tendons as they courses below the fibular tip. The peroneus brevis tendon appears attenuated at this level, suggestive of chronic attritional tearing. The peroneus longus tendon appears disrupted at its surface, likely representing a longitudinal split tear.LIGAMENTS: The talofibular and calcaneofibular ligaments are intact. The visible fibers of the deltoid ligament are intact.ARTICULAR SURFACES AND BONE: There appears to be a mild pes cavus deformity, as suggested on the prior radiographs. The bone marrow signal is normal. No osteochondral lesion is identified. ADDITIONAL", "output": "1. Findings suggestive of a longitudinal split tear of the peroneus longus tendon and possible chronic attritional tearing of the peroneus brevis tendon as they course below the fibular tip.2. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Status post left nephroureterectomy. Evaluate for recurrent or metastatic disease. 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: Postsurgical changes from left nephroureterectomy. No evidence of residual or recurrent disease in the nephrectomy bed.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": "Abnormal thickening and enhancement of the left superolateral aspect of the bladder with mild adjacent perivesicular stranding; compatible with patient's known recurrent bladder cancer.No evidence of metastatic disease. "}
{"instruction": "Generate impression based on findings.", "input": "cT4N1Mx left tongue squamous cell carcinoma, status post treatment. There is no measurable residual tumor in the left tongue or surrounding structure. There is no significant lymphadenopathy in the neck. The thyroid and major salivary glands are unchanged. The osseous structures and paranasal sinuses are unremarkable. The imaged intracranial structures and orbits are unremarkable.", "output": "No evidence of gross measurable tumor or significant lymphadenopathy in the neck. "}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female with right knee pain. MENISCI: There is globular intermediate signal intensity within the body of the posterior horn of the medial meniscus. There is equivocal mild fraying of the undersurface posterior horn of the medial meniscus, but we see no discrete tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage and bone marrow signal intensity are normal.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Edema between the iliotibial band and lateral femoral condyle suggesting iliotibial band friction syndrome.2. Intrasubstance degeneration of the medial meniscus and equivocal minimal undersurface fraying, but no discrete meniscal tear is noted."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male patient with newly diagnosed prostate cancer, Gleason 6 adenocarcinoma left mid medial gland. Staging examination. PELVIS:PROSTATE:Prostate Size: 4.2 x 5.5 x 4.4 cm.Peripheral Zone: Numerous linear areas of low T2 signal with low ADC values are indeterminate. The largest on the right measures 1.0 x 0.7 cm (image 95, series 301) and the largest on the left measures 1.0 x 0.5 cm (image 95, series 301). Central Gland: The central gland is hypertrophied with BPH nodules.Seminal Vesicles: No evidence of involvement.Extracapsular Extension: No specific evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Areas of signal abnormality within the bilateral peripheral zone which is indeterminate for tumor. No specific evidence of extraprostatic extension. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for change in enhancing lesion. Patient is now on high dose of steroids. History of grade 2 meningioma. New visual symptoms. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination demonstrates noticeable interval decrease in vasogenic edema in the left anterior frontal since prior exam with resultant better visualization of cortical sulci and the subarachnoid space.There is also significant interval decrease in the extent of patchy enhancement of left frontal cortex and periventricular white matter of the frontal horn of left lateral ventricle since prior exam.A previously noted uniformly enhancing masslike lesion along the floor of the left anterior cranial fossa with resultant subtle elevation of the left frontal lobe and significant bulge into the apex of the left orbit is again noted. This mass demonstrate interval decreased enhancement and with a new central focus of hypoenhancement . This lesion however demonstrate no convincing evidence of change in its size, extent or overall mass effect on the left orbital apex. On coronal T2 weighted images the mass measures at least 11.5 mm in cranial caudad axis which is nearly identical to prior exam.Extra-axial enhancing lesion along the lateral aspect of the middle cranial fossa anteriorly is again identified without evidence of change in its size and measuring approximately 20 x 12 mm in transaxial dimensions (axial post enhanced series 11 image 23). There is however subtle interval decrease in intensity of enhancement since prior study.", "output": "1.No diffusion-weighted abnormalities.2.Interval significant decreased vasogenic edema in the left frontal lobe since prior study.3.Interval significant decrease in enhancement of the left frontal cortex and left frontal periventricular white matter.4.Extra-axial mass along the floor of left anterior cranial fossa without significant change in its size or mass effect on the apex of the orbit however it demonstrate decreased enhancement as detailed/measured about. This mass similar to prior exam demonstrate extension into the left anterior aspect of the cavernous sinus.5.Decreased enhancement however without change in the size of a left lateral anterior middle cranial fossa mass since prior exam."}
{"instruction": "Generate impression based on findings.", "input": " There is significant dilatation of the bilateral lateral ventricles due to a large intra- and suprasellar mass invading and obstructing the third ventricle. Periventricular T2 hyperintensity is compatible with transependymal flow. There is a large multicystic and solid mass arising from the sella with osseous remodeling of the sphenoid body. The entire left sphenoid sinus and the majority of the right sphenoid sinus are obliterated by the mass. The mass measures 4.9 x 6.3 x 4.2 cm and the solid portions avidly enhance. The superior portion of the mass is predominantly multicystic with fluid-fluid levels, which may represent blood, and scattered intrinsic T1 signal hyperintensity. There is encasement of the left internal carotid artery and lateral displacement of the right internal carotid artery. The right internal carotid artery is asymmetrically smaller compared to the left. The additional vessels within the circle of Willis are displaced peripherally by the mass. Presumably the optic chiasm and optic tracts are stretched, but are not clearly delineated on this examination.The cavernous sinus is likely filled with tumor. The right Meckel's cave is visualized and the left Meckel's cave is not visualized. There is mild bilateral convexity dural thickening and enhancement, likely secondary to recently shunt placement. Note that diffusion-weighted images are nondiagnostic anteriorly, as there is also dental hardware resulting in artifact.There are two frontal approach shunt catheters in place. The shunt catheter on the right extends to midline immediately superior to the suprasellar mass. The left catheter tip is in the body of the left lateral ventricle. A punctate focus of susceptibility effect is noted in the dependent portion of the left occipital horn, likely blood product secondary to shunt placement. Small amount of air in the nondependent portion of the right lateral ventricle. No extra-axial fluid collection is identified.", "output": "1.Large intrasellar and suprasellar partially multicystic enhancing mass causing hydrocephalus from obstruction of the third ventricle most likely represents a craniopharyngioma, versus other etiologies such as an adenoma, or less likely a germ cell tumor or primary astrocytoma.2.Encasement of the left internal carotid artery by the mass and lateral displacement of the right internal carotid artery."}
{"instruction": "Generate impression based on findings.", "input": "19 year-old male with right shoulder/acromioclavicular joint pain. ROTATOR CUFF: The rotator cuff is intact and unremarkable.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a cleft in the posterior labrum is consistent with a posterior labral tear. No paralabral cyst is identified.BICEPS TENDON: The biceps tendon is intact and unremarkable. ADDITIONAL", "output": "Findings consistent with a posterior labral tear of the right shoulder."}
{"instruction": "Generate impression based on findings.", "input": "T8 -- T9 level mass. Possible vascular period recommended CTA for further evaluation. Examination demonstrates a dural based high density mass measuring approximately 22 mm in cranial cephalad access in 5-mm in AP access immediately anterior to the superior facet of T8 on the left. There is no evidence of increased vascularity to suggest arteriovenous malformation, dural aVF at this location. This lesion is primarily on the left side however a very small extension of the lesion across the midline to the right is noted. The finding is believed to represent a meningioma. A high density lesion on axial images is more suggestive of calcification rather than enhancement. Review of prior MRI examination demonstrates no abnormal edema of the cord. No definitive increased vascularity within the epidural dorsal fat pad is detected.", "output": "Dural based intradural extra medullary high density (likely calcification and less likely enhancement) may represent an intracanalicular meningioma. No definitive evidence of increased vascularity to suggest vascular malformation and no evidence of edema of the cord on prior MRI examination from 4 -- 9 -- 2009 was noted."}
{"instruction": "Generate impression based on findings.", "input": " Alignment of the lumber spine is anatomic. The vertebral body heights are grossly preserved without evidence of fracture. There is infiltrative marrow abnormality involving all lumbar vertebral bodies and the visualized T11-12 vertebral bodies with slight increase in the right aspect of L1 and L2. At the level of L4, there is circumferential epidural enhancing soft tissue abnormality with mild to moderate central spinal stenosis, similar to the prior exam. Additionally, there is epidural tumor at the level of L3, eccentric to the left, which effaces the posterolateral aspect of the thecal sac and extends into the left lateral recess, unchanged. There is a large soft tissue mass with osseous destruction of the left iliac bone extending into the ipsilateral sacroiliac joint, unchanged.", "output": "Widespread metastatic disease involving the vertebrae, epidural space, and left iliac bone; stable to minimally progressed since prior. Extent of epidural disease is not significantly changed in the interval with mild to moderate spinal canal stenosis at L3 and L4 again seen. "}
{"instruction": "Generate impression based on findings.", "input": "Assessment of Chiari 1 malformation. MRI Brain:There is left tonsilar herniation extending 1 cm below the level of the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are mildly enlarged and the posterior horn of the right lateral ventricle is mildly ectatic compared to the left. The fourth ventricle is patent without evidence of obstruction. The 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. Incidental note is made of some fluid within the right mastoid air cells.MRI C-Spine:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. There is no evidence of a syrinx.Degenerative changes are seen in the cervical spine as described below:C2-3: Left greater than right disc osteophyte complex with mild left neuroforaminal stenosis. No right neuroforaminal or central spinal canal stenosis.C3-4: Disc osteophyte complex is noted with mild bilateral neuroforaminal stenosis and mild central spinal canal stenosis.C4-5: Disc osteophyte complex is seen with uncovertebral hypertrophy causing mild central spinal canal stenosis but no neuroforaminal stenosis.C5-6: A right greater than left disc osteophyte complex and uncovertebral hypertrophy with mild central canal stenosis, moderate to severe right neuroforaminal stenosis and mild left neuroforaminal stenosis.C6-7: Left greater than right disc osteophyte complex with moderate uncovertebral hypertrophy causing mild right and moderate left neuroforaminal stenosis. No central canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.MRI T-Spine:The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no evidence of a syrinx.Ligamentum flavum and facet hypertrophy involving the T6/7-T9/10 levels but no neuroforaminal narrowing or central spinal canal stenosis. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remaining thoracic spine.", "output": "1.Left tonsillar herniation 1 cm below the foramen magnum compatible with Chiari I malformation.2.No evidence of a syrinx within the cervical or thoracic cord.3.Multilevel degenerative changes of the cervical spine which causes at most mild central spinal canal stenosis at multiple levels and moderate to severe right neural foraminal stenosis at the C5-6 level."}
{"instruction": "Generate impression based on findings.", "input": "Treated squamous cell carcinoma of the left upper alveolus that grew around an implant, status post left infrastructure maxillectomy and left neck dissection with STSG. Pathology demonstrated invasion into bone and pathologic stage was T4aN0M0, - margins, but + perineural invasion, treated with XRT. The patient subsequently developed a second primary tumor in the left lateral tongue (pT1N0 squamous cell carcinoma with PNI), status post re-excision of close margins. There are postoperative findings related to infrastructure left maxillectomy, left neck dissection, and left lateral glossectomy. There is no evidence of measurable enhancing mass lesions in the treatment bed. There is a left mandibular dental implant. There is no evidence of significant lymphadenopathy in the neck. The thyroid and remaining salivary glands are unremarkable. The imaged intracranial structures and orbits are unremarkable. There is mild multilevel degenerative spondylosis in the lower cervical spine.", "output": "Post-treatment findings centered in the left oral cavity region with no evidence of gross residual tumor or significant lymphadenopathy in the neck."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male patient with history of HCV and a focal cirrhosis, status post TACE/RFA for HCC. Note the examination is limited by patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.RFA defect in the inferior segment six is unchanged with no new arterial enhancement.RFA defect in segment eight of the liver is again noted. There is heterogeneous signal with intrinsic T1 hyperintensity compatible with proteinaceous or blood products, decreased compared to prior exam. Surrounding the RFA defect there is an area of postcontrast enhancement that does not demonstrate washout and correlates with vague T2 hyperintensity, decreased in size compared to prior.No new arterial enhancing lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 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.Segment eight ablation defect with interval decrease in intrinsic T1 signal compatible with proteinaceous or hemorrhagic products. Postcontrast enhancement without washout in the adjacent parenchyma appears stable to slightly smaller compared to prior examination and likely represents postinflammatory/perfusional changes as opposed to recurrent cancer.2.Stable segment six ablation defect. No evidence of residual or recurrent tumor."}
{"instruction": "Generate impression based on findings.", "input": "73 year-old female history of pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: Subsegmental left hepatic lobe nonenhancing cyst. The common bile duct appears normal measuring 5 mm. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is decreased intrinsic T1 signal abnormality with distal fatty atrophy. There is pancreatic ductal dilatation measuring up to 9mm with tortuosity about the neck, body, and tail region and dilated sidebranches. There are three areas of abrupt narrowing without enhancing mass, filling defect or nodularity. The proximal duct appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter nonenhancing left interlobar cyst.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.Dilated and tortuous pancreatic duct with multiple areas of abrupt narrowing as above without abnormal enhancement, filling defect or mass, likely secondary to benign strictures. Decreased intrinsic T1 signal of the pancreas with distal atrophy. Constellation of findings suggests chronic pancreatitis. Continued follow up with Secretin stimulated MRCP is recommended if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic melanoma with new left posterior thigh mass Within the left gluteus maximus of the left hip is a mixed solid and cystic mass measuring 3.1 x 3.3 x 3 cm in the greatest transaxial and craniocaudal dimensions. The solid component demonstrates T1 hyperintensity when compared to surrounding skeletal musculature. There is layering intermediate signal within the mass suggesting internal hemorrhage or debris. Following contrast administration, there is enhancement of the solid component which is situated medially. There is a mild amount of subcutaneous edema surrounding the mass.No additional masses are identified. The underlying bone marrow signal is normal.", "output": "Mixed solid and cystic mass within the left gluteus maximus concerning for metastatic disease. No additional masses are identified and there is no suspicious bone marrow signal."}
{"instruction": "Generate impression based on findings.", "input": "sudden onset right arm and leg weakness, dysphagia There is focal restricted diffusion on the left internal capsule posterior limb without evidence of hemorrhagic lesion. This lesion indicates acute ischemic infarction.Underlying brain shows periventricular white matter high signal intensities on FLAIR images indicating non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. 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. Acute ischemic infarction on the left internal capsule posterior limb without evidence of hemorrhagic conversion.2. Otherwise no remarkable finding."}
{"instruction": "Generate impression based on findings.", "input": "Follow up on right breast mass seen on prior imaging. Personal history of left breast lumpectomy in 2015 for DCIS followed by radiation and hormonal therapy. Family history of breast cancer in mother, diagnosed at the age of 56. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No new abnormal enhancing lesion is seen in either breast. Small enhancing mass in the right breast 3:00 position is again seen and measures up to 6 mm today. The right breast 6:00 focus is stable, as are multiple other scattered foci in the right breast. Post surgical change is noted in the left breast, unchanged. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. Stable right breast masses/foci. Annual MRI and mammography are recommended given her dense breasts and young age at cancer diagnosis. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Rotator cuff tear ROTATOR CUFF: There is a tiny focus of increased signal intensity within the supraspinatus tendon at its insertion upon the greater tuberosity which likely represents a small concealed interstitial tear with a small cyst in the underlying greater tuberosity. Mild fraying of the bursal surface fibers of the anterior supraspinatus are also noted but there is no full-thickness rotator cuff tear. The infraspinatus, teres minor, and subscapularis tendons are intact. The muscles of the rotator cuff are normal in caliber and signal intensity.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. A trace amount of fluid is noted in the subacromial bursa which is not necessarily of any clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis and cartilage degeneration affects the glenohumeral joint. There is abnormal signal intensity of the superior labrum indicating the presence of a tear with a bucket handle type fragment. There is low signal intensity extending inferiorly along the posterior labrum which may represent a labral fragment resulting from the aforementioned tear or simply a prominent posterior capsular band. Additional linear signal is present within the anterior superior labrum also likely representing extension of the above-mentioned SLAP tear. There is no joint effusion.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "1. Tiny concealed interstitial tear of the supraspinatus tendon with possible bursal surface fraying; however there is no evidence of a full-thickness rotator cuff tear.2. Moderate osteoarthritis of the acromioclavicular joint.3. SLAP tear and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Female 94 years old Reason: renal pathology History: rising cr, urinary frequency RIGHT KIDNEY: 10.5 cm in length. Numerous cysts. There is concern that the collecting system might also be dilated. Parenchyma mildly echogenic.LEFT KIDNEY: Several cysts, the largest measuring 6 x 5.7 cm. Heterogeneous left lower pole solid lesion with somewhat spongy cystic components. A mass cannot be excluded. The lesion measures 9.4 x 8.1 x 10.5 cm. Ultimately this could represent abnormal renal parenchyma with numerous small cysts. The kidney should be evaluated further with dedicated renal CT or MR. If patient cannot get intravenous contrast due to abnormal renal function then an MRI is recommended.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Bilateral renal cysts. Possible heterogeneous mass left lower pole kidney. Possible hydronephrosis on the right although hydroureter is not seen. Recommend further evaluation with dedicated renal MRI. Dedicated renal CT may be obtained if the patient can receive IV contrast.Discussed with Dr. David Meltzer."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with continued left shoulder pain despite injections. ROTATOR CUFF: There is a full-thickness near complete tear of the supraspinatus tendon with retraction of the proximal tendon by approximately 3 cm. There is mild atrophy of the supraspinatus. There is thickening and intermediate signal intensity within the infraspinatus tendon indicating moderate tendinosis. There is partial thickness tearing of the anterior fibers of the infraspinatus at the level of its insertion on the greater tuberosity. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. There is mild fatty infiltration along the myotendinous junction of the infraspinatus. There is partial thickness undersurface tearing of the subscapularis tendon. There is mild fatty atrophy of the subscapularis muscle. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Mild to moderate degenerative changes affect the acromioclavicular joint with subchondral cyst formation. There is a small amount of fluid identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality affecting the superior and anterior glenoid labrum consistent with degenerative tearing.BICEPS TENDON: There is a longitudinal split tear affecting the intra- and extra-articular portion of the long head of the biceps tendon. ADDITIONAL", "output": "1. Full-thickness near complete tear of the rotator cuff with retraction as described above. 2. Degenerative tearing of the glenoid labrum. 3. Longitudinal split tear of the long head of the biceps tendon as described above."}
{"instruction": "Generate impression based on findings.", "input": "Prior pT2N0M0 right lateral tongue cancer, resected May 2016 now with intermittent pain evaluate for any submucosal mass in region of right glossotonsillar sulcus. There are post-treatment findings, including partial right glossectomy and neck dissection. There is an infiltrative mass in the posterior right tongue that measures up to approximately 20 mm. There is no evidence of significant lymphadenopathy in the imaged portions of the neck. The remaining salivary glands and thyroid are unremarkable. The osseous structures appear to be intact. The imaged intracranial structures are unchanged. There is a small amount of fluid in the left mastoid air cells.", "output": "Post-treatment findings in the neck with an infiltrative mass in the posterior right tongue that measures up to approximately 20 mm, which likely represents recurrent tumor. Otherwise, no evidence of significant lymphadenopathy in the imaged portions of the neck. "}
{"instruction": "Generate impression based on findings.", "input": "Rule out progression of metastatic brain disease: breakthrough seizures. There are new subcentimeter enhancing lesions in the superior left precentral gyrus and bilateral cerebellar hemispheres with a mild degree of vasogenic edema. In addition, two superior right cerebellar hemisphere lesions have increased in size. The other subcentimeter enhancing lesions within the inferior right cerebellar hemisphere, cerebellar vermis, and right parietal lobe have not significantly changed. There is also an unchanged subcentimeter enhancing lesion within the fundus of the right internal auditory canal. There are postoperative findings related to left parieto-occipital craniotomy without evidence of nodular enhancement to suggest tumor recurrence in this location. There is unchanged confluent white matter T2 hyperintensity at the treatment bed. There is an unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations. There is unchanged mild periventricular white matter T2 hyperintensity. There is unchanged mild encephalomalacia in the left cerebellar hemisphere. There is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration, with ex vacuo dilatation of the left lateral ventricle. There is minimal midline shift to the left. There is minimal fluid signal within the left mastoid air cells. There is mild mucosal thickening in the paranasal sinuses. The skull and extracranial soft tissues are unchanged.", "output": "1. New subcentimeter metastatic lesions in the superior left precentral gyrus and bilateral cerebellar hemispheres, as well as increase in size of right superior cerebellar hemisphere metastases. Other subcentimeter intracranial metastases have not significantly changed.2. Unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations.Discussed with JACOBSEN, JOHN at 10:55 AM on 11/5/15."}
{"instruction": "Generate impression based on findings.", "input": "pt with bladder cancer; possible metastatic lesion to T12 that requires a biopsy for definitive result . Benign compression fracture versus malignancy. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.", "output": "T12 vertebral bone biopsy under CT guidance. A total of five samples were delivered to pathology for analysis."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old man with thyroid nodule requiring further assessment. RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 2.0 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.7 x 2.4 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: 2 nodules are noted in the right lobe of the thyroid. Both measure 7 x 8 mm. The medial and anterior nodule which is predominantly hypoechoic and slightly nodular in contour corresponds to the abnormality documented on recent PET/CT.LEFT LOBE: 7 mm complex nodule noted in the left lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple thyroid nodules. The anterior-medial nodule in the right lobe of thyroid measuring 7 x 8 mm corresponds to the PET CT abnormality. FNA of this nodule could be attempted however given relatively small size, a nondiagnostic result is a distinct possibility."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up of IPMN in pancreatic tail ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small splenule.PANCREAS: Stable tiny cystic focus in pancreatic tail, measuring 4 mm. Nondilated pancreatic duct. Nondilated main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Spinal degenerative disease and scoliosis.OTHER: No significant abnormality noted.", "output": "Unchanged 4 mm cystic focus in pancreatic tail, likely a sidebranch IPMN (intraductal papillary mucinous neoplasm). "}
{"instruction": "Generate impression based on findings.", "input": "Reason: 65 yo male with pancreas mass; please do scan and evaluate for changes and or abnormalities History: pancreas mass ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation. No evidence of hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: Multilobulated cystic lesion in the head of the pancreas with thin nonenhancing septations and communication with the main pancreatic duct is unchanged in size measuring 3.2 x 1.6 cm (8/19), previously 3.4 x 1.6 cm. Slight prominence of the main pancreatic duct to 3 mm is unchanged. No abnormal enhancement within the lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Lesion in the gastric body measures 3.6 x 1.8 cm, similar to prior exams in follows fat on all sequences, suggestive of an intramural lipoma.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Multilobulated cystic lesion in the pancreatic head is stable and likely represents a side branch IPMN.2.Lesion in the gastric body is suggestive of an intramural lipoma."}
{"instruction": "Generate impression based on findings.", "input": "50 year old man with heart/kidney transplant on 10/22/15, referred for serial MRI as part screening for cardiac allograft rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the end diastolic volume is 151 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 87 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Quantitatively, the myocardial to skeletal T2-enhancement ratio is 1.2, which is in the normal range. The global relative enhancement is 2.2, which is in the normal range and has normalized since the last exam. The native myocardial T1 time in the interventricular septum is 1090-1110ms, which is elevated and may indicate edema or fibrosis, but this value measures similarly to the previous study. The extra-cellular volume fraction (ECV) is 31%, which is similar to that obtained on the previous exam. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 71 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.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 mild 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 mildly dilated (32mm)Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is persistent evidence of fibrin sheaths versus catheter within the SVC.PericardiumNo pericardial effusion noted on this study. There is no increased signal in the pericardium on T2-STIR and late gadolinium imaging to suggest edema or inflammation of the pericardium. Extracardiac FindingsSternal wires are present. There is diffuse low signal of the liver and spleen, which was seen on the previous study. 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. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 53%. This is slightly lower than the previous exam.2. The myocardial to skeletal T2 ratio and global relative enhancement are normal. There is no late gadolinium enhancement. The native T1 myocardial relaxation time is stable, and the ECV is marginally elevated from previous.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%. This is similar to the previous previous exam. 4. Mild tricuspid regurgitation. 5. See extracardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with right lateral epicondylar pain and weakness. LIGAMENTS: The radial collateral ligament is intact. No other significant abnormalities are identified.TENDONS: There is a 1 cm area of increased signal intensity at the attachment of the common extensor tendon to the lateral epicondyle, suggestive of partial intrasubstance tear. Minimal adjacent soft tissue edema is present.ARTICULAR SURFACES AND BONE: The osseous structures and articular surfaces are normal in appearance. No joint effusion is identified/SURROUNDING STRUCTURES: There is minimal soft tissue edema adjacent to the lateral epicondyle.ADDITIONAL", "output": "Moderate signal abnormality of the common extensor tendon at its insertion site to the lateral epicondyle, suggestive of partial intrasubstance tear."}
{"instruction": "Generate impression based on findings.", "input": "Prostate cancer status post prostatectomy with rising PSA PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. No definite residual prostatic tissue seen.Seminal Vesicles: Surgically absent.BLADDER: 3 x 3 mm enhancing polypoid lesion along the posterior inferior bladder wall.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Status post prostatectomy without residual prostatic tissue evident.2.3 mm enhancing polypoid lesion along the posterior inferior bladder wall, suspicious for a primary bladder neoplasm. Evaluation with cystoscopy may be helpful. "}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: hydronephrosis? History: CKD, aki Limited by body habitus.RIGHT KIDNEY: 10 cm in length. Normal echogenicity. No hydronephrosis or hydroureter.LEFT KIDNEY: 12.4 cm in length. No hydronephrosis or hydroureter.URINARY BLADDER:No significant abnormality noted.OTHER: Trace ascites. Perisplenic varices.", "output": "No hydronephrosis. Trace ascites. Perisplenic varices which are also seen on the CT of 11/16/2015."}
{"instruction": "Generate impression based on findings.", "input": "History of partial right nephrectomy. Type II papillary renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology. There is an 8 mm focus in segment 7 of the liver (series 11/26) which is mildly T2 hyperintense and demonstrates arterial enhancement. A similar segment 5 8-mm focus is present (series 11/60). There is no rim enhancement, washout, restricted diffusion or interval growth of these lesions.There is no ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: Subcentimeter perihilar splenules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes from a prior right renal inferior pole partial nephrectomy. No evidence of residual or recurrent disease in the surgical bed. No regional lymphadenopathy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel are normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Subcentimeter segment 7 and 5 arterially-enhancing lesions are difficult to characterize given their small size, but they have no suspicious imaging characteristics, such as rim enhancement, washout, restricted diffusion or interval growth of these lesions. These may reflect perfusional abnormalities. Attention to these lesions on follow-up surveillance imaging is recommended.2. Postsurgical changes from right inferior pole partial nephrectomy without evidence of recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "34 years Female (DOB: 10/17/1981)Reason: ? Spinal cord process History: L sided hypotensionPROVIDER NAME: MICHAEL A WARD NAOUM P ISSA MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an air-fluid level in the left maxillary sinus. There is partial desiccation of the left frontal sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.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.", "output": "1.No intracranial mass lesion or other explanation for the patient's generalized weakness is appreciated.2.There is no compromise of the cervical spinal canal and no abnormal enhancing lesion within the cervical spine.3.There is an air-fluid level in the left maxillary sinus. The possibility of an acute sinusitis cannot be excluded. Please correlate with patient's clinical evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other cervical disc displacement, unspecified cervical regionClinical question: herniated disk The cervical vertebral bodies are appropriate in overall alignment and height. Since the prior exam the patient is undergone anterior fusion at C4-5. A previously noted disc extrusion at C4-5 has been removed.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a diffuse disc bulge associated with posterior ligamentum flavum hypertrophy as well as uncovertebral osteophytes. There is effacement of spinal fluid ventral and posterior the spinal cord at this level associated with mild flattening the spinal cord. Compared to the previous exam this has not progressed significantly. There is spinal stenosis of a moderate degree present at this level. There is mild encroachment of the exiting nerve roots within the neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal. The patient is status post anterior fusion at this level and removal of disc protrusion. There is mild encroachment of the left-sided exiting nerve roots within the neural foramen at this level. There is subtle cord signal hyperintensity present this level which was also present on the preoperative exam.At C5-6 there is no significant compromise to the spinal canal. There is a mild disc bulge present at this level associated with some mild ligamentum flavum hypertrophy. There is mild encroachment of left-sided exiting nerve roots related to a small disc protrusion and some uncovertebral osteophytes.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level associated with some mild ligamentum flavum hypertrophy.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.", "output": "1.There is moderate spinal stenosis and mild encroachment of exiting nerve roots present at C3-4 related to a degenerative changes which has not progressed since the prior exam.2.Status post anterior fusion at C4-5 with alleviation of spinal stenosis due to a large disc extrusion.3.There is encroachment of left-sided exiting nerve roots at C4-5 related to disc disease and uncovertebral osteophytes.4.There is mild encroachment of left-sided exiting nerve roots at C5-6 due to degenerative changes."}
{"instruction": "Generate impression based on findings.", "input": "Female 16 years old Reason: Chiari malformation and syrinx, yearly eval for changes, Cervical spine: Redemonstrated are findings of Chiari I with peg-like cerebellar tonsils measuring up to 17 mm below the foramen magnum and unchanged. There remains severe crowding at the foramen magnum with effacement of the anterior and posterior CSF spaces and severely diminished biphasic flow. There is unchanged retroflexed configuration of the odontoid which contributes to the foramen magnum narrowing.Overall, no significant change in syringomyelia which extends from C3 to T11. It measures 2 x 7 mm at the C6 level in the AP and transverse dimensions in the axial plane. There appears to be tiny decrease at certain levels, for example measuring 1.9 mm in the sagittal plane at C7, previously 2.6 mm .The vertebral body heights and intervertebral disk spaces are maintained. The alignment is anatomic. No bone marrow signal abnormalities. No significant disc disease, spinal canal or neural foraminal stenosis. No significant change in CSF signal structure in the posterolateral right spinal canal at the C1 level measuring 8 x 4 mm which may represent a pocket of CSF/arachnoid cyst. Thoracic spine: Syringomyelia extending to T11 as described above with areas appearing stable to minimally smaller in the interval. The vertebral body heights are maintained. Thoracic dextroscoliosis and thoracolumbar levoscoliosis again noted and better assessed on standing radiographs. No bone marrow signal abnormalities. Mild degenerative changes including disc osteophyte complex at T11-12. No significant spinal canal or neural foramen stenosis.Lumbar Spine: The vertebral body and intervertebral disk heights are maintained. The alignment is anatomic. No bone marrow signal abnormalities. The conus medullaris terminates at the L1 level and the filum terminale is within normal limits. No significant spinal canal or neural foramen narrowing.", "output": "Compared to 8/7/2014, no significant change in findings of Chiari I with cervico-thoracic syrinx extending from C3 to T11. Upper thoracic dextroscoliosis and thoracolumbar junction levoscoliosis better assessed on standing radiographs. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Headache. Signs and symptoms: Headache. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates few punctate foci of FLAIR hyperintensity primarily in the subcortical white matter of bilateral frontal lobes without evidence of hemorrhagic changes or enhancement. Findings are nonspecific however considering patient's stated age possibility of demyelinating disease or small vessel ischemic stroke to be considered.The anatomical morphology and the signal intensity of brain parenchyma is otherwise within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal enhancement of brain parenchyma or the leptomeninges.Unremarkable images through the orbits and including axial fat sat post enhanced series.Calvarium and soft tissues of the scalp demonstrate normal signal intensity and without abnormal enhancement.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.", "output": "1.Negative diffusion weighted images.2.Few punctate nonspecific foci of FLAIR hyperintensity only in the subcortical white matter of frontal lobes as detailed.3.Unremarkable pre and post enhancement brain MRI otherwise as detailed above.4.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells."}
{"instruction": "Generate impression based on findings.", "input": "Right cavernous sinus meningioma: surveillance. There are postoperative findings related to right pterional craniotomy with encephalomalacia and gliosis in the anterior right temporal lobe. There is a dural-based, enhancing mass in the right cavernous sinus region, measuring up to 12 mm in thickness, which is not significantly changed. A petroclival portion of the tumor abuts the pons, extension of the tumor into Meckel's cave compresses the trigeminal nerve roots, and sellar extension of tumor abuts the pituitary gland. There is persistent marked narrowing of the right integral carotid artery by the tumor. There are a few scattered nonspecific foci of cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits are grossly unremarkable.", "output": "No significant interval change in the right cavernous sinus region meningioma."}
{"instruction": "Generate impression based on findings.", "input": "Female 29 years old Reason: Right shoulder pain evaluate for rotator cuff tear, biceps injury History: Right shoulder pain ROTATOR CUFF: Small degenerative cysts in the humeral head at the insertion of the supraspinatus without evidence of tearing. The rotator cuff is intact. SUPRASPINATUS OUTLET: Type I acromion. Moderate osteoarthritis affects the acromioclavicular joint with subchondral cysts.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is well seated at the glenoid. No evidence of labral tear.BICEPS TENDON: The biceps tendon is well seated within the bicipital groove and normal in appearance. ADDITIONAL", "output": "Osteoarthritis without evidence of rotator cuff tear or biceps injury as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "Female, 50 years old. R posterior arm palpable mass A palpable marker is placed over the posterior lateral aspect of the arm, near the level of the mid humeral diaphysis. The imaged soft tissues of the right arm are unremarkable, without focal areas of abnormal enhancement, solid mass lesions, or discrete fluid collections. The visualized neurovascular structures are grossly unremarkable.The underlying osseous structures are unremarkable, with normal cortical thickness and marrow signal.", "output": "No focal abnormality to account for the patient's symptoms. Note: On MR images, some palpable subcutaneous lipomas cannot be readily distinguished from surrounding normal fat."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Schiller submitted outside studies for review. Submitted for review are:-Right breast diagnostic mammogram: 8/1/2016-Bilateral breast ultrasound: 8/1/2016-Left breast ultrasound-guided biopsy: 8/2/2016-Bilateral breast MRI: 8/17/2016-Bilateral breast ultrasound: 8/24/2016-Left breast diagnostic mammogram: 8/24/2016The right breast diagnostic mammogram and bilateral breast ultrasound dated 8/1/2016, and left breast ultrasound-guided biopsy dated 8/2/2016 were performed at Diagnostic Imaging Specialists of Chicago. The bilateral breast MRI dated 8/17/2016, bilateral breast ultrasound dated 8/24/2016, and left breast diagnostic mammogram dated 8/24/2016 were performed at Rush University Medical Center.For comparison, bilateral screening mammograms dated 11/4/2013, 12/4/2014, and 11/19/2015 and bilateral breast ultrasound dated 5/19/2015 are available. RIGHT BREAST DIAGNOSTIC MAMMOGRAM: CC, MLO, ML, and spot compression views of the right breast are submitted.The breast parenchyma is heterogeneously dense, which may obscure small masses. There is a BB marker overlying the lower inner right breast. No suspicious masses, microcalcifications or areas of architectural distortion are seen in the right breast. BILATERAL BREAST ULTRASOUND: Static ultrasound images are submitted.In the area labeled palpable in the right breast, along the 1:00 radian, there is an 8 x 7 x 4 mm simple cyst. There are subcentimeter cysts in the right breast at the 4:00 and 9:00 positions.In the left breast, 2-3:00 position, 5 cm from the nipple, there is an irregular mass with posterior shadowing and internal vascularity. This mass measures 9 x 7 x 5 mm. There are additional subcentimeter cysts in the left breast at the 12:00, 1:00, 2:00, 7:00, 9:00, 10:00, and 11:00 positions.ULTRASOUND-GUIDED BIOPSY, LEFT BREAST: Static ultrasound images are submitted.The irregular mass in the left breast at the 2-3:00 position was targeted for biopsy. Targeting appears appropriate. Biopsy clip is seen within the target mass.Postprocedure mammogram demonstrates a lock-shaped biopsy clip in the central outer left breast at posterior depth. There are grouped calcifications in the upper inner left breast, which appear similar to prior studies dating back to 2013.BILATERAL BREAST MRI: Multiple enhanced MR sequences are submitted per outside institution protocol.There is heterogeneous fibroglandular tissue. There is mild background parenchymal enhancement. There are bilateral enhancing foci, none more suspicious than the rest.Left breast:There is susceptibility artifact from biopsy clip centered within a 9 x 9 x 9 mm enhancing mass in the central outer left breast, corresponding to biopsied malignancy. A few typically benign foci of enhancement with internal non-enhancing areas are seen. These may represent small fibroadenomas. Right breast:There is a 6 x 6 x 6 mm irregular enhancing mass in the central slightly inner right breast at mid-depth. This mass demonstrates mixed enhancement kinetics with areas of rapid wash in and washout. Elsewhere a few typically benign enhancing foci are also seen.BILATERAL BREAST ULTRASOUND: Static ultrasound images are submitted.In the left breast, 3:00 position, there is a 6 mm hypoechoic mass, corresponding to biopsied malignancy. There is a subcentimeter cyst in the left breast at the 6:00 position.There are subcentimeter cysts in the right breast at the 9:00 and 2:00 positions.LEFT BREAST DIAGNOSTIC MAMMOGRAM: CC, MLO, ML, and spot magnification views of the left breast were submitted.A lock-shaped biopsy clip is seen in the central outer left breast at posterior depth. Again seen are grouped calcifications in the upper inner left breast, which appear similar to prior studies dating back to 2013 and demonstrate benign morphology on spot magnification views.OUTSIDE PATHOLOGY (per outside report):Left breast mass, ultrasound-guided biopsy: Invasive ductal carcinoma, grade 1", "output": "1. Biopsy-proven left breast invasive ductal carcinoma. Surgical management of known malignancy is recommended.2. Indeterminate 6 mm irregular enhancing mass in the central slightly inner right breast at mid-depth. No sonographic correlate was identified on outside imaging. MR-guided biopsy is recommended based on the lack of sonographic correlation. Follow up MRI in 6 months for the typically benign enhancing foci is also recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "11-year-old girl with history of shoulder pain and palpable posterolateral chest wall mass. ROTATOR CUFF: No abnormality noted. Normal signal is seen in the rotator cuff tendons.SUPRASPINATUS OUTLET: No abnormality seen in the supraspinatus outlet.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic. Although this is not an arthrogram, no gross labral tear is identified. There is no joint effusion.BICEPS TENDON: The biceps tendon is intact and appropriately located in the bicipital groove. Minimal amount of bicipital tendon sheath fluid is normal.ADDITIONAL", "output": "Normal examination. Specifically, no mass at the marked site."}
{"instruction": "Generate impression based on findings.", "input": "80 years, Female, altered mental status. Evaluate for etiology of mental status decline. There is moderate degree of restricted diffusion involving the right frontal and anterior parietal lobes including the cortex and subcortical white matter with corresponding FLAIR hyperintensity and is new since 4/23/2015. There is extensive confluent T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which is otherwise similar to prior. Encephalomalacia involving the right parietal lobe posteriorly is unchanged. Extensive encephalomalacia involving the left basal ganglia with FLAIR hyperintensity extending into the subinsular white matter and left thalamus is also unchanged. There is FLAIR hyperintensity extending along the left corticospinal tracts which is similar to prior and consistent with Wallerian degeneration. There is extensive enhancement involving the right frontoparietal cortex corresponding to the region of restricted diffusion and extending into the subcortical and deep white matter, new since prior.There is ex vacuo dilatation, particularly of the left lateral ventricle without evidence of hydrocephalus. Multiple foci of susceptibility effect including the left frontal lobe, left temporal lobe, and left parietal lobe are unchanged and consistent with chronic microhemorrhages. No intracranial mass or mass effect. No extra-axial collections. Major arterial flow-voids are present. Bone marrow signal and extracranial soft tissues are grossly unremarkable.", "output": "1. Late acute to subacute infarct involving the right frontal and right parietal lobes.2. Advanced chronic small vessel ischemic disease and multiple chronic infarcts including the right posterior parietal lobe and the left basal ganglia. Evidence of Wallerian degeneration along the left corticospinal tract. Unchanged scattered chronic microhemorrhages, which may be related to amyloid angiopathy but nonspecific.Dr. Ali discussed findings with Dr. Tang at 1350 hours on 8/26/2015."}
{"instruction": "Generate impression based on findings.", "input": "Speech delay, hyperreflexia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. 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.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 conus medullaris is positioned at the L1 level. There is no evidence of intraspinal mass lesions. The paravertebral soft tissues are unremarkable.", "output": "1. No evidence of acute intracranial anomalies.2. No evidence of spine anomalies."}
{"instruction": "Generate impression based on findings.", "input": "Male 53 years old with left shoulder pain. Evaluate degree of degenerative changes. There is mild acromioclavicular and glenohumeral joint osteoarthritis. There may be an os acromiale. There are cysts in the greater tuberosity at the expected site of insertion of the rotator cuff, and the humeral head appears high riding on the transscapular view. If there is clinical concern for rotator cuff tearing, MRI may be considered.", "output": "Osteoarthritis and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate epidural fluid. Signs and symptoms: Status post AP CSF leak into epidural space causing back pain and headache. Nonenhanced brain MRI:Diffusion weighted images nondiagnostic due to fairly extensive artifact from patient's dental braces.There is evidence of prior suboccipital Chiari decompression.There is also deterioration of images on other MRI sequences secondary to metallic artifact however they remain diagnostic.Examination demonstrates no detectable intracranial abnormality beyond the artifact that obscures the lower aspect of frontal lobes and anterior bilateral temporal lobes.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and alignment into the brain are unremarkable. The signal void of major intracranial arterial branches are identified. There is intensity of intracranial venous sinuses are beginning normal. Calvarium and soft tissues of the scalp are unremarkable.Images through the paranasal sinuses, orbits are nondiagnostic due to extensive artifact.Nonenhanced total spine MRI:Examination demonstrate expected postoperative changes of Chiari decompression with expansion of subarachnoid space. On sagittal images there is pointed tenting deformity of the posterior cerebellum toward the surgical site/dura which may represent a focus of adhesion.The signal intensity and caliber of the cord remains within normal and in particular no evidence of syrinx is detected. There is no evidence of abnormal signal intensity or fluid collection in the epidural space to suggest CSF leak. There is a thin band of T2 hyperintensity under the subcutaneous fat extending from T11 to L5 (sagittal T2 series 1101 image 10 ) which could represent fluid and possibly as result of CSF leak. This finding measures maximum of 3.5-mm in thickness and overall 152-mm in length. No axial images were acquired on this exam.  There is no evidence of a spinal canal or neural foraminal compromise at any level.CSF flow study is deteriorated secondary to metallic hardware artifact from patient's braces. Within this limitation however the study demonstrate normal biphasic flow through the foramen magnum both anterior and posterior to the cord. There is also detectable flow through the fourth ventricle and the aqueduct.", "output": "1.Nonenhanced brain MRI images are degraded due to extensive metallic artifact from patient's dental braces. Beyond the artifacts examination demonstrate no evidence of intracranial pathology. Expected postoperative changes of Chiari decompression is noted.2.Total spine MRI demonstrate expected postoperative changes of Chiari decompression as detailed. No detectable CSF leak into the epidural space. A thin band of fluid signal intensity under the subcutaneous fat extending from T11 to L5 and measuring maximum of 3.5-mm in thickness which could represent fluid and CSF leak. No axial images were acquired on this study. Normal signal intensity and caliber of the cord. Normal CSF flow study at the level of foramen magnum."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female with history of recent nasopharyngeal cancer status post chemo/RT. Please eval extent of disease. CT of soft tissues of the neck with infusion.Images through the skull base demonstrates a slight prominence of the left cavernous sinus compared to the right and also there are sclerotic changes of the sphenoid bone on the left side. Subtle erosive changes of the pterygoid bone on the left, specifically the medial leaf of the pterygoid bone is noted. combination of the above findings are highly suspected of possible extension of tumor into the skull base and the left cavernous sinus. These findings were present on the prior study. Further evaluation with an MRI examination is recommended.Chronic inflammatory sinus disease of the sphenoid sinus is also present which was also noted on the prior exam and demonstrates no interval change. There is complete opacification of bilateral mastoid air cells and middle ear cavities. These findings on the left were present on the prior study however the findings on the right are new since prior exam.In comparison to prior exam there is significant interval reduction in the size of previously noted left high nasopharyngeal tumor. On the current exam some subtle soft tissue swelling with edematous changes and without definitive enhancement is still is present. This finding extends anteriorly into the posterior choana of the left nasal cavity.No evidence of any pathologic adenopathy neck is detected.Limited images of the apices of the lungs are unremarkable. No additional areas of bony erosion or metastatic lesions is detected.CT of brain with infusion.No evidence of metastatic lesion of the brain parenchyma or the meninges is detected. The bony density of calvarium is unremarkable with the exception of findings described on the left side of the sphenoid bone/pterygoid adjacent to the patient's known tumor.", "output": "1.Significant reduction in the size of patient's known high left nasopharyngeal cancer with no definite measurable tumor on the current study.2.Erosive and sclerotic changes of the skull base involving the left pterygoid bone and left aspect of the body of sphenoid bone as detailed.3.The bony changes as well is a slight prominence of the cavernous sinus on the left raises the possibility of extension of tumor into the skull base and cavernous sinus. Further follow-up with an MRI is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Female, 68 years old. Reason: 5 x 4 cm mass on posterior right thigh. Has a history of metastatic HCC with pulmonary metastasis. Please evaluate for etiology. History: see above There is low T1 signal and high T2 signal within the intramuscular mass in the right biceps femoris at the level of the mid femur. The mass exhibits heterogeneous enhancement but does not extend to the cortex. The mass measures 5.1 x 5.3 x 8.3 cm (series 16, image 7). The remaining soft tissues appear unremarkable. The vessels appear patent. The soft tissues of the left thigh and the left femur are grossly unremarkable as seen on the coronal view.", "output": "Enhancing mass in the right posterior thigh which is suspicious for primary soft tissue sarcoma or metastatic carcinoma. "}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female patient with newly diagnosed cervical cancer. Evaluate for disease status. PELVIS:UTERUS, ADNEXA: There is a 5.3 x 3.6 x 3.5 (craniocaudal by AP by transverse) lesion within the cervix demonstrating low T2 signal and enhancement compatible with tumor (image 18, series 601 and image 16, series 801). The lesion extends into the posterior wall of the lower uterine body. There is parametrial invasion along the posterior wall of the cervix, more predominately along the left side extending to the mesorectal fascia. The mass protrudes into the vagina and may involve the upper third of the vaginal wall.There is a focus of susceptibility artifact within the lower anterior uterine body.There is a solid lesion within the right ovary measuring 5.1 x 3.2 cm with more focal hypointense T2 components. This lesion demonstrates progressive enhancement on postcontrast imaging. The left ovary is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: There is a enlarged left common iliac station lymph node measuring 1.7 x 1.6 cm (image 362, series 1001), which is suspicious for metastatic adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Cervical mass compatible with cervical cancer with parametrial invasion.2.Solid right ovarian lesion is non-specific but may represent an ovarian metastasis or a fibrous tumor such as a fibroma, fibrothecoma, or Brenner's tumor given low T2 components.3.Enlarged left iliac station lymph node is suspicious for metastatic lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Female 64 years old; Reason: r/o growth of nodule, adenopathy History: h/o thyroid nodule. 1.5 year follow up study RIGHT LOBE MEASUREMENTS: 4.9 x 1.6 x 2.0 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.1 x 1.1 cmISTHMUS MEASUREMENT: 0.2 cmRIGHT LOBE: There are at least three subcentimeter hypoechoic nodules in the anterior right lobe of the thyroid. There is a hypoechoic round nodule inferior and posterior to the right thyroid lobe measuring 2.3 x 1.5 x 1.5 cm, previously 2.0 x 1.4 x 1.7 cm. There is no demonstrable color Doppler flow.Reference right thyroid nodule measures 0.6 x 0.3 x 0.5 cm, previously 0.5 x 0.6 x 0.3. There is no demonstrable color Doppler flow.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: Right level 1B lymph node measures 1.1 x 0.4 x 0.7 cm. OTHER: No significant abnormality noted.", "output": "1.No significant change in a hypoechoic round nodule inferior and posterior to the right thyroid lobe. This may represent a parathyroid adenoma. Correlate with PTH.2.No significant change in the reference right thyroid nodule.3.No significant lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "70 year-old male with the history of recent CVA in the right MCA found unresponsive. Right frontal cortical hypoattenuation consistent with infarction noted on MRI of 2/21/2008. Periventricular hypoattenuation consistent with microangiopathic vascular disease demonstrated on prior MRI. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Right frontal infarction and white matter hypoattenuation compatible with microangiopathic vascular disease as demonstrated on prior MRI."}
{"instruction": "Generate impression based on findings.", "input": "History of low back pain and hip flexor weakness. Known metastatic cervical cancer, including lumbar mets from CT. Evaluate spinal and nerve root involvement. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. Within the anterior and lateral portion of the right L2 vertebral body is an enhancing lesion extending into the adjacent right soft tissues with mass effect on and deviation of the right psoas muscle compatible with an osseous metastasis with soft tissue extension. There is thickening and enhancement right L2 nerve root compatible with perineural extension of the tumor towards the epidural space but there is no evidence of leptomeningeal involvement. Similarly within the anterior and lateral portion of the right L3 vertebral body is a osseous metastatic lesion with extension into the anterior and lateral right retroperitoneum. The right L3 nerve root is thickened and enhances indicating perineural extension of tumor towards the epidural space but there is no evidence of leptomeningeal involvement. There appears to be no involvement of the pedicles. There is no loss of vertebral body height and there is no neuroforaminal or spinal canal stenosis.There is high T2/STIR signal intensity involving the adjacent right paraspinal musculature with faint diffuse enhancement but there is no necrosis or evidence of a mass. These changes could be related to post radiation inflammatory changes if the patient has had recent radiation. Less likely is diffuse infiltration of tumor.Note is made of partially visualized liver lesions compatible with the patient's known metastases. There are also multiple retroperitoneal lymph nodes partially visualized which are better evaluated on the recent prior CT of the abdomen and pelvis.", "output": "1.Osseous metastatic lesions involving the anterolateral right L2 and L3 vertebral bodies with retroperitoneal soft tissue extension of tumor and findings compatible with likely perineural spread of tumor along the right L3 and L2 nerve roots. There does not appear to be epidural or leptomeningeal involvement, or neuroforaminal or spinal canal stenosis.2.High T2/STIR signal intensity and diffuse subtle enhancement of the right posterior paraspinal soft tissues which could indicate post radiation inflammation if the patient has received recent radiation treatment. Less likely is diffuse infiltration of tumor.3.Multiple liver lesions and retroperitoneal lymph nodes are partially visualized and better characterized on the recent previous abdominal pelvic CT."}
{"instruction": "Generate impression based on findings.", "input": "Pain after injury Due to the patient's body habitus, the high-definition MRI coil could not be used. An alternative coil was used, which slightly limits image quality and evaluation. MENISCI: There is abnormal signal separating the posterior horn of the medial meniscus from its expected tibial attachment indicating a complete or near-complete posterior root tear. Signal abnormality within the retracted root of the posterior horn fibers with corresponding mineralization seen on the recent prior radiographs likely represents a meniscal ossicle. There is extrusion medially of the medial meniscal body with globular increased internal signal indicating intrasubstance degeneration. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the weight-bearing portion of the medial compartment, with areas of the articular surface appearing devoid of cartilage and with mild degenerative signal abnormality in the underlying bone marrow. A small full thickness cleft is seen in the articular cartilage of the lateral tibial plateau. Moderate osteoarthritis affects the patellofemoral joint, with loss of cartilage particularly at the medial eminence and medial facet of the patella. Tricompartmental osteophytes are present. LIGAMENTS: The ACL is indistinct, although we suspect that we can trace a few fibers from the tibia to the femur. This likely represents chronic degeneration versus an old tear of the ACL. The PCL is intact, though we suspect mild chronic degeneration of the PCL as well. The MCL and LCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Near-complete to complete tear of the root of the posterior horn of the medial meniscus with a meniscal ossicle in the posterior horn.2. Cartilage degeneration as described above, most severe in the medial compartment.3. Poor visualization of the anterior cruciate ligament, which may represent chronic degeneration or an old tear. "}
{"instruction": "Generate impression based on findings.", "input": "84-year-old female with history of hepatocellular carcinoma status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Hepatic veins, portal veins, and hepatic artery are patent. Esophageal varices, similar to prior exam.Stable segment 6 ablation cavity with internal debris/hemorrhage. No suspicious enhancement to indicate residual/recurrent tumor.Previously seen subcentimeter arterially enhancing focus in segment 3 is not evident on the current exam. No new focal hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst with thin septation, unchanged. Subcentimeter left renal cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Esophageal varices.BONES, SOFT TISSUES: Fat-containing ventral hernia. L1 and L2 vertebral body hemangiomas. OTHER: No significant abnormality noted.", "output": "1.Stable right hepatic lobe ablation cavity without evidence of residual/recurrent tumor.2.Previously seen subcentimeter arterially enhancing focus in segment 3 is not evident on the current exam. No new focal hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "22 day old female ex-24 week premature with abnormal head ultrasound. No acute intracranial hemorrhage.Again seen is a low attenuation it least partially extra-axial fluid collection overlying the superior right frontal lobe as was seen on multiple previous sonogram examinations. Additionally there appears to be a low density component within the parenchyma of the right frontal lobe which may reflect a parenchymal component. This collection is causing a mass effect with a left of midline shift of approximately 3 mm. Given the limitations of brain CT in newborns further characterization is limited. MRI could be obtained for further characterization of this abnormality.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. Right frontal extra-axial and intraparenchymal collection causing left of midline shift as detailed above. Given the limitations of brain CT newborns, further characterization could be obtained with MRI."}
{"instruction": "Generate impression based on findings.", "input": " Compared to prior MRIs dating back to October 2012, there is no evidence of significant interval change in the size of a nonenhancing 1.8 x 1.6 cm T2 hyperintense lesion in the left frontal operculum with mild local mass effect. However, this lesion has enlarged mildly when compared to exams from 2011 earlier. Few scattered T2 hyperintense foci in the periventricular and subcortical white matter are unchanged. There is a probable small pontine capillary telangiectasia which appears slightly more prominent perhaps related to technical differences. There is an unchanged right cerebellar development of venous anomaly. The ventricles and sulci are unchanged. There is no acute infarct.", "output": "Stable nonenhancing left frontal operculum lesion dating back to 2012; however, there has been mild interval enlargement when compared to more remote exams."}
{"instruction": "Generate impression based on findings.", "input": "Hip pain after injury BONE MARROW: There is a minimally displaced fracture of the left inferior pubic ramus. Additionally, there is symmetric marrow edema identified within the anterior acetabulum bilaterally of which the left side appears to be associated with a nondisplaced fracture. Marrow edema is also present along the left pubic symphysis. Furthermore, abnormal marrow edema is identified within the left ilium at the level of the sacroiliac joint.SOFT TISSUES: Abnormal edema is identified within the left obturator internus muscle which is likely reactive given the adjacent inferior pubic ramus fracture.JOINTS: Mild osteoarthritis affects the hips. There is no joint effusion.ADDITIONAL", "output": "Minimally displaced fracture of the left inferior pubic ramus. Additional areas of marrow edema described above may represent additional sites of nondisplaced fractures particularly at the left superior acetabulum and along the left pubic symphysis. These findings can be further evaluated with CT as clinically warranted. An additional site of marrow edema within the left ilium along the sacroiliac joint may represent an insufficiency fracture."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for LESI, s/p lumbar surgery with continued LBP, right knee pain and left LE numbness History: evaluate for LESI, s/p lumbar surgery with continued LBP, right knee pain and left LE numbness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. The patient is status post laminectomy and posterior fusion with instrumentation at the L3-4 level. There is atrophy of the paraspinous musculature in the lower lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level right slightly more than left.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge present at this level associated with ligamentum flavum hypertrophy. The fat at the lateral recess these is not effaced. There is fluid present within the facet joints left more than right.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.Status post lumbar surgery at L3-4. 2.There are degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or neural foramina."}
{"instruction": "Generate impression based on findings.", "input": "49 years, Female, progression of multiple sclerosis. Brain: Examination is obtained per demyelinating disease protocol and mildly motion degraded. There is a unchanged ovoid area of FLAIR hyperintensity and mild T1 hypointensity in the left inferior parietal subcortical white matter near the temporal lobe junction. No new lesion is appreciated. No abnormal enhancement is appreciated. Brain parenchymal volume is within normal limits. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Visualized extracranial soft tissues are unremarkable.Cervical spine: Examination is mildly motion degraded but demonstrates no definite new lesion since 8/29/2014. There is T2 hyperintense lesion involving the right lateral aspect of the cord at the C7-T1 level compatible with chronic demyelinating plaque. No new lesions or lesions with enhancement are appreciated. Additional apparent T2 hyperintense foci such as the C3-C4 level favored to be artifactual. Cervical cord volume is maintained.Vertebral body heights and alignment are maintained. Bone marrow signal is benign. No significant spinal canal or neural foraminal stenosis is seen at any level.Thoracic spine: Small T2 and STIR hyperintense lesions are suspected in the cord at the T8 and T9 levels. No abnormal enhancement. Cord volume is maintained. Vertebral body heights and alignment are maintained. Bone marrow signal is benign. No significant spinal canal or neural foraminal stenosis is appreciated.", "output": "1. Unchanged nonenhancing left parietal lesion. No new lesions to suggest demyelinating disease progression in the brain.2. Unchanged nonenhancing right lateral C7-T1 lesion. No new lesion in the cervical cord.3. There are two small nonenhancing thoracic cord lesions. No comparison thoracic MRI is available, but these are favored to be chronic."}
{"instruction": "Generate impression based on findings.", "input": "5-year-old male status post trauma rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Within the posterior occipital bone there is a 1 mm of displacement without adjacent hemorrhage. The fracture line extends from the skull base through the occipital bone just above the transverse sinus. MRI/MRV may be considered as clinically indicated to determine involvement of the adjacent vascular structures.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. Right posterior occipital bone fracture, displaced by approximately 1 cortex width with extension cranial to the transverse sinus. MRI/MRV may be considered as clinically indicated to determine involvement of the adjacent vascular structures.2. No acute intracranial abnormalities."}
{"instruction": "Generate impression based on findings.", "input": " Right frontal approach Omaya catheter with the tip not discretely visualized however appears to terminate in the right foramen of Monro. There is mild associated susceptibility along the right frontal scalp. The ventricles are stable in size. The basal cisterns remain patent. There is no midline shift or mass effect. Extensive symmetric periventricular and subcortical white matter FLAIR hyperintense signal similar in distribution to recent CT head but markedly progressed since previous MRI brain study on 3/19/2016. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures.", "output": "1. Incomplete exam as above. Extensive symmetric periventricular and subcortical white matter FLAIR hyperintense signal similar to recent CT head however markedly progressed since prior MRI brain study of 3/19/2016. This is nonspecific but likely represents treatment-related changes given the symmetric distribution however evaluation is limited without intravenous contrast and other pathology is not excluded.2. Stable ventricular caliber with right frontal approach ventriculostomy catheter."}
{"instruction": "Generate impression based on findings.", "input": " There is moderate levolumbar scoliosis centered at L2-L3. There is left lateral translation of L3 on L4. The vertebral body heights are grossly preserved. There is severe loss of disc height and endplate degenerative changes at L3-L4 and L4-L5. The vertebral bone marrow signal is mildly heterogeneous with scattered foci of T1 hyperintense signal, likely representing focal fatty replacement or fat-containing hemangiomas. There is a T1 isointense and T2 hyperintense lesion in the T11 vertebral body that measures up to 17 mm. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Incidentally noted is a 4.5 cm right upper pole renal cyst. The abdominal aorta appears to be mildly ectatic and there is crescentic signal projecting over the lumen.T12-L1: Thickening of the ligamentum flavum. Mild left greater than right foraminal stenosis, but no significant spinal canal stenosis. L1-L2: Disc bulge, thickening of the ligamentum flavum and facet arthropathy, contributing to mild right neural foramen stenosis, but no significant spinal canal stenosis. There is also a sucentimeter posteromedially directed left facet synovial cyst. L2-L3: Disc bulge with superimposed left paracentral and left foraminal disc protrusions, thickening of the ligamentum flavum and facet arthropathy, contributing to moderate to severe right foraminal stenosis, effacement of the right lateral recess with impingement of the nerve roots and mild to moderate spinal canal stenosis. L3-L4: Disc bulge with superimposed central disc protrusion, thickening of the ligamentum flavum and facet arthropathy, contributing to moderate to severe right and minimal left foraminal stenosis and mild to moderate spinal canal stenosis, with impingement of the nerve roots in the left lateral recess. L4-L5: Disc bulge with superimposed central disc protrusion, thickening of the ligamentum flavum and facet arthropathy, contributing to moderate to mild right and severe left foraminal stenosis and effacement of the lateral recesses, with impingement of the nerve roots in the left lateral recess. L5-S1: Disc bulge, thickening of the ligamentum flavum and facet arthropathy, contributing to mild left foraminal stenosis. No significant spinal canal stenosis.", "output": "1. Advanced degenerative spondylosis of the lumbar spine with moderate levolumbar scoliosis, most prominent at L2-L3 and L3-L4, with lateral listhesis of L3 on L4 as well as mild to moderate spinal canal stenosis associated with apparent nerve root impingement and variable multilevel foraminal stenosis, as described in the findings section.2. A T1 isointense and T2 hyperintense lesion in the T11 vertebra that measures up to 17 mm may represent an atypical hemangioma or perhaps less likely a neoplastic process. Followup via an MRI with contrast may be useful.3. The abdominal aorta appears to be mildly ectatic and there is crescentic signal projecting over the lumen, which may be artifact rather than intramural thrombus. Nevertheless, a Doppler ultrasound may be useful for further evaluation.Findings were conveyed to Dr. Tung on 3/26/2015 by EPIC mail."}
{"instruction": "Generate impression based on findings.", "input": "Reason: pt with h/o chr abdominal pain and PD dilatation, evaluate for pancreatic ductal/parenchymal abnormalities or CP History: chronic abd pain,. ABDOMEN:LIVER, BILIARY TRACT: Right cystic lesion in the dome of the liver demonstrates thick peripheral enhancement and thin internal septations. Compared to as far back as prior 2011 examination, lesion has increased in size exam, measuring 3.9 x 4.5 cm (series 4 image 4), previously 3.5 cm. Mild intrahepatic and extrahepatic biliary ductal dilatation and irregularity, unchanged. Focal narrowing of the proximal common hepatic duct. The common bile that measures up to 1 cm. Hypointense focal defects in the biliary ducts likely represent pneumobilia as seen on prior CT. Post surgical changes of cholecystectomy. Diffuse heterogeneous enhancement of the liver.Hepatic vasculature patent.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic ductal dilatation measuring up to 0.7 cm. No definite mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Cystic lesion in the dome of the liver with thick peripheral enhancement has grown compared to as far back as 2011. 2.Stable biliary and pancreatic ductal dilatation. 3.Heterogeneous enhancement of the liver. "}
{"instruction": "Generate impression based on findings.", "input": "28 years Female (DOB:3/26/1988)Reason: evaluate response to therapy in patient with metastatic breast cancer to brain. History: 3903PROVIDER/ATTENDING NAME: ANDREA LOUISE AMICO ANDREA LOUISE AMICO The CSF spaces are appropriate for the patient's stated age with no midline shift. On FLAIR MRI there is heterogeneous cortically based hyperintense lesion associated with heterogeneous contrast enhancement measuring 10 x 10 mm located along the medial aspect of the left paracentral lobule adjacent to the pars marginalis it previously measured 9 x 7 mm axial dimensions. The FLAIR signal abnormality is also larger on the current exam when compared to the prior exam.. Similar lesions are present in the right postcentral gyrus laterally where the enhancing component measures 10 x 15 mm axial dimensions and previously measured 12 x 9 mm. One in the right cerebellar hemisphere superiorly is also unchanged and measures 18 x 9 mm axial dimensions on other located in the right cerebellar hemisphere posteriorly and inferiorly measures 11 x 27 mm axial dimensions and is larger compared to prior exam when it measured 23 x 9 mm. Another lesion is present in the right occipital lobe measuring 10 mm x 6 mm axial dimensions along the inferior aspect of the cuneus previously measured 6 x 7 mm. Another is located along the right cingulate gyrus behind the splenium of the corpus callosum measuring 11 x 7 mm axial dimensions previously measured 7 x 11 mm. Another is located along the right superior frontal gyrus measuring 5 x 7 mm mm in diameter which previously measured 5 x 9 mm.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Multiple cortical based lesions are scattered in both hemispheres of the brain as well as the cerebellum. These are compatible with metastases which have increased in size based on contrast enhanced imaging when compared to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Follow up pituitary adenoma treated with cabergoline. There is overall interval decrease in size of the pituitary tumor, particularly the suprasellar component that extends along the planum sphenoidale, which no longer displays intrinsic T1 hyperintensity related to prior hemorrhage. Indeed, the tumor measures up to 27 mm in the craniocaudal dimension, previously 37 mm. There is consequently decreased massa effect upon the right gyrus rectus and optic apparatus. There is mild volume loss in the anterior gyrus rectus, perhaps related to chronic ischemia from mass effect. There is persistent extension of tumor in the bilateral cavernous sinuses, left greater than right, with encasement of the left cavernous internal carotid artery. The infundibulum is deviated to the right.", "output": "Interval decrease in size of the pituitary macroadenoma, particularly the suprasellar component."}
{"instruction": "Generate impression based on findings.", "input": "Female, 2 years old, history of GBS meningitis with ventriculomegaly, cerebral cysts, monitor cyst post fenestration. A ventricular catheter traverses the right frontal lobe to terminate along the margin of the right lateral ventricle, grossly similar in position. Since the prior examination, a second catheter has been placed traversing through the right frontal lobe, coursing posteriorly, medially and inferiorly. This catheter traverses a dilated midline space at approximately the level of the cerebral aqueduct, ultimately terminating along the posterior margin of the fourth ventricle. Susceptibility at the catheter tip may represent an artifact or hemosiderin staining.The caliber of the frontal horns and widely splayed cavum septum pellucidum, in aggregate, has increased measuring up to 41 mm in maximum transverse dimension, previously 38 mm. Ventricular caliber at the level of the atrium has increased from 8 mm to 11 mm on the left, and decreased from 8 mm to 6 mm on the right. Caliber of the left temporal horn has also decreased. Caliber of the third ventricle has probably not changed.Numerous periventricular and choroid plexus cysts are redemonstrated. A cyst along the choroid plexus at the level of the right atrium has changed variably with one component slightly larger and another slightly smaller. A cyst along the medial right temporal lobe has not significantly changed in size. A cyst along the medial left temporal lobe has decreased in size.Dilatation through the region of the cerebral aqueduct is probably not significantly changed. Fourth ventricular cysts extending through the foramina of Luschka have not significantly changed in size.The pituitary region is unremarkable. The corpus callosum remains markedly thinned and deformed similar to prior. No restricted diffusion is seen. Scattered foci of parenchymal and ependymal susceptibility are unchanged and likely reflect sequelae of prior instrumentation and/or infection. Mild periventricular T2 hyperintense rimming also remains unchanged.", "output": "1.Interval placement of a new catheter which traverses the right frontal lobe, courses through the tentorial incisure at the level of the cerebral aqueduct, ultimately terminating in the region of the fourth ventricle. The pre-existing right frontal ventricular catheter is in stable position.2.Mild interval increase in the caliber of the ventricles at the level of the frontal horns and also at the left atrium. Ventricular caliber elsewhere is stable or decreased.3.Variably changing cysts along the choroid plexus at the level of the right atrium with some components slightly smaller and some slightly larger. The remaining cysts, including those along the temporal lobes and within the posterior fossa, are stable to smaller as discussed above."}
{"instruction": "Generate impression based on findings.", "input": "Paresthesias, evaluate for demyelinating disease.. Brain: There are approximately 10 T2/FLAIR hyperintense lesions in the bilateral periventricular and subcortical white matter. While some of these foci are nonspecific, morphology and distribution of several of the lesions is suggestive of chronic demyelinating disease. The current study is of higher resolution and previously seen lesions are better appreciated. No new lesion is definitively appreciated to suggest progression of demyelinating disease since 10/24/2014. No infratentorial lesions are definitively appreciated. No significant burden of T1 hypointense lesions. Brain parenchymal volume is preserved.No intracranial mass or mass effect. Ventricles and sulci are normal. No extra-axial collections. Bone marrow signal and extra soft tissues are grossly unremarkable.Cervical spine: Focus of T2 signal abnormality involving the right dorsal aspect of the cord at the right C2 level is again seen. No additional lesions in the cervical cord are appreciated. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. Minimal spondylotic changes are present including tiny disc protrusion at the C5-C6 level. There is no spinal canal or foraminal stenosis within the cervical spine at any level. The paravertebral soft tissues are unremarkable.", "output": "1. Multiple, approximately 10, supratentorial white matter lesions are not significantly changed since 10/24/2014 allowing for differences in technique. The distribution and morphology of several of the lesions is suggestive of chronic demyelinating disease.2. Unchanged T2 hyperintense lesion in the right dorsal cervical cord at the C2 level is compatible with a chronic demyelinating plaque. No new lesions in the cervical cord are appreciated."}
{"instruction": "Generate impression based on findings.", "input": " There has been interval expected evolution of sequela of hypoxic ischemic injury, with essentially severe cystic degeneration of the majority of the brain parenchyma bilaterally with sparing of the posterior fossa and brainstem. The basal ganglia, caudate, and thalami are relatively preserved, with scant scattered cerebral hemispheric tissue elsewhere, predominantly along the ventricular margins and the diminutive occipital as well as temporal lobes.There has been interval increased size of the left holohemispheric subdural collection, with with its contents demonstrating prominent T1 hyperintensity to gray matter and conspicuous T2 hyperintensity greater than CSF. This now measures up to 14 mm in greatest thickness, with flattening of the subjacent cystic appearing tissue. There appears to be a septation deep within this collection. Linear intrinsic T1 hyperintensity with diffusion restriction and susceptibility remain along this septation along the surface of the encephalomalacic tissue, likely relating to chronic blood products. Scattered punctate foci susceptibility remaining along the left greater than right frontal convexity likely relate to sequela of previous subarachnoid blood products.In the right frontal extra-axial space, there is also increased prominence of the now 8 mm thick collection which is also T1 hyperintense to gray matter, although remaining essentially isointense to gray matter on T2-weighted imaging. There is also mass effect from this smaller collection upon the right frontal tissue. These are consistent with evolving blood products. Is significant ex vacuo dilatation of the lateral and third ventricles.Intracranial flow-voids associated with the circle of Willis are diminutive in size likely relating to the extensive tissue loss.", "output": "1.Interval expected evolution of previous sequelae of hypoxic ischemic injury, with essentially near complete cystic and cephalization of the cerebral hemispheres with relative sparing of the deep gray nuclei and portions of the temporal and occipital lobes.2.Conspicuous increased size of left much greater than right subdural collections containing blood products with mild mass effect.3.Minimal susceptibility remaining from previous scattered convexity subarachnoid hemorrhage.4.Associated ex vacuo dilatation of the lateral and third ventricles."}
{"instruction": "Generate impression based on findings.", "input": "56 years, Female, Reason: rectovaginal fistulae eval History: rectovaginal fistulae eval. PELVIS: UTERUS, ADNEXA: Postsurgical changes of total abdominal hysterectomy. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are postsurgical findings with surgical clips at the anorectal junction. In this region, there is a small outpouching extending from the 12 o'clock position anteriorly to the posterior wall of the vagina which likely represents a fistulous communication.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Fistulous communication between the vagina and the anorectal junction."}
{"instruction": "Generate impression based on findings.", "input": "Female, 78 years old, with weakness. A focus of mildly restricted diffusion measuring up to 1 cm is seen in the left cerebellar hemisphere with mild associated FLAIR hyperintensity. No other definite areas of restricted diffusion are seen.Extensive scattered parenchymal encephalomalacia is noted, mostly affecting the right cerebral hemisphere with lesions in the frontal, parietal and temporal lobes. There is corresponding T2 hyperintensity compatible with gliosis, and volume loss in the form of ventricular ex vacuo dilatation and widening of the sulci. Several small foci of encephalomalacia are also noted in the bilateral cerebral hemispheres.No evidence of significant parenchymal edema or generalized mass effect is seen. No abnormal extra-axial fluid or intracranial hemorrhage is suspected. No pathologic parenchymal or extra-axial enhancement is seen.", "output": "1.Small focus of late acute or subacute ischemia in the left cerebral hemisphere.2.Extensive chronic territorial ischemic disease affecting predominantly the right cerebral hemisphere.3.No definite additional acute intracranial abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "82 years, Female, suspected vascular dementia. Prior ischemia seen on CT. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. There is a chronic infarct involving the right posterior frontal corona radiata extending inferiorly into the right putamen. There is ex vacuo dilatation of the right lateral ventricle. There is rim of susceptibility effect involving the infarct compatible with chronic blood products.There is moderate degree of patchy T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which is nonspecific, but compatible with chronic small vessel ischemic disease. There is moderate degree of global cerebral volume loss without a particular lobar distribution. Moderate volume loss involving the cerebellar hemispheres is also noted.There is a right maxillary sinus mucus retention cyst. There is also mild left maxillary sinus opacification. Calvarium and extracranial soft tissues are grossly unremarkable.", "output": "1. Chronic infarct involving the right frontal corona radiata which extends into the putamen. There is associated susceptibility effect indicating prior hemorrhage in this region.2. Moderate chronic small vessel ischemic disease.3. No intracranial mass, mass effect or hydrocephalus.4. Moderate supra and infratentorial parenchymal volume loss."}
{"instruction": "Generate impression based on findings.", "input": "47 year-old female with strong family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Anhancing intramammary lymph node is present at posterior 9 o'clock position.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Neoplasm of unspecified behavior of brainClinical question: preop planning for tumor resection. Pt has unspecified tumorSigns and Symptoms: preoperative planning There is redemonstration of an extra-axial mass which involves the right planum sphenoidale as well as the anterior and medial aspect of the right middle cranial fossa which displaces the adjacent right frontal and temporal lobes. It measures 36 x 30 mm axial dimensions and has not changed since the prior exam. It is associated with a vasogenic pattern of edema in the right frontal lobe, right medial temporal lobe and right external capsule. It displaces the right internal carotid artery medially and the right middle cerebral artery posteriorly. It abuts the right cavernous sinus and right optic nerve. It displaces the right optic nerve medially.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.An extra-axial mass adjacent to the right frontal and temporal lobes most likely represents a meningioma. It displaces adjacent structures.2.Please note this is a limited exam for the purpose of stereotactic guidance"}
{"instruction": "Generate impression based on findings.", "input": "Evaluate temporal lobe abscess: headaches, recurrent mastoiditis. History of mastoiditis status post tympanomastoidectomy and craniotomy with post-auricular incision with draining fistula tract. There are postoperative findings related to right tympanomastoidectomy and temporal craniotomy with diffuse enhancement of the overlying subcutaneous tissues and in the bone marrow surrounding the mastoid bowl, as well as high T2 signal in the mastoid bowl and few remaining right mastoid air cells. There is a peripherally enhancing lesion with diffuse T1 and T2 hypointensity and susceptibility effect, which corresponds to previously demonstrated calcifications, in the right inferior temporal lobe overlying the tegmen mastoideum that measures 12 mm in diameter with extensive surrounding edema. There is no evidence of acute 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, including the right sigmoid and internal jugular veins. The orbits are grossly unremarkable.", "output": "Postoperative findings in the right temporal region with a lesion in the right inferior temporal lobe that is compatible with a residual abscess, perhaps with granuloma formation, as well as suggestion of osteomyelitis and mastoiditis in the region of the right mastoidectomy cavity along with overlying cellulitis and/or treatment effects."}
{"instruction": "Generate impression based on findings.", "input": "Right facial droop, dysarthria. There is an area of restricted diffusion and high T2 signal in the left corona radiata that measures up to approximately 20 mm. There is no evidence of associated hemorrhage. There is a background of extensively diffuse cerebral white matter T2 hyperintensity bilaterally. There is diffuse cerebral and cerebellar volume loss. There is no midline shift or herniation. There is a right thalamus developmental venous anomaly and associated punctate cavernous malformation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.", "output": "1. Small acute infarct in the left corona radiata in a background of chronic small vessel ischemic disease. 2. Right thalamus developmental venous anomaly and associated punctate cavernous malformation."}
{"instruction": "Generate impression based on findings.", "input": "Female, 53 years old, with history of grade III oligodendroglioma with 1p19q deletion, s/p surgery, proton beam RT, and now on TMZ. Redemonstrated is evidence of right frontal lobe tumor resection. The surgiccal cavity is unchanged in size and morphology. Dural thickening along the craniotomy is expected and stable. Continued interval reduction is seen in the amount of wispy curvilinear enhancement along the posterior cavity margin, likely post-operative in nature. Heterogeneous thickened tissue which remains in the left frontal lobe, extending into the genu of the corpus callosum, had also not significantly changed. No new parenchymal thickening or pathologic enhancement is seen.Ill defined T2 hyperintensity has progressed bilaterally in the centrum semiovale, more so on the left. These areas are associated with no mass effect and no elevated rCBV. The changes are therefore likely related to treatment.No new mass effect or edema is seen. No new intracranial hemorrhage or fluid collections are seen. The ventricular system is patent and stable in size.", "output": "Mild progression of white matter signal abnormality most compatible with treatment effect. No evidence of tumor progression is seen."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Surgery aborted due to brain swelling. Evaluate for cause of brain swelling? Signs and symptoms: Brain swelling CT of brain without the infusion:The examination demonstrates expected postoperative changes of a left posterior temporal -- parietal craniotomy. There is no evidence of hemorrhage. There is no detectable cerebral edema. Prominence of cortical sulci and underlying encephalomalacia as was noted on prior MRI is again identified. There is no evidence of mass effect, midline shift or hydrocephalus.", "output": "1.Expected postoperative changes of left parietal craniotomy.2.No evidence of underlying hemorrhage, edema, mass effect or midline shift."}
{"instruction": "Generate impression based on findings.", "input": "65 years, Female, multiple sclerosis, evaluate for progression. Brain: There are multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter with distribution and morphology compatible with known demyelinating disease. Differences in technique limit comparison; there are few small lesions involving the bilateral frontal and parietal subcortical white matter which are present on current high-resolution study and not evident on prior MRI from 4/14/2012 and 11/8/2010. The relatively largest lesions involving the right periatrial white matter as well as the right posterior pericallosal lesions are again seen and demonstrate T1 hypointensity. No new large lesions are demonstrated. No infratentorial lesions are definitively appreciated. No lesions with enhancement to suggest active demyelination. A right frontal developmental venous anomaly is incidentally noted. Brain parenchymal volume is within normal limits for age. No intracranial mass effect. No hydrocephalus or extra-axial collections. Calvarium and extracranial soft tissues are unremarkable. Cervical: Again seen are multiple T2 hyperintense lesions in the cervical cord including the right lateral C2 level, dorsal C2-C3 level, and left dorsal lesion extending from the C5-C6 to the C7 level, which is also associated with focal volume loss. No associated enhancement is seen. No new lesion is seen. The previously seen lesion in the cord at T3 is again seen and partially imaged on the sagittal sequence.Vertebral body heights and alignment are maintained. Mild degenerative changes are again seen with small disc disc protrusions at the C3-C4 to C5-C6 levels without significant spinal canal or neural foraminal stenosis. Foci of T1 hyperintensity compatible with small hemangiomas or focal fat. No suspicious osseous lesions are evident. Paraspinous soft tissues are unremarkable.", "output": "1. Multiple T2/FLAIR hyperintense lesions are compatible with known chronic demyelinating disease. Differences in technique with prior study from 4/14/2012 limited precise comparison; however, there are small lesions which are present on the current high-resolution study and not seen on prior. Comparison is technically better with MRI from 11/8/2010 with more definitive evidence of a few small lesions which are new since then. Overall there is minimal interval progression of disease in the brain. No new large lesions are evident.2. Unchanged multiple T2 hyperintense lesions in the cervical cord and upper thoracic cord compatible with chronic demyelinating disease. No new lesions."}
{"instruction": "Generate impression based on findings.", "input": "Lateral elbow pain LIGAMENTS: The radial collateral ligament is intact. There is increased signal and thickening of the common extensor tendon adjacent to the lateral epicondyle. This is best seen on the coronal PD fat sat image 11/24.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Specifically, the lateral epicondyle is normal in marrow signal.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL", "output": "Partial tearing of the of the common extensor tendon at the origin near the lateral epicondyle. The lateral of the condyle itself is normal marrow signal. No additional abnormalities are identified within the elbow."}
{"instruction": "Generate impression based on findings.", "input": "59 year old female with biopsy-proven sarcoidosis (bronchoscopic LN biopsy with non-necrotizing granulomas) and palpitations referred to rule out cardiac involvement. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 63 ml/m2 (normal range: 65+/-11), the LVEDV is 140 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 62 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is a subtle region of subepicardial late gadolinium enhancement involving the basal inferior and inferolateral walls which spares the endocardium and is atypical for prior myocardial infarction. This has not changed from previous CMR done1/2014. The finding could suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 58 ml/m2 (normal range 69+/-14), the RVEDV is 140 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 78 ml (normal range 35+/-13). 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 mild-moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 FindingsMediastinal and hilar lymphadenopathy noted. 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. Normal LV size and systolic function (LVEF 56%).2. There is a subtle region of late gadolinium enhancement involving the basal inferior and inferolateral walls which spares the endocardium and is atypical for prior myocardial infarction. This could suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process; however, this finding has not changed from previous CMR dated 1/2014.3. Normal RV size and systolic function (RVEF 50%).4. Moderate LA dilation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: right hip avn History: right hip pain There is increased signal abnormality within the anterior superior labrum likely representing a combination of degeneration and degenerative tearing. There is curvilinear signal abnormality within the right femoral head indicating avascular necrosis. There is flattening of the superior femoral head indicating subchondral collapse/fracture. There is bone marrow signal abnormality within the superior and medial right acetabulum which may be degenerative in etiology, although this could also represent additional foci of avascular necrosis. There is also a small focus of signal abnormality within the superomedial left femoral head also likely representing avascular necrosis. There is no evidence of subchondral collapse affecting the left hip. The alignment is anatomic. No additional bone marrow signal abnormality is identified. There is a small right hip joint effusion likely related to the aforementioned avascular necrosis of the right femoral head. There is fatty atrophy of the imaged musculature of the right hip. Severe degenerative disc disease affects image lower lumbar spine.", "output": "Findings indicating bilateral femoral head avascular necrosis, right greater than left. There is deformity of the right femoral head indicating subchondral collapse/fracture. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Previous MRI with possible left sided arteriovenous malformation: seizures. MRI: there is a subcentimeter curvilinear area of T2 hyperintensity, enhancement, and susceptibility effect in the posterior limb of left internal capsule. Otherwise, there is no evidence of acute 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.MRA: There is no evidence of significant steno-occlusive lesions, arteriovenous malformations, or aneurysm.", "output": "1. A lesion in the posterior left internal capsule likely represents a small developmental venous anomaly.2. No evidence of arteriovenous malformation, within the limits of MRA."}
{"instruction": "Generate impression based on findings.", "input": "66 year old male patient with renal mass on CT. Evaluate for a pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is a 1.5 x 2.0 cm lobulated, septated cystic lesion within the head of the pancreas (image 55, series 1304), which appears to communicate with the main pancreatic duct (image 56, series 1304). An additional lobulated, septated cystic lesion within the head/uncinate process measuring 2.3 x 2.2 cm (image 72, series 1304) also appears to communicate with the pancreatic duct. There is no suspicious enhancement of either lesion. The main pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 6.7 x 4.8 x 4.4 cm multiseptated right upper pole renal sinus cyst without suspicious features or enhancement. A subcentimeter lesion within the left lower pole is not hyperintense on T2 images, but is too small to fully characterize. Multiple additional bilateral T2 hyperintense lesions likely represent cysts. No evidence of hydronephrosis. RETROPERITONEUM, LYMPH NODES: Susceptibility artifact within the infrarenal IVC secondary to an IVC filter. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Two dominant cystic pancreatic lesions without suspicious features which appear to communicate with the pancreatic duct likely represent sidebranch type IPMNs.2.Complex left renal sinus cyst without suspicious enhancement. No hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "Dysequilibrium, evaluate for posterior circulation infarct. There is no evidence of acute infarction, intracranial hemorrhage, or mass. There is mild scattered periventricular and subcortical T2 hyperintensity. There is also a subcentimeter focus of encephalomalacia in the left thalamus. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral staphylomas. There is a subcentimeter Thornwaldt cyst.", "output": "No evidence of acute intracranial hemorrhage, mass, or acute infarct. Mild scattered periventricular and subcortical T2 hyperintensity is suggestive of chronic small vessel ischemic disease and a subcentimeter focus of encephalomalacia in the left thalamus is suggestive of a chronic lacunar infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Meningioma, 6 month follow up for changes. There is an extra-axial enhancing left lateral skull base mass centered along the left petrous apex with extension into the cavernous sinus left prepontine cistern and along the left tentorial leaflet. There is associated hyperostosis and permeation of tumor into the underlying bone. The mass also protrudes in the sella, traverses the left lateral wall of the sphenoid sinuses, and extends into the left optic canal. Overall, the mass measures up to approximately 7 cm. Although the mass has not significantly changed since 2014, it appears to have increased slightly in size since 2013. There is mass effect and a patchy area of high T2 signal in the inferior left temporal lobe, which is compatible with vasogenic edema. There is encasement of the left cavernous carotid artery with diffuse narrowing of the flow void. The ventricles are normal in size and configuration. There is no significant midline shift. There is staphylomatous deformity of the bilateral globes. There is mild high T2 signal within the left mastoid air cells suggestive of fluid or mucosal thickening. There appears to be filler material within the bilateral nasolabial folds.", "output": "An extra-axial enhancing left lateral skull base mass centered along the left petrous apex with extension into the cavernous sinus left prepontine cistern and along the left tentorial leaflet with associated hyperostosis and permeation of tumor into the underlying skull, as well as encasement of the left cavernous carotid artery, and vasogenic edema in the left temporal lobe is compatible with a meningioma. Although the mass has not significantly changed since 2014, it appears to have increased slightly in size since 2013. "}
{"instruction": "Generate impression based on findings.", "input": "Right foot pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Specifically, there is no evidence of abnormal signal within the midfoot to suggest avascular necrosis.ADDITIONAL", "output": "Mild nonspecific edema of the plantar musculature. There is no evidence of muscle tear or plantar fasciitis."}
{"instruction": "Generate impression based on findings.", "input": "62 year old male with elevated PSA. Evaluate for prostate carcinoma. PELVIS:PROSTATE:Prostate Size: 4.8 x 2.5 x 3.6 cm (TR x AP x CC)Peripheral Zone: There is extensive decreased T2 signal abnormality with associated restricted diffusion and enhancement in the left posterior base of the peripheral zone of the prostate gland which is suspicious for prostate carcinoma. This extends into the left base and mid body anteriorly as well. There is an additional focus of enhancing signal abnormality in the left posterior apex of the peripheral zone of the prostate gland which is also suspicious for prostate carcinoma.Note is made of multiple foci of signal abnormality with restricted diffusion and enhancement in the right mid body and base of the peripheral zone of the prostate which are also suspicious for prostate carcinoma. Seminal Vesicles: There appears to be extension of signal abnormality in the left posterior base to the level of the left seminal vesicle which raises the question of seminal vesicle involvement by tumor. Extracapsular Extension: There is a capsular bulge along the aforementioned areas of signal abnormality which is suspicious for extensive extracapsular extension with involvement of the left seminal vesicle and probable extension to involve the neurovascular bundle. BLADDER: There is concentric thickening of the bladder suggestive of chronic outlet obstruction.LYMPH NODES: No evidence of lymphadenopathy. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple foci of signal abnormality in the left base, body, and apex of the peripheral zone of the prostate gland, suspicious for prostate carcinoma. There is apparent extracapsular extension and probable involvement of the left seminal vesicle. No evidence of lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": " Exam severely limited due to patient motion. CERVICAL SPINE: Multiple small osseous lesions are again seen in the cervical spine consistent with known multiple myeloma. Example lesions involve the anteroinferior C2 and posterolateral and anteroinferior C5 which are not significantly changed from the previous exam.Lack of contrast somewhat limits evaluation. However, no evidence of epidural mass or cord compression related to tumor is seen. There is moderate spinal canal stenosis at C4-5 and C5-6 and mild canal narrowing at C3-4 and C6-7 related to degenerative disease with disc-osteophyte complexes and ligamentum flavum buckling better seen on prior. Appearance is grossly stable. There is questionable T2 signal abnormality from C4 to C6 which is unchanged. Moderate to severe left C6-7 neural foramen narrowing is similar to prior.THORACIC and LUMBAR SPINE: Multiple small lesions also seen scattered in the thoracic spine. Again seen is a relatively prominent T3 antero-inferior lesion similar to the prior MRI.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. Motion degradation limits evaluation of the epidural tumor. There is however compared to 1/22/2015, significant decrease in extent of epidural soft tissue with thin in residual epidural soft tissue seen in the right aspect of the spinal canal extending from the lower T12 to the L2-L3 level. There is significant interval improvement in mass effect on the conus and upper cauda equina. Extension of epidural soft tissue through the neural foramen on the right at T12-L1, L1-L2, and L2-L3, again seen. Significant decrease in soft tissue involving the right paraspinous musculature and psoas muscle again noted.No significant spinal canal or foraminal stenosis within the upper and mid thoracic spine.Previously seen T2 hyperintensity and swelling of the distal thoracic cord/conus is improved.Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is minimal L5-S1 retrolisthesis, alignment is otherwise maintained. Small osseous lesions are again seen such as at the dorsal L3 vertebral body compatible with known myeloma. L2 lesion with T1 hyperintensity most compatible with a benign hemangioma. No large lesions or compression fractures.Degenerative changes are also seen in the lumbar spine with disk desiccation at L5-S1. There is moderate right and mild left L4-L5 neural foramina stenosis and mild to moderate right and mild left L5-S1 neural foramina stenosis related to disk bulge and facet arthropathy. No spinal canal stenosis is seen inferior to the mid L3 level.", "output": "1. Very motion degraded exam of the spine. Compared to 1/22/2015, there is some decrease in extent of epidural soft tissue in the lower thoracic and upper lumbar spine likely related to combination of treatment effect and decrease in hemorrhagic component of the tumor. Residual epidural soft tissue is again seen in the right aspect of the spinal canal extending from the lower T12 to the L2-L3 level. There is interval improvement in mass effect on the conus and upper cauda equina. Extension of epidural soft tissue again seen extending into the neural foramina on the right at T12-L1, L1-L2, and L2-L3. Decrease in soft tissue involving the right paraspinous musculature and psoas muscle also noted.2. Multiple myeloma with small scattered osseous lesions in the cervical, thoracic and lumbar spine. No large destructive osseous lesions or compression fractures."}
{"instruction": "Generate impression based on findings.", "input": "History of lumbar discectomy, evaluate for abnormality, disc herniation. Recurrent pain down left leg. Right calf numbness and toe cramping. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is grossly maintained. Bone marrow signal is benign. The conus medullaris is normal in position. Postsurgical changes of prior discectomy at L4-L5 with small laminotomies are noted.Lumbar spinal canal appears mildly narrowed congenitally with superimposed degenerative changes, as described below. L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is mild disc bulge with central disc protrusion which effaces the ventral thecal sac and lateral recesses right greater than left. There is bilateral facet arthropathy and ligamentum flavum thickening. There is mild central canal stenosis. No significant neural foraminal narrowing.L3-L4: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy contribute to mild to moderate spinal canal stenosis at this level. Minimal bilateral neural foraminal narrowing.L4-L5: Mild disc bulge without evidence of recurrent disc herniation at this level. Moderate bilateral facet arthropathy is noted. There is mild left neural foraminal narrowing and minimal right neural foraminal narrowing. No significant spinal canal narrowing, markedly improved since prior.L5-S1: Mild disc bulge, ligament of flavum thickening, and facet arthropathy resulting in mild central spinal canal stenosis. There is mild left neural foraminal narrowing and minimal right neural foraminal narrowing.Paraspinous soft tissues demonstrate postsurgical changes in the posterior paraspinous soft tissues at L4-L5 but otherwise unremarkable.", "output": "1. Postsurgical changes in the lumbar spine at L4-L5 without findings to suggest recurrent disc herniation or residual stenosis at this level. 2. There appears to be mild congenital narrowing of the lumbar spine with superimposed degenerative changes with mild to moderate spinal canal stenosis at L2-L3 (with disc extrusion) and at L3-L4. Minimal to mild multilevel neural foraminal narrowing. No high-grade spinal canal or high-grade neural foraminal stenosis is appreciated at any level."}
{"instruction": "Generate impression based on findings.", "input": "Secondary malignant neoplasm of brain and spinal cord(198.3)Malignant neoplasm of other parts of bronchus or lung. Malignant neoplasm of bronchus and lung, unspecified site. Other malignant neoplasm without specification of site. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a small left occipital lobe lesion which enhances following contrast administration and is surrounded by hyperintense signal on FLAIR and T2 images. It currently measures 5 mm diameter and previously measured 5 mm diameter.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. These were also present on the prior exam and have not substantially changed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.A left occipital lobe lesion is stable on the current exam when compared to the prior exam.. 2.Periventricular white matter lesions are present of the moderate degree which are stable since the prior exam. These are nonspecific. They could be vascular related or related to prior treatment."}
{"instruction": "Generate impression based on findings.", "input": "Female 47 years old Reason: R shoulder pain, previous rotator cuff surgery, eval for recurrent tear History: as above ROTATOR CUFF: Postsurgical changes related to prior rotator cuff surgery. The supraspinatus is thickened consistent with tendinosis. There is undersurface tearing along the distal tendon and at the insertion with a full-thickness component approximately 1.5 cm from the insertion with minimal retraction of undersurface fibers. The supraspinatus muscle appears unremarkable. Fluid is identified within the subacromial subdeltoid bursa. Fluid completely surrounds the surgical anchor and threads along its length without clear evidence of anchoring within the bone. SUPRASPINATUS OUTLET: Moderate osteoarthritis of the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Normal glenohumeral joint alignment. No evidence of glenoid labrum tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "1. Supraspinatus tendinosis with undersurface tearing and a full-thickness tear approximately 1.5 cm from the insertion with minimal retraction of undersurface fibers.2. Fluid completely surrounds the surgical anchor and threads along its length without clear evidence of anchoring within the bone."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up prolactinoma: headaches and irregular menses. The pituitary gland enhances slightly heterogeneously, but no discrete tumor is discernible. The pituitary gland is not enlarged and there is no mass effect upon the optic apparatus or cavernous sinuses. The posterior pituitary bright spots is not conspicuous, however. The infundibulum is intact and located in the midline. There are subcentimeter nasopharyngeal retention cysts. There are foci of T2 hyperintensity in the imaged portions of the cerebral white matter.", "output": "1. The pituitary gland enhances slightly heterogeneously and the posterior pituitary bright spot is not apparent, but no discrete tumor is discernible to suggest an adenoma, and no evidence of pituitary apoplexy.2. Nonspecific foci of T2 hyperintensity in the imaged portions of the cerebral white matter. Follow up via a dedicated brain MRI may be useful."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with history of endometrial hyperplasia without atypia and cervical dysplasia. Evaluate for adenomyosis. PELVIS:UTERUS, ADNEXA: Asymmetric juntional zone with the zone measuring approximately 14 mm. There are subendometrial T2 hyperintense foci compatible with cystic foci. T2 hypointense lesion in the anterior uterus with mild enhancement measuring up to 2.7 cm compatible with a leiomyoma.The endometrial stripe measure up to 4 mm. 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": "Findings consistent with adenomyosis and leiomyoma."}
{"instruction": "Generate impression based on findings.", "input": "Prepared encephalocele. Rhinorrhea. Question CSF leak. There is a large defect at midline involving the floor of the anterior cranial fossa through which a combination of CSF and dysplastic brain parenchyma extend to completely fill the nasal cavity. The herniated, dysplastic brain parenchyma also shows cystic change, which likely represents cystic encephalomalacia. Linear T2 hypointense structure (probably graft material from previous repair) is oriented higher anteriorly than posteriorly. There is an apparent, 9-mm in transverse diameter defect posterior to this presumed graft and anterior to the body of sphenoid. Through this defect, there is apparent direct communication between the nasal cavity and the anterior cranium. Multiple foci of susceptibility effect are related to previous repair or calcifications.T2 hyperintensity and volume loss involving the inferior aspect of the frontal lobes is probably gliosis and encephalomalacia, possibly relating to previous repair. The large nasoethmoidal cephalocele and the encephalomalacia/gliosis in the frontal lobes are associated with expected ex vacuo enlargement of the frontal horns of the lateral ventricles, left more than right. The frontal horn of the left lateral ventricle is pulled inferiorly towards the encephalocele opening as well. These parenchymal changes are associated with expected anterior thinning of the corpus callosum. The olfactory bulbs are not well delineated. The remainder of the brain shows no significant abnormality. The pituitary gland and infundibulum are normal. There is mild hypertelorism and orbital deformity which are better appreciated on the comparison CT scan. The optic nerves, chiasm and tracts are normal. The left internal carotid artery is small and shows attenuated flow-related signal/loss of signal up to the supraclinoid segment where it is joined by a large left posterior communicating artery which provides the flow to the left middle and anterior cerebral arteries. The flow void in the left M1 segment is partially attenuated compared to the normal right one, which may reflect slower flow. The sylvian branches are fairly symmetric and normal. These left internal carotid artery findings are probably related to prenatal thrombosis/injury given the that left petrous carotid canal is very small. The right anterior cerebral artery and its branches are smaller than on the right but show no focal stenosis. The vertebral arteries included are symmetric and normal. There is a small fenestration along the proximal basilar artery which is otherwise normal. In addition to the large left posterior communicating artery, there is a smaller right posterior communicating artery as well. The included downstream segments of the posterior cerebral arteries included are symmetric.The nose is markedly deformed without normal anatomic landmarks or features. As discussed above, the nasal cavity is entirely occupied by the cephalocele. While the hard palate is present, there is no soft palate. There is asymmetric, right more than left, enlargement of the palatine and pharyngeal tonsils. The nasopharynx is partly filled with secretions but the patient is intubated. There is T2 hyperintensity in the mastoid cells and middle ear cavities. The inner ears are unremarkable. Mucosal thickening in the maxillary sinuses may part relate to obstruction of outflow by the large nasoethmoidal cephalocele.Please refer to the companion CT scan for better assessment of the osseous structures involved.", "output": "1.While there are changes suggesting previous repair, there is still a large anterior encephalocele containing CSF and dysplastic likely partially encephalomalacia brain parenchyma occupying the nasal cavity. 2.The presumed graft along the floor of the anterior cranial fossa is deficient posteriorly with a 9 mm left paramedian defect as described above.3.Apart from expected changes in the frontal lobes related to the large nasoethmoidal cephalocele and its repair, the brain shows no significant abnormality. 4.Markedly attenuated flow in the left internal carotid artery is probably related to antenatal insult as described above. A left posterior communicating artery provides flow to the left anterior and middle cerebral arteries. Please see above for more details."}
{"instruction": "Generate impression based on findings.", "input": "Male 30 years old status post OLT in 1987 for biliary atresia admitted with conjugated hyperbilirubinemia and diarrhea. Evaluate for biliary dilation. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of liver transplant. Nodular, cirrhotic liver morphology. Atrophic right hepatic lobe with reticular T2 hyperintensity is consistent with fibrosis. There is compensatory hypertrophy of the left lobe.Again seen is multifocal intrahepatic biliary ductal stricturing and dilatation. The common duct is not well seen which may be related to technique particularly as there is no upstream biliary ductal dilatation. The overall appearance is concerning for multifocal strictures.There is a new subcentimeter intrinsically T1 hyperintense, mildly enhancing lesion in hepatic segment 2 (series 18, image 24) with no washout is nonspecific, attention on follow-up imaging is recommended. The hepatic vasculature is patent.SPLEEN: Mild splenomegaly measuring 16 cm in craniocaudal dimension.PANCREAS: Unchanged mild narrowing of mid-body main pancreatic duct with stable upstream ductal prominence. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst. Stable mild prominence of the left collecting system.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small bilateral pleural effusions and associated atelectasis.", "output": "1. Cirrhotic liver morphology with right hepatic lobe fibrosis.2. Accounting for differences in technique stable multifocal intrahepatic biliary stricturing. The common duct is not well seen which may be related to technique as there is no upstream biliary ductal dilatation.3. Small bilateral pleural effusions.4. Mild splenomegaly.5. Additional findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Brain metastases from colon or breast cancer status post stereotactic radiation. There are postoperative findings related to craniotomy involving portions of the right parietal and temporal bones. There is unchanged high T2 signal in the treatment bed, but no associated enhancement. There is encephalomalacia in the left parietal lobe and left basal ganglia. There are also scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute intracranial hemorrhage or acute infarcts. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is mild fluid signal within the right mastoid air cells. There are bilateral lens implants.", "output": "1. Stable post-treatment findings without evidence of intracranial tumor recurrence. 2. Chronic left parietal lobe and left basal ganglia infarcts."}
{"instruction": "Generate impression based on findings.", "input": "Neck pain due to lifting at work. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from straightening which may be in part positional. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc osteophyte complex. Minimal narrowing of the spinal canal. Mild left neural foraminal stenosis. Right neural foramen is patent.C5-6: There is a disc osteophyte complex including a small left paracentral extrusion component. There is mild indentation of the ventral cord, left greater than right. There is overall mild to moderate spinal canal stenosis. There is also moderate right and mild left neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Small disc osteophyte complex with mild spinal canal stenosis. There is left-sided uncovertebral hypertrophy with moderate left-sided neural foraminal stenosis. There is mild right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "1. Multilevel degenerative changes in the cervical spine with up to mild-to-moderate spinal canal stenosis at the C5-C6 level particularly involving the left aspect of the spinal canal. 2. There is also mild or mild-to-moderate neural foraminal stenosis at the C4-C5, C5-C6, and C6-C7 levels. Additional details as above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: altered mental status, evaluate for CVA or other lesions History: as above MRI BRAIN: There is an area of restricted diffusion in the left frontal lobe involving the middle and inferior frontal gyri. Additional, smaller areas of restricted diffusion are noted along the right insula and external capsule as well as the left periventricular white matter of the occipital horn. Microhemorrhages in both thalami appear increased from the prior exam. Periventricular FLAIR signal abnormality is consistent with small vessel ischemic disease. There are old lacunar infarcts in both thalami in addition to the left ventral pons. There is no evidence of a mass. Parenchymal volume loss appears to preferentially affect the parietal and temporal lobes. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.MRA BRAIN: The exam is significantly limited by patient motion artifact. There is intracranial atherosclerotic disease without evidence of significant major vessel stenosis. The right ICA is larger than the left. There are multiple intracranial aneurysms including a 2.5 mm proximal basilar aneurysm, 3 mm right P-comm aneurysm, 3 mm right sub hypophyseal right ICA aneurysm and 3 mm ACOM aneurysm. There is also a 1 to 2 mm outpouching arising from the left cavernous ICA, which likely represents a small aneurysm verus prominent infundibulum. The right ACA is dominant. The middle cerebral arteries appear normal. There is a fetal origin of the right PCA. The left vertebral artery is dominant. The right vertebral artery primarily supplies the PICA. The basilar artery appears normal. There is no evidence of flow-limiting stenosis.MRA NECK: There is a separate origin of the innominate, left common carotid and left subclavian arteries from the aortic arch. The origin of the left vertebral artery is not well-seen but the remainder of the vessel is well opacified. The origin of the right vertebral artery is widely patent. The distal right vertebral artery is attenuated but remains opacified. The common and cervical internal carotid arteries are normal in course. There is mild narrowing of the proximal left ICA without evidence of significant stenosis by the NASCET criteria.", "output": "1.Areas of restricted diffusion in the middle and inferior left frontal gyri and additional, smaller areas of restricted diffusion in the right insula and external capsule as well as the left periventricular white matter of the occipital horn are consistent with acute cerebral infarcts in multiple territories. 2.Multiple intracranial aneurysms including a 2.5 mm proximal basilar aneurysm, 3 mm right P-comm aneurysm, 3 mm right sub hypophyseal right ICA aneurysm and 3 mm ACOM aneurysm. There is also a 1 to 2 mm outpouching arising from the left cavernous ICA, which likely represents a small aneurysm verus prominent infundibulum.3.No evidence of flow-limiting stenosis in the head or neck. There are intracranial atherosclerotic changes present.4.There are microhemorrhages present in the thalami which have accumulated further since the previous exam from 20115.Old lacunar infarcts in the brainstem and basal ganglia.6.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 7.The left vertebral artery is not readily identified. It's possible this is artifactual appearance though the possibility of a left vertebral artery stenosis cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for lesion, inflammatory changes: concern for transverse myelitis, decreased lower extremity sensation, wide based gait. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct, within the limits of artifact, from what may be dental hardware. The brain parenchyma and pituitary gland appear 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, although metal artifact obscures portions of the right face region.Spine: The spinal cord displays normal signal and morphology. The tip of the conus medullaris is positioned at the L1 level and the cauda equina nerve roots are unremarkable. There is no evidence of abnormal enhancement or tumors. There is mild straightening of the cervical spine alignment in the sagittal plane. The vertebral column alignment is otherwise 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 paravertebral soft tissues are unremarkable.", "output": "No evidence of intracranial or spine lesions to suggest an inflammatory process."}
{"instruction": "Generate impression based on findings.", "input": "21 year-old woman with history of lateral knee pain. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is mildly increased signal of the medial facet of the patella without discrete tear or defect of the articular cartilage. Articular cartilage of the tibiofemoral compartments is intact. The marrow and cortical signal in the underlying bone is normal.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "Fraying of the articular cartilage over the medial facet of the patella, otherwise no additional finding to explain the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Thumb pain The proximal phalanx is adducted relative to the first metacarpal which distorts the anatomy of the first metacarpophalangeal joint and limits evaluation of the ligamentous structures. A low signal intensity structure that I believe to be the ulnar collateral ligament proper is seen extending from the dorsal aspect of the first metacarpal head to the base of the proximal phalanx. It appears thickened, but I cannot tell if this is simply due to redundancy related to patient positioning or the sequela of prior trauma. I am not convinced of a full-thickness injury to the ligament or a Stener lesion. The accessory ulnar collateral ligament likewise appears thickened and redundant which may be due to patient positioning. There is increased signal intensity within the radial collateral ligament at its attachment to the metacarpal head that may reflect chronic degeneration or sequela of prior injury. I am not convinced, however, that there is a full thickness tear of this ligament. Small cysts are seen within the underlying metacarpal head. I suspect that there is degeneration of the articular cartilage along the radial aspect of the metacarpophalangeal joint. The sesamoid bones appear intact.The ligaments of the interphalangeal joint of the thumb appear intact.The tendons of the thumb appear intact. Other than the aforementioned cysts in the neck of the first metacarpal, bone marrow signal intensity is within normal limits. Please note that this study does not include the first carpometacarpal joint.", "output": "Evaluation of the ligaments of the first metacarpophalangeal joint is limited due to abduction of the proximal phalanx relative to the first metacarpal. Focal increased signal intensity within the radial collateral ligament at its attachment to the first metacarpal head suggests chronic degeneration or perhaps sequela of prior trauma, although I am not convinced that there is a full-thickness tear of this ligament. The ulnar collateral ligament appears thickened which may reflect a prior sprain or partial-thickness tear, but this may simply be due to redundancy as a result of suboptimal positioning. We will attempt to have the patient return for repeat images with better positioning of the first MCP joint at no charge, assuming the patient can tolerate this positioning.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female with history of spinal stenosis with acute worsening of pain. The visualized calvaria and skull base are radiographically normal.Cervical spine alignment is anatomic. Vertebral body heights and density is within normal limits. The foramen magnum is unremarkable.C2-3 is unremarkable.C3-4 demonstrates neuroforaminal compromise bilaterally with mild central spinal stenosis and ventral hypertrophic changes.C4-5 demonstrates mild spinal stenosis and ventral hypertrophic changes with neuroforaminal narrowing but laterally.C5-6 demonstrates bilateral neuroforaminal narrowing, and advanced degenerative disk disease.C6-7 demonstrates bilateral neuroforaminal narrowing, and advanced degenerative disk disease.C7-T1 demonstrates bilateral neuroforaminal narrowing.T10-11 and T11-12 demonstrates severe degenerative disk disease and near complete loss of disk height.T10/11 demonstrates significant neuroforaminal compromise.T12-L1 is unremarkable.L1-2 is unremarkable.L2-3 shows degenerative disk disease with hypertrophy of the posterior elements.L3-4 demonstrates a large diffuse bulging of disk density material that extends to the ventral epidural space greater on the left which may represent diffuse disk bulge or hypertrophic changes. For further elucidation of this level an MRI may be considered. Advanced degenerative disease is noted with sclerotic end plate changes and vacuum phenomenon. Neuroforaminal compromise is noted bilaterally and a high suspicion for central spinal stenosis.L4-5 demonstrates advanced degenerative disease with vacuum phenomenon. There is complete right neuroforaminal compromise by lateral hypertrophic changes. There is a high suspicion for a tight central spinal stenosis.The L5-S1 shows advanced degenerative disease and a significant diffuse disk bulge. Neuroforaminal compromise affects the right side. The left neuroforamina remains patent.", "output": "Multilevel degenerative disk disease, neuroforaminal compromise and spinal stenosis as described above."}
{"instruction": "Generate impression based on findings.", "input": "57 years, Female, post brain biopsy. History of breast cancer and AML. Again seen are postsurgical changes of biopsy of left occipital intraparenchymal hemorrhagic lesion via burr hole. There has been evolution of the signal features of the blood products as well as slight decrease in size of the lesion, which measures approximately 2.2 x 2.8 x 2.3 cm, previously 3.2 x 3.2 x 3.1 cm. Surrounding vasogenic edema has resolved. There is intrinsic T1 hyperintensity related to late subacute hematoma without definite enhancement.No restricted diffusion to suggest acute ischemia. There is a punctate focus of susceptibility in the right ventral pons likely representing a chronic microhemorrhage. No new intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is a 9 x 7 mm small pineal cyst which remains unchanged. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes and/or posttreatment-related changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. No destructive lesions within the calvarium.", "output": "1. Interval evolution of left occipital intraparenchymal hematoma with decrease in size and resolution of surrounding edema. There is no convincing evidence of metastatic disease in the brain; however, given the hemorrhagic nature of the lesion which may potentially obscure enhancement, consider an additional follow-up study. 2. Punctate focus of chronic microhemorrhage in the right pons. "}
{"instruction": "Generate impression based on findings.", "input": "New daily headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.", "output": "No evidence of intracranial hemorrhage, mass, or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: to r/o vp shunt malfunctioning History: pineal tumor, progressing, vp shunt in situ Suboccipital midline craniectomy is redemonstrated. Extensive bilateral cerebellar and left occipital cortical calcification is again identified and with no interval change. Finding are secondary to post therapy changes.There is filling of the subarachnoid space in the posterior fossa with high attenuation material which extends into the basal cistern. This is noted in the subarachnoid space at the level of foramen magnum, ambient cistern, prepontine cistern, and cerebellar pontine angles. These findings are believed to represent worsening of previously noted extensive pachymeningitis and possible carcinomatosis. There is suggestion of mass effect on the medulla secondary to above findings. Further follow-up with a dedicated MRI examination will significantly better characterize the above findings.Unchanged course and position of right lateral ventricular catheter. The shunt appears to partially traverse the right lateral ventricle. No change in the normal size of ventricular system since prior study. Diffuse low attenuation of the bilateral hemispheric white matter is stable since prior exam. This finding is believed to represent post therapy changes and surgical intervention for placement of multiple prior ventricular catheter placement.There is no hemorrhage, edema, mass effect or midline shift. The calvarium and soft tissues of the scalp are within normal limits. Air-fluid levels within the maxillary sinuses bilaterally. The mastoid air cells are clear.", "output": "1.High attenuation content within the subarachnoid space in the posterior cranial fossa with extension into the suprasellar cistern. Findings are believed to represent interval worsening of patient's known extensive pachymeningitis and possible carcinomatosis.2.Further evaluation with an infused MRI examination is recommended.3.Stable size of shunted supratentorial ventricular system.4.Stable extensive bihemispheric white matter low-attenuation believed to represent post therapy changes.5.Therapy related calcification within the cerebellum bilaterally and left occipital cortex with minimal interval worsening."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Marler is a 64 year old female on neoadjuvant therapy. Mild parenchymal enhancement is noted bilaterally.The index cancer now measures 1.7 x 1.0 x 1.3 cm, compared to 1.8 x 1.1 x 1.4 cm. The posterior satellite continues not to be visible on today's exam. The total area of abnormal enhancement now measures 4.3 cm, compared to 6.0 cm (in the AP direction). The lateral benign intramammary lymph nodes are unchanged. In the left axilla, the reference lymph node now measures 0.8 x 0.5 cm, compared to 0.8 x 0.7 cm. Other lymph nodes are also smaller when compared to priors. There is no new abnormal enhancement seen in either breast. No new abnormal axillary lymph nodes are identified in either axillary region. A vascular port is again present in the right chest wall.", "output": "1. Decreasing size of index cancer and other abnormal enhancement in the left breast. 2. Decreasing size of left axillary lymph nodes.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "80 year-old male, concern for renal cell carcinoma, right renal mass 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: Multifocal right renal masses. The largest lower pole mass measures 11.5 x 9.7 cm. There is enhancing tumor thrombus extending into the renal vein and IVC to the level of the IVC filter. The tumor abuts and is inseparable from Gerota's fascia as well as the renal sinus fat. An additional exophytic right upper pole mass measures 3.4 x 4.2 cm.The left kidney is not visualized and presumably absent. RETROPERITONEUM, LYMPH NODES: IVC filter is noted. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Multifocal right renal masses, consistent with renal cell carcinoma. Tumor thrombus extends into the renal vein and IVC to the level of the IVC filter. 2.The left kidney is not visualized and presumably absent. "}
{"instruction": "Generate impression based on findings.", "input": "History of acute cholecystitis secondary to biliary stricture status post biliary stent placement. History of pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: There is moderate intrahepatic biliary ductal dilatation to the level of the common hepatic duct, increased from the prior especially in the right hepatic lobe. The visualized common hepatic duct demonstrates diffuse circumferential wall thickening and a focal region of enhancement and thickening centrally (series 1203, image 428). The common bile duct stent is noted resulting in surrounding susceptibility artifact.Contracted gallbladder with percutaneous cholecystostomy tube.Small cyst near the right hepatic dome. No suspicious focal lesion. Transient hepatic intensity difference noted in the posterior segment of the right hepatic lobe. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas. There is mild prominence of the main pancreatic duct at the level of the pancreatic body with an abrupt transition point without a focal lesion, suspicious for a stricture although an underlying neoplasm cannot be excluded (series 801/57).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several round regions of decreased T2 weighted signal intensity in the kidneys bilaterally with decreased enhancement and associated striated nephrograms, similar to prior CT. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild basilar atelectasis.", "output": "Long segment peripherally thickened enhancing stricture of the proximal common hepatic duct with increasing upstream biliary ductal dilatation. Given the history of negative EUS/ERCP bile duct brushings (as cholangiocarcinoma/malignancy can appear similarly) and constellation of findings in the kidneys and pancreas auto-immune sclerosing cholangiopathy should be considered.Prominence of the main pancreatic duct with abrupt transition at the pancreatic body without a focal lesion, suspicious for a stricture (similar etiology as above) although underlying neoplasm cannot be excluded.The renal findings described could also be a manifestation of IgG4 related autoimmune disease."}
{"instruction": "Generate impression based on findings.", "input": "History: pain. Rule out epicondylitis. LIGAMENTS: The ulnar collateral ligament, lateral ulnar collateral ligament, and radial collateral ligament appear intact within the limitations of a non arthrogram study.TENDONS: The common flexor and extensor tendons appear intact. The biceps and brachialis tendons appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. SURROUNDING STRUCTURES: There is increased signal abnormality within the ulnar nerve as it traverses within the cubital tunnel under the ligament of Osbourne which may represent a neuritis and clinical correlation is indicated.ADDITIONAL", "output": "1. No evidence of epicondylitis as clinically questioned.2. Increased signal abnormality within the ulnar nerve as it traverses through the cubital tunnel which may represent a neuritis and clinical correlation with the patients symptoms is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RCT? History: pain Slightly suboptimal evaluation secondary to metallic susceptibility artifact related to the patient's history of prior rotator cuff repair.ROTATOR CUFF: There is linear increased signal abnormality within the distal supraspinatus tendon approximately 1 cm proximal to its insertion on the greater tuberosity measuring approximately 7 mm in AP dimension. This likely represents a near full-thickness bursal surface tear which is partially filled with granulation tissue, although focal tendinosis is also a possibility. There is also increased signal abnormality within the anterior fibers of the infraspinatus indicating a partial-thickness tear involving less than 50% of the tendon width measuring approximately 6 to 8 mm in the AP dimension. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a moderate amount of fluid within the subacromial subdeltoid bursa. There are foci of low signal intensity debris internally which may represent a bursitis. Moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Moderate osteoarthritis affects the glenohumeral joint. There is heterogeneity and increased signal intensity within the superior and anterior glenoid labrum likely representing a combination of degeneration and degenerative tearing. There is a small glenohumeral joint effusion.BICEPS TENDON: Note is made of postsurgical changes of a prior biceps tenodesis. ADDITIONAL", "output": "1. Postsurgical changes of prior rotator cuff repair with findings likely representing a high grade near full-thickness tear of the supraspinatus although focal tendinosis is a consideration. 2. Rotator cuff tendinosis and partial thickness tearing of the infraspinatus as described above. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Status post endovascular treatment of a giant vertebrobasilar aneurysm. Evaluate residual aneurysm and mass effect. MRI of the brainThere are five or six punctate foci of diffusion restriction in the cerebellum, thalami and occipital lobes as well as left middle frontal gyrus.There is a 42x34x34 mm premedullary and prepontine mass (thrombosed aneurysm now with coils distally and proximally) with heterogenous signal on T1 and T2 associated with flow voids. Much of the signal is hyperintense on T1WI.The brainstem is displaced and compressed posteriorly by the mass and drapes over the mass. The inferior aspect of the 4th ventricle is narrowed and the foramina of Luschka are distorted. There is mixed signal along the periphery of the mass on SWI phase imaging with some bright signal and some dark signal some of which is opposite in signal on the corresponding magnitude SWI images (suggesting peripheral calcification). The vertebral arteries and basilar artery are contiguous with this mass.A similar signal characteristic well-circumscribe mass is present in the left upper carotid space measuring 16x22xmm. It is stable compared to the prior exam.The temporal horns of the lateral ventricles are dilated. Overall there is mild enlargement of the third ventricle (10 mm width) and lateral ventricles (41mm biventricular diameter at the level of foramina of Monro).There are several supratentorial periventricular and subcortical white matter T2 and FLAIR hyperintense lesions without diffusion restriction.Normal vascular flow voids are present in the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The patient is status post embolic coil occlusion of a 44x35x35mm giant vertebrobasilar aneurysm and occlusion of the LVA distal to the PICA origin. Stents are present in the RVA across the origin of the aneurysm. There is a residual 2mm aneurysm at the more proximal RVA neck of the aneurysm extending superiorly. There is a 26x26x16 mm LICA cervical segment aneurysm redemonstrated which is not adequately compared to the prior exam because it was not entirely included on the prior exam.The anterior communicating artery is identified. The posterior communicating arteries have dilated since the prior exam.", "output": "1.Status post stent assisted embolic coil occlusion of a vertebrobasilar junction giant aneurysm and embolic occlusion of the left vertebral artery (LVA) distal to the PICA. There is 2mm residual filling of the aneurysm at the neck of the RVA component of the aneurysm.2.Several punctate foci of diffusion restriction in the posterior circulation likely represent microinfarcts.3.The overall dimensions of the aneurysm and the mass effect remain stable compared to the prior exam. The ventricles are stable.4.Stable appearing LICA cervical segment dissecting aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "31 years, Male, Reason: Evaluate for HCC History: Cirrhosis with a concerning findings on MRI/Unable to biopsy. ABDOMEN: Left gastric embolization coils produces artifact in this region which obscures visualization.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mildly nodular contour. Segment 4 lesion is unchanged in size measuring 2.3 x 1.8 cm (9/225). This lesion has some signal dropout on out of phase images, indicating some steatosis. No significant enhancement identified, however there is mild hypointensity on portal venous and delayed phase images which is similar to the prior exam. There is also a minimal amount of adjacent ill-defined hypointensity on post contrast images which is unchangedSubcentimeter right hepatic lobe simple cyst. Transjugular intrahepatic portosystemic shunt is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland is not visualized. Right adrenal gland is normal.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Segment 4 lesion is stable in size and has nonspecific MRI features. Continued follow up is recommended."}
{"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 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": "52-year-old male, evaluate lesion in cervical spine. Evaluate for tumor in cervical spine.IMAGE ACQUISITION: Contrast-enhanced CT of the cervical spine was performed after the administration of 80 mL of Omnipaque 350 at 2.5 ml/sec. Again seen is abnormal sclerosis of the left occipital condyle, left lateral mass of C1, posterior arch of C1 with associated collapse. This was previously described on the prior CT and its overall appearance of is unchanged. Associated soft tissue and marrow abnormalities are better appreciated on the recent MRI.Also seen is a subtle focus of cortical erosion along the medial aspect of the right occipital condyle which was present retrospectively on the prior CT. This lies just lateral to a fluid signal collection much better seen by prior MR technique.The vertebral arteries are patent.There is no evidence of fracture or significant degenerative disease in the cervical spine.A new air-fluid level is present in the sphenoid sinus.", "output": "1. Abnormal sclerotic change in the left occipital condyle and left C1 vertebra which has not significantly changed from the prior study. There is also subtle cortical erosion along the medial aspect of the right occipital condyle which was also present retrospectively on the prior CT. These findings in addition to the abnormalities seen on the recent MRI are suspicious for neoplastic disease versus osteoradionecrosis. Infection is considered less likely.2. New air-fluid level in the sphenoid sinus."}
{"instruction": "Generate impression based on findings.", "input": "Lower extremity wound Examination is limited by motion artifact on multiple sequences.There is a large ulceration of the anterolateral soft tissues of the leg at approximately the level of the junction between the upper and middle thirds. The ulceration extends into the tibialis anterior muscle and appears to disrupt the central tendon. There is edema and enhancement of the tibialis anterior muscle and adjacent soft tissues. The ulceration extends to within a couple of millimeters of the anterior tibial cortex where there is a small defect as seen on the recent radiographs. While this may represent an erosion related to the ulceration, there is no abnormal marrow signal intensity in the underlying bone to confirm osteomyelitis. This defect may be posttraumatic in nature.The fibula appears normal. There is subcutaneous edema extending laterally down the leg into the ankle. There are no additional fluid collections separate from the ulceration. Small foci of signal void along the margins of this ulceration may represent foci of gas or less likely tiny metallic foreign bodies. Subcutaneous edema is also noted along the medial ankle.", "output": "Soft tissue ulceration with extension into the tibialis anterior muscle and a small superficial cortically-based defect of the adjacent tibia. While this defect could represent erosion due to the ulceration, there is no abnormal signal intensity to confirm osteomyelitis and it is possible this defect is posttraumatic in nature."}
{"instruction": "Generate impression based on findings.", "input": "Family history of bicuspid AV: Quality of echocardiogram limited. Cardiac MRI ordered to evaluate aortic valve morphology and aorta Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 61 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 22 ml/m2 (normal range 25+/-9), the LVESV is 54 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 125 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 169 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 76 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. The aortic valve is trileaflet.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. Quality of MRA poor precluding aorta measurements.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 drain normally into the right atrium. Prominent azygous vein which drains into the SVC. 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. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%3. Prominent azygous vein which drains into the SVC. 4. Quality of MRA poor precluding aorta measurements."}
{"instruction": "Generate impression based on findings.", "input": "44 years, Female, Reason: h/o Chronic pancreatitis with PRSS1 gene mutation. Pt needs secretin stimulating MRCP. History: Abdominal Pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is diffuse hepatic steatosis with regions of fatty sparing. A wedge-shaped segment 6 focus shows diffusion restriction, edema and progressive enhancement. Left hepatic subcentimeter simple cystsStatus post cholecystectomy. The common bile duct is mildly dilated to 9 mm with a small amount of stricturing in the distal common bile duct which is likely benign, no obstructing lesion delineated. Mild intrahepatic biliary ductal dilatation.SPLEEN: Multiple peri-splenic collateral vessels. The splenic vein is not visualized and likely thrombosed .PANCREAS: There are areas of narrowing involving the mid pancreatic duct with multiple dilated side branches. A blunted response to secretin is observed, compatible with element of exocrine dysfunction. There is diffusely decreased signal on T1-weighted images. Overall these findings suggest sequela of chronic pancreatitis.ADRENAL GLANDS: Two left adrenal lesions measuring 8 mm and 7 mm appear to lose signal on phase images, likely adenomas, are unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "1.Findings of chronic pancreatitis.2.Thrombosis of the splenic vein.3.Wedge-shaped region of diffusion restriction, edema and enhancement within the liver. A vascular etiology is suspected, such as a small portal venous thrombus which is not directly visualized.4.Likely benign stricturing of the distal common bile duct with mild intrahepatic and extrahepatic biliary ductal dilatation.5.Left adrenal nodules are stable, likely adenomas.6.Contrast extravasation as above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 63 years old, with history of breast cancer. Baseline exam prior to starting on clinical trial. A 22 x 14 mm region of enhancing marrow replacement is evident within the right frontal bone. This correlates with an area of increased radiotracer uptake on prior bone scan. A lobular subcentimeter enhancing focus within the left parietal bone may simply represent a vascular space.Postcontrast images are degraded by motion artifact, but within this limitation, no definite pathologic parenchymal or extra-axial enhancement is seen. No evidence of active parenchymal edema is detected.Encephalomalacia is evident involving the right insula, basal ganglia and corona radiata with surrounding parenchymal T2 hyperintensity and mild associated susceptibility. Scattered additional foci of T2 hyperintensity are evident within the periventricular and subcortical white matter.No evidence of any acute intracranial hemorrhage is seen. No abnormal collections are detected. Ex vacuo dilatation of the right lateral ventricle is demonstrated. The ventricular system is otherwise within normal limits.", "output": "1.A lesion within the right frontal bone most likely represents a metastatic deposit, particularly given the nuclear medicine evidence for osseous metastatic disease elsewhere.2.Within the limitations of a motion degraded exam, no definite evidence of any parenchymal metastatic disease is seen.3.Chronic sequelae of right MCA distribution ischemia are demonstrated along with scattered lesions which likely reflect chronic microvascular ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female patient with ileocolonic Crohn's disease status post ileocecectomy off therapy. Strictured anastomosis. Evaluate for ileal disease. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions identified. No intra or extrahepatic ductal dilatation. The gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of an ileocecectomy. There is narrowing and wall thickening of the neo-terminal ileum over a 6 cm length with mild wall enhancement near the ileocolonic anastomosis compatible with acute on chronic disease (image 733, series 16). There is upstream dilatation of small bowel. There is fibrofatty proliferation.There is multifocal narrowing of the distal descending colon and rectosigmoid colon with corresponding wall enhancement compatible with acute inflammation. Furthermore, there is a tract of signal abnormality extending from the rectosigmoid colon to a small bowel loop within the right pelvis which likely represents a fistula (image 337, series 16). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As described above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Stricturing and enhancement of the neo-terminal ileum with proximal focal bowel dilation compatible with acute on chronic disease.2.Multifocal narrowing and enhancement of the descending and rectosigmoid colon compatible with acute on chronic inflammation.3.Probable fistula between the rectosigmoid colon and small bowel within the right pelvis. "}
{"instruction": "Generate impression based on findings.", "input": "Other convulsions [780.39] / Secondary malignant neoplasm of brain and spinal cord [198.3], Reason for Study: ^Reason: evaluate for tumor metastases, focal motor seizures LUE History: Cont. Keppra 500 mg bid as per verbal neurology consult There are multiple enhancing lesions including ring-enhancing lesion (14.3mm x 12.7mm) on the left post-central gyrus, irregularly enhancing lesion (14.3mm x 11.3mm) on the left pre-central gyrus and nodular enhancing lesion on the left the superior temporal gyrus with surrounding edema. The post central gyrus lesion shows susceptibility effects on gradient echo images indicate possible intra lesional hemorrhage or mineralization.Comparing to prior scan, both pre and post central gyri lesions appear to be increased in size and the left temporal lobe lesion is a new lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no acute ischemic or hemorrhagic lesion and the midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Right maxillary sinus shows opacification.", "output": "Interval increase in size of left pre and post central gyri lesions and a new nodular enhancing lesion on the left superior temporal gyrus which are consistent with multiple metastatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old Male with prostate cancer now with increased PSA ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral punctate stones without evidence of hydronephrosis. Bilateral hypodense lesions like representing cyst. Some Ultima to small to accurately characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland demonstrates nodular contour. Posterior laterally on the left side with slight enhancement. Residual disease in the prostate cannot be excluded. MRI may be helpful for further evaluation.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Nodular contours in the left posterior lateral aspect of the prostate, suspicious for residual disease. MRI is recommended for further evaluation. This lesion may be amenable to MR guided prostate biopsy if clinically indicated.Bilateral punctate stones and small renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Reason: metastatic colon cancer on chemotherapy holiday since January. Evaluate for interval change. Changed to MRI per patient request History: met colon cancer ABDOMEN:LIVER, BILIARY TRACT: Hepatic metastases have increased in size compared to prior CT. Previous reference segment 4/8 metastasis measures 3.1 x 2.9 centimeters (series 903 image 583), previously 2 x 1.9 cm. No new hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small subcentimeter left renal cysts, unchanged.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": "Interval increase in size of hepatic metastases. No new lesions."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Intracranial hemorrhage. Signs and symptoms: Intracranial hemorrhage. CT brain without infusion:Images through posterior fossa are unremarkable.Images through the supratentorial space demonstrate massive left frontal contusion with significant amount of hemorrhage. Two lesser degree extensive areas of contusion and hemorrhage in the right frontal lobe is also noted. Compared to prior suboptimal CT of brain there is a slight interval increase in the amount of hemorrhage in the right frontal lobe.Extensive bilateral anterior temporal lobe contusions are again identified. Slight increase in the hemorrhage in the left temporal lobe is suspected, however note should be made that the quality of the exam on the prior study is very poor due to extensive motion.Vasogenic edema surrounding all areas of the above described hemorrhage. Extensive subarachnoid hemorrhage is again identified. There is evidence of bilateral subdurals along the leaves of tentorium which is better appreciated on the current exam than prior. The subdurals extend dorsal to the occipital lobes (left greater than right). The thickest measurable portion of the larger left subdural measures only 3.7 mm on axial image 17. There is mass effect on the left frontal horn secondary to hematoma in the left frontal lobe. The degree of mass-effect remains identical to prior study. Residual blood within the bilateral dependent portion of the lateral ventricles remain similar to prior study. No change in the size of normal appearing ventricle or system.Calvarium is intact, mastoid air cells and middle ear cavities are unremarkable. Opacification of bilateral ethmoid air cells and otherwise well pneumatized paranasal sinuses.Images through orbits demonstrate severely enlarged superior ophthalmic veins which are abnormal and are concerning for increased flow secondary to carotid cavernous fistula. Recommend auscultation and bilateral orbit for detection of bruit and further evaluation with a dedicated MRI, MRA, MRV examination is recommended.", "output": "1.Extensive bifrontal and temporal contusion with surrounding vasogenic edema.2.Suggestion of slight increase in the amount of hemorrhage as detailed above.3.Extensive subarachnoid hemorrhage with no appreciable interval change.4.No appreciable interval increase in the degree of mass effect or size of ventricular system.5.Better visualization of blood in the subdural space overlapping bilateral tentorial leafs as detailed.6.Calvarium remains intact.7.Significantly enlarged and bilateral superior ophthalmic veins is concerning for a carotid cavernous fistula considering patient's history of trauma and extensive intracranial hemorrhage. Above findings were discussed with neural ICU fellow pager number 6228."}
{"instruction": "Generate impression based on findings.", "input": "Male, 63 years old, with history of Parkinson's disease, planning for deep brain stimulator. Parenchymal morphology is within normal limits. There is questionable asymmetric increased T2 signal within the left upper pons. No other significant parenchymal signal abnormality is detected on the provided sequences. No pathologic enhancement is seen. There is a small incidental developmental venous anomaly within the left temporal lobe. Focal CSF widening along the high left precentral gyrus may reflect anatomic variation or a small arachnoid cyst. The ventricular system is normal in size and morphology.", "output": "No acute intracranial abnormality is suspected on these selected sequences obtained for surgical planning purposes."}
{"instruction": "Generate impression based on findings.", "input": "History of right breast cancer status post partial mastectomy and sentinal node biopsy after neoadjuvant therapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Right outer breast 1.5 cm seroma has expected thin peripheral enhancement, but no suspicious nodular enhancement. Right breast skin thickening compatible with previous radiation therapy is also noted. No abnormal axillary lymph nodes are identified in either axillary region. Post surgical change noted in the right axilla.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Sanner is a 58 year old female with a family history of breast cancer in her mother (diagnosed at the age 50). She has a history of multiple bilateral benign breast biopsies. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Stable scars are present in the upper outer quadrant of each breast. A subcentimeter benign morphology non-enhancing mass is present in the right upper outer breast, which corresponds to a benign fibroadenoma as seen on prior ultrasound examinations. A stable subcentimeter circumscribed enhancing mass at the left 3 o'clock position is compatible with a benign intramammary lymph node. There is no abnormal enhancement identified in either breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female with a strong family history of breast cancer in her mother, maternal aunt, maternal grandmother, and two maternal cousins. Known BRCA1 mutation carrier. History of left cyst aspiration in 2011. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Seemingly recurrent facial palsy originally diagnosed as Bell's palsy and treated with steroids with a partial response 1 year ago. This has been seen in the past, but it could simply mean a variant reinnervation as a cause. The imaged portions of the bilateral facial nerves appear unremarkable. Indeed, the bilateral internal auditory canals and cranial nerve 7 and 8 complexes are unremarkable. There is no abnormal enhancement along the imaged portions of the facial nerves. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.", "output": "1. No evidence of proximal facial nerve lesions.2. No evidence of intracranial hemorrhage, mass, or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "History of recurrent nasopharyngeal carcinoma and oral cavity squamous cell carcinoma, status post treatment. There are post-treatment findings in the neck. There is ill-defined heterogeneity of the right tonsillar fossa region, but no evidence of discernible residual measurable mass in the oral cavity. There is mildly prominent enhancement of the upper aerodigestive track mucosa diffusely, which likely represents mucositis. There are no significantly enlarged lymph nodes in the neck. Indeed, the left level 2A lymph node measures up to 6 mm in short axis, previously 10 mm. The salivary glands and thyroid are unchanged. The imaged intracranial structures and orbits are unremarkable. The osseous structures are unchanged. There are subcentimeter retention cysts in the right maxillary sinus.", "output": "Post-treatment findings in the neck without convincing evidence of measurable tumor."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Right rotator cuff tear History: Right shoulder pain ROTATOR CUFF: There is partial thickness tearing of the articular surface fibers of the supraspinatus at the level of its insertion on the greater tuberosity, involving less than 50% of the tendon width, measuring approximately 8 mm in AP dimension. There is no significant retraction. There is increased signal abnormality within the infraspinatus indicating tendinosis. There is undersurface fraying of the teres minor at the level of its insertion on the greater tuberosity. There is interstitial tearing of the subscapularis at the level of its insertion on the greater tuberosity. There is mild fatty atrophy of the infraspinatus at the level of the myotendinous junction.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Moderate to severe degenerative changes affect the glenohumeral joint with large portions of the glenoid completely devoid of articular cartilage. There is underlying subchondral cyst formation. There is linear increased signal abnormality traversing the posterior labrum which extends to involve the articular cartilage of the glenoid, indicating a tear (glenolabral articular disruption), within the limitations of this non arthrogram study. There is heterogeneity and increased signal abnormality within the superior and inferior labrum also consistent with degeneration/degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the glenohumeral joint versus a tenosynovitis.ADDITIONAL", "output": "1. Partial thickness tearing of the supraspinatus and interstitial tearing of the subscapularis without evidence of a full-thickness rotator cuff tear or retraction.2. Osteoarthritis of the right shoulder including full-thickness articular cartilage degeneration and tearing of the glenoid labrum as described above.3. Loose bodies within the joint and tendon sheath of the long head of the biceps.4. Findings suggestive of a tenosynovitis involving the long head of the biceps tendon."}
{"instruction": "Generate impression based on findings.", "input": "Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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, and scalp soft tissues are grossly unremarkable. There is moderate right sphenoid and posterior ethmoid sinus, as well as left maxillary and anterior ethmoid sinus mucosal thickening.", "output": "1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Inflammatory mucosal disease involving the right sphenoid and posterior ethmoid sinuses, as well as left maxillary and anterior ethmoid sinuses."}
{"instruction": "Generate impression based on findings.", "input": "Male 72 years old Reason: hx of bladder cancer s/p radical cystectomy with ileal conduit urinary diversion, evaluate for metastatic disease History: see above ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Native kidneys are atrophic. Hemorrhagic debris fills the right renal collecting system, unchanged.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta. There are small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Status post cystoprostatectomy and ileal conduit urinary diversion without evidence of lymphadenopathy or metastatic disease2.Signal and body involving the parasymphysial regions and posterior inferior pubic rami most suggestive of stress fractures."}
{"instruction": "Generate impression based on findings.", "input": " Limited sequences were obtained for surgical localization. There is presumably heterogeneously enhancing mass in the mid to inferior fourth ventricle which is dilated, extending into the upper cervical spinal canal at the upper C1-C2 level. T2-weighted images demonstrate central areas of cystic change especially along its cranial margin. There is associated and mild to moderate dilatation of the lateral and third ventricles due to this obstructive process, although flow void is identified through the cerebral aqueduct. Significant T2 hyperintensity within the periventricular white matter to suggest acute transependymal edema. The mass measures 2.4 cm transverse x 2.9cm AP x 5.5 cm CC, and appears to extend out of the foramen of Magendie. There is significant mass effect upon the brainstem, essentially effacement of the prepontine cistern.Sulci also appear somewhat prominent for patient's stated age. There is no midline shift. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. SPINE", "output": "1.Large heterogeneously enhancing mass centered in the fourth ventricle extending along the dorsal upper cervical spinal canal, with localized mass effect on the brainstem. Differential diagnosis includes primary neoplasms such as ependymoma given patient's age, as well as medulloblastoma and pilocytic astrocytoma. Rarely, glioblastoma can also have this appearance.2.Associated obstructive hydrocephalus although without MR evidence of acute transependymal edema.3.No acute cord compression. No gross spinal abnormality on this noncontrasted spine exam."}
{"instruction": "Generate impression based on findings.", "input": "Slurred speech [R47.81] / Facial myokymia [G51.4], Reason for Study: ^Reason: structural lesions, vascular abnormalities History: left sided facial twitching and slurring of words. feels disconnect Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or 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.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal with the right distal vertebral artery is hypoplastic. No intracranial arterial flow restricting stenosis or arterial aneurysm is seen.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal brain MRA. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 32 years old, with leg weakness, numbness and back pain. No evidence of acute cord compression is seen. A disc herniation at L5-S1 is noted which may impinge upon some of the adjacent nerve roots. Mild disc degeneration with annular fissuring is evident at L4-5. Elsewhere, the intervertebral discs are preserved and the spinal canal is not significantly compromised. Spinal alignment is anatomic. Vertebral body height, morphology and signal characteristics are within normal limits. The visualized spinal cord shows normal signal intensity and morphology throughout.", "output": "1.No acute cord compression.2.A disc herniation is evident at L5-S1 which may impinge upon some of the adjacent nerve roots. This can be further assessed with nonemergent dedicated lumbar spine MRI."}
{"instruction": "Generate impression based on findings.", "input": "Reason: right knee pain History: right knee pain MENISCI: There is blunting of the posterior horn of the lateral meniscus indicating a new longitudinal tear although some of this may in part reflect postsurgical change from prior partial meniscectomy. There is blunting and deformity of the posterior horn of the medial meniscus likely representing a combination of prior complex tearing, postsurgical change and degeneration which extends to involve the body of the meniscus. There is a ghost meniscus affecting the posterior horn of the medial meniscus near its root indicating a full-thickness radial tear.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the weightbearing surface of the medial femoral condyle measuring approximately 1.5 cm in the AP dimension. There is a focal full-thickness articular cartilage defect along the femoral trochlea centrally, which extends along the lateral facet, measuring approximately 13 mm in the craniocaudal dimension.LIGAMENTS: Note is made of postsurgical changes of prior ACL graft reconstruction. The graft appears intact. The PCL appears intact. The MCL and LCL appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Postsurgical change of prior ACL graft reconstruction. The graft appears intact.2. Radial tear of the posterior horn of the medial meniscus near its root, new from prior examination. There is also blunting and deformity of the posterior horn of the medial meniscus which likely represents a combination of prior complex tearing, postsurgical change and degeneration.3. Tearing of the posterior horn of the lateral meniscus which also appears new from the prior examination.4. Focal full-thickness articular cartilage defects along the femoral trochlea and medial femoral condyle which are new when compared to the prior examination."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer with metastatic brain lesions: three-month follow-up. There are postsurgical findings related to left parietal metastasectomy. There is adjacent dural thickening and blood products, but no evidence of enhancing tumor in the resection cavity. There is a 6 mm enhancing lesion along the left superior parietal lobule, which appears to have slightly more confluent in enhancement, but is unchanged in size. There is also a 2 mm focus of enhancement in the right middle frontal gyrus and right medial orbitofrontal gyrus, which are also unchanged in size. There is a non-enhancing subcentimeter nodular focus of susceptibility effect along the ependymal surface of the right caudate head. There is no evidence of intracranial hemorrhage or acute infarct. The pituitary gland appears unremarkable. There is no other abnormal intracranial enhancement. Multiple foci of T2 hyperintensity in the bilateral cerebral white matter are nonspecific, but compatible with chronic small vessel ischemic disease. 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. There is mild mucosal thickening involving the anterior ethmoid air cells and bilateral mucous retention cysts of the maxillary sinuses, right greater than left. The remaining paranasal sinuses and mastoid air cells are otherwise clear. The orbits are grossly unremarkable.", "output": "1. Postsurgical findings of left parietal metastasectomy without evidence of recurrent tumor at this site.2. Subcentimeter left parietal lobe and right frontal lobe lesions are stable in size. Likewise, the non-enhancing subcentimeter nodular lesion along the ependymal surface of the right caudate head is unchanged.3. No evidence of acute infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Male, 5 years old, with history severe constipation, L1-L2 vertebral anomaly, solitary kidney. A partial block vertebra anomaly is demonstrated at the L1 level. Specifically, there is partial segmentation of the right aspect of the vertebral body which is taller than the left. There are two pedicles on the right resulting in an extra facet complex and an extra neural foramen on the right but no discrete disc space. The left aspect of the L1 vertebra is of normal height and has formed only one pedicle. As a result of this anomaly, there is a relatively focal dextroscoliotic curvature of the spine centered in the upper lumbar region with some compensatory levoscoliosis of the lower lumbar spine. The sacrum is asymmetric as well with the possibility of some posterior dysraphism at the lowest sacral levels, though this is difficult to assess on MR.Counting the block vertebra at L1 is a single vertebral body level, there is a normal complement of vertebral bodies which otherwise appear to be fully formed and intact. Sagittal alignment is within normal limits. No evidence of marrow replacement or edema is seen. The spinal canal and neural foramina are patent throughout. The intervertebral discs are normal.The conus tip terminates at the upper L3 level which is below the lower limit of normal. The filum terminale is T1 hyperintense for part of its course and closely apposed to the posterior aspect of the thecal sac. The spinal cord otherwise demonstrates normal morphology. On prone images, there does not appear to be much anterior motion of the conus and cauda equina relative to supine imaging.A single right-sided kidney is demonstrated. The partially visualized colon and bladder appear to be distended.", "output": "1.Partial block vertebra anomaly at L1 which results in a scoliotic deformity of the lumbar spine. The remaining vertebral body levels appear to be fully formed and normal, with the possible exception of the lowest sacral levels where there may be some posterior dysraphism.2.Findings are seen suggestive of tethered cord including a low-lying conus, fatty infiltration of the filum terminale, and little if any anterior motion on prone imaging.3.Incidental findings include a solitary right kidney and distended bladder and colon."}
{"instruction": "Generate impression based on findings.", "input": "A 47 year old male with history of paroxysmal atrial fibrillation, normal left ventricular function with mild concentric left ventricular hypertrophy and symptoms of palpitations. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 191 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 91 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 108 g (normal range 164+/-36). No regional or concentric hypertrophy is noted. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. A small left ventricular diverticulum is noted in the basal inferior wall. This finding can be a normal variant but has also been described in family members of individuals with hypertrophic cardiomyopathy.No cardiac iron overload noted.No findings of cardiac amyloid.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 199 ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 100 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 trace 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. The left ventricle is normal in size with low normal systolic function, the LVEF is 53%. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. No regional or concentric hypertrophy noted. No cardiac iron overload noted. No findings of cardiac amyloid. 4. A small left ventricular diverticulum is noted in the basal inferior wall. This finding can be a normal variant but has also been described in family members of individuals with hypertrophic cardiomyopathy.5. The right ventricle is normal in size with normal systolic function, the RVEF is 50%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Secondary malignant neoplasm of brainClinical question: s/p craniotomy used for SRS evaluationSigns and Symptoms: S/P craniotomy The patient is status post frontal craniotomy for removal of a right superior frontal gyrus mass. There are signal changes present at the right superior frontal gyrus white matter and some susceptibility effect at the tumor bed.There is redemonstration of a subgaleal fluid collection superficial to the craniotomy site which appears relatively stable compared to the 10/28/2015 exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.The patient is status post right frontal lobe surgery. There is no enhancing mass present along the right frontal lobe at this time. There is interval regression of associated vasogenic edema.2.There is a subgaleal fluid collection present at the craniotomy site which is stable since the prior exam.3.Exam was performed for treatment planning and is a limited exam"}
{"instruction": "Generate impression based on findings.", "input": "60 years Female (DOB:1/4/1956)Reason: r/ostroke History: right face tinglingPROVIDER/ATTENDING NAME: GREGG M HELLAND JACQUELINE T. BERNARD MRI of the brainThere is diffusion restriction present along the left posterior limb of internal capsule extending to the centrum semiovale measuring 24 x 12 mm axial dimensions. There is associated FLAIR and T2 signal abnormality.There is a punctate focus of FLAIR signal hyperintensity in the right basal ganglia.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are very small.. The vertebral arteries are similar in size. There is extracranial origin of the right posterior inferior cerebellar artery. The left A1 segment is larger than the right A1 segment.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.", "output": "1.Acute infarction involving left posterior limb of internal capsule and adjacent centrum semiovale. 2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm.4.No evidence for extracranial cerebrovascular occlusive disease."}
{"instruction": "Generate impression based on findings.", "input": "Neck mass, likely thyroglossal duct cyst. There is a midline intrinsically T1 hyperintense cystic lesion anterior to the body of the hyoid bone that measures up to 20 mm. The thyroid gland and base of the tongue are unremarkable. There is no evidence of significant cervical lymphadenopathy. There is multilevel degenerative cervical spondylosis with indentation upon the spinal cord at CC4-5 to C6-7. The salivary glands are unremarkable. The imaged intracranial structures are also unremarkable. There are bilateral lens implants.", "output": "Findings compatible with a thyroglossal duct cyst at the level of the hyoid bone, measuring up to 20 mm."}
{"instruction": "Generate impression based on findings.", "input": "Male 25 years old Reason: RLE pain, hx of NF1. Right thigh/buttock pain and twitching. Evaluate for plexiform neurofibroma or sarcoma. Right femur: Bone marrow signal is within normal limits. Visualized muscles and tendons are unremarkable. Visualized soft tissues are unremarkable. No T2 hyperintense signal in the muscles in the right thigh. Small joint fluid is noted in the right knee.Pelvis: T2 hyperintense edema signal is seen in the left gluteal musculature. There is scarring in the overlying left subcutaneous soft tissue with a loss of subcutaneous fat. There is a focal area of superficial soft tissue scarring with low signal. No plexiform neurofibromas are identified. No lesions that are suspicious for malignant peripheral nerve sheath tumors are identified.", "output": "1.Left gluteal musculature edema with overlying subcutaneous superficial scarring.2.No plexiform neurofibromas identified, and no lesions that are suspicious for malignant peripheral nerve sheath tumors within limitations of a noncontrast-enhanced examination."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with history of ventral hernia now with mental status changes. Possibly blood seen on CT. Rescan for concern for hemorrhage. Focus of high attenuation in the left frontal region is less conspicuous. This may represent cortical hemorrhage or possibly a dural based calcified meningioma. If clinically indicated, an MRI could be considered for follow-up.Small vessel disease and corticomedullary volume loss as described in prior exam.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": "Focus of high attenuation is less conspicuous in the left frontal region. This may represent a cortical hemorrhage or a small calcified dural based meningioma. MRI is recommended for follow-up if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Intracranial hemorrhage? Signs and symptoms: Headaches. Non-enhanced MRI of brain:Extensive postoperative changes of large bifrontal craniotomy. Significant widening of the epidural space containing serosanguineous fluid and air. This is a postoperative findings. Epidural collection causes mass effect and posterior displacement of frontal lobes. Residual air within the subarachnoid space from patient's surgery. No evidence of parenchymal hemorrhage. Interval reduction in the low density cyst in the basal cistern. On the current exam the cyst measures approximately 19 mm in AP and 27-mm in transverse diameter. This is a smaller than prior examination which measured 25 mm x 36-mm. no evidence of hemorrhage within the cyst.", "output": "1.Reduction in the size of cyst within the basal cistern consistent with patient's past history of craniopharyngioma.2.Extensive postoperative changes all bifrontal craniotomy as detailed above.3.No evidence of acute hemorrhage within the brain parenchymal or cyst within the basal cistern."}
{"instruction": "Generate impression based on findings.", "input": "80 year old male with hypertension, hyperlipidemia, coronary artery disease, diabetes, peripheral arterial disease, and hyperthyroidism. Prior anterior MI in 1996 treated medically. PCI of RCA and LCx in 2012. Cath in January 2015 showed ostial occlusion of RCA stent with collateralization, and 75% stenosis of LAD. DES placed in LAD.MEDICATIONS: ASA, atorvastatin, carvedilol, plavix, digoxin, fluticasone, gabapentin, levothyroxine, mefoxin, clarithromycin, moxifloxacin. First Pass PerfusionDuring hyperemia a perfusion defect was noted in (1) the basal to mid inferior and inferoseptal walls and (2) basal to mid anterolateral and inferolateral walls. Viability/ Myocardial ScarThere is a large transmural myocardial infarction involving much of the LAD territory, which is unlikely to be viable. There is no evidence of myocardial infarction in most of the LCx and RCA territories, which are likely to be viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is marked thinning and akinesis in most of the LAD territory. There is hypokinesis in the RCA territory. There is normal wall motion in the LCx territory. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 180 ml/m2 (normal range: 74+/-15), the LVEDV is 277 ml (normal range 142+/-34), the LV end systolic volume index is 145 ml/m2 (normal range 25+/-9), the LVESV is 222 ml (normal range 47+/-19), the LV mass index is 72 g/m2, and the LV mass is 110 g. Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 52 ml/m2 (normal range 82+/-16), the RVEDV is 81 ml (normal range 142+/-31), the RV end systolic volume index is 21 ml/m2 (normal range 31+/-9), and the RVESV is 31 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet and opens widely. There is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is mild diastolic mitral regurgitation suggesting increased left ventricular end-diastolic pressure. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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. There is a transmural myocardial infarction in the LAD territory.2. There is mild ischemia with normal wall motion and viability in the LCx territory.3. There is severe ischemia with hibernating myocardium and viability in the RCA territory. 4. Severe left ventricular dilation with severely reduced systolic function (LVEF 20%).5. Normal RV size and systolic function (RVEF 61%).6. Mild aortic regurgitation.7. There is mild diastolic mitral regurgitation suggesting high left ventricular end-diastolic pressure. "}
{"instruction": "Generate impression based on findings.", "input": " There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Fluid is present within a few right mastoid air cells. The remaining visualized paraspinal contents are unremarkable.C1/2: Ligament thickening is present without significant resulting stenosis.C2/3: Trace anterolisthesis C2 on C3, mild posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral facet hypertrophy with bilateral facet fusion. There is moderate bilateral neural foraminal stenosis, however there is no central stenosis.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and left-sided facet hypertrophy with left facet fusion. There is mild central, severe left neural foraminal, and mild to moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and facet hypertrophy. There is mild to moderate central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.C6/7: Grade 1 anterolisthesis C6 on C7, posterior osteophyte disc complex, bilateral uncinate hypertrophy, and bilateral facet hypertrophy. There is mild central, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.C7/T1: Trace anterolisthesis C7 on T1, ligamentum flavum thickening, and bilateral facet hypertrophy. There is severe left neural foraminal and mild to moderate right neural foraminal stenosis.Bilateral facet hypertrophy is present involving all visualized upper thoracic levels which encroach the neural foramina bilaterally.", "output": "1.Fluid is present within a few right mastoid air cells. 2.C2/3: Moderate bilateral neural foraminal stenosis, however there is no central stenosis.3.C3/4: Mild central, severe left neural foraminal, and mild to moderate right neural foraminal stenosis.4.C4/5: Mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.5.C5/6: Mild to moderate central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.6.C6/7: Mild central, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.7.C7/T1: Severe left neural foraminal and mild to moderate right neural foraminal stenosis.8.Bilateral facet hypertrophy is present involving all visualized upper thoracic levels which encroach the neural foramina bilaterally."}
{"instruction": "Generate impression based on findings.", "input": " Motion artifact degrades image quality.MRI BRAIN: There is no diffusion restriction to suggest acute infarct. There is encephalomalacia of the left cerebellar hemisphere, consistent with chronic left PICA territory infarct. There are associated areas of susceptibility effect in this region, consistent with hemosiderin deposition from remote hemorrhage. There is no evidence of acute intracranial hemorrhage or mass. There are very minimal punctate foci of T2 signal abnormality in the cerebral white matter, consistent with minimal small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There appears to be a small left posterior frontal developmental venous anomaly. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. MRA HEAD: The left A1 segment is hypoplastic. There appears to be mild irregularity of the left M1 segment without significant stenosis. There is focal stenosis of the right P2 segment. There is paucity of flow-related enhancement stenosis of the proximal V4 segment of the left vertebral artery. There also appears to be irregularity of the V4 segment of the right vertebral artery. There is mildly irregular flow-related enhancement in the bilateral carotid siphons, likely due to the presence of calcifications. There is no evidence of aneurysm.MRA NECK: There is paucity of enhancement in multiple locations along the course of the cervical portion of the left vertebral artery, particularly the V1 segment. The right vertebral artery flow void appears to be intact. There is mild stenosis of the left internal carotid artery near the bifurcation. The common carotid arteries and cervical internal carotid arteries are tortuous with a retropharyngeal course. There also appears to be mild stenosis of the left proximal internal carotid artery. There is a three vessel aortic arch. There is a small effusion at the left occipital-C1 articulation.", "output": "1. Chronic left PICA territory infarct, but no evidence of acute or subacute infarct.2. Multiple focal stenoses of the intracranial and extracranial vessels, particular involving the right P2 and left V1 and V4 segments.3. Mild stenosis of the proximal left internal carotid artery. Otherwise, no high-grade stenosis of the right internal carotid artery.Findings discussed with Dr. Verma on 1/5/2015 at the time of dictation."}
{"instruction": "Generate impression based on findings.", "input": "Male, 47 years old. Left knee pain, s/p left knee medial femoral condyle microfracture, evaluate healing, evaluate for new chondral injury, meniscus tear. MENISCI: There is attenuation of the body and posterior horn of the medial meniscus consistent with partial meniscectomy. There is globular high signal intensity within the remaining posterior horn of the medial meniscus near its root likely representing intrasubstance mucoid degeneration that appears to extend to the inner edge of the meniscus, likely representing a degenerative tear appearing similar to that seen on the prior study. Also again seen is branching intermediate signal intensity within the periphery of the posterior horn more medially suggesting a complex, predominantly vertical tear that appears similar to that seen on the prior study. Given its location in the periphery of the meniscus, it is possible that this represents a healed tear. We see no lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: There is new subchondral edema within the medial femoral condyle above the anterior horn of the medial meniscus. There is an overlying full-thickness cartilage defect. The articular cartilage of the lateral compartment and patella are relatively well preserved. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. There is some edema in the subcutaneous tissues anterior to the patella and patellar tendon which is nonspecific.ADDITIONAL", "output": "1.New focus of degenerative subchondral signal abnormality in the medial femoral condyle with an overlying full-thickness cartilage defect.2.Surgical changes involving the medial meniscus with degeneration and tearing as described above, appearing similar to prior."}
{"instruction": "Generate impression based on findings.", "input": "seizure and nystagmus No evidence of acute ischemic or hemorrhagic lesion.Multifocal scattered FLAIR high signal intensity lesions on bilateral periventricular white matter indicate minimal non specific small vessel disease, no change since prior exam. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or 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.2. No interval change of minimal non specific small vessel ischemic disease since prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Radiculopathy, lumbar regionClinical question: Back pain and h/o metastatic breast cancerSigns and Symptoms: Back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is diffuse heterogeneous marrow replacement throughout the visualized osseous structures of the lumbar spine as well as the sacrum and iliac bones. Compared to the prior exam from 1/14/2015 the foci of marrow replacement appear to be somewhat smaller. For example at the first sacral segment a marrow replacing focus has decreased from 19 x 14 mm sagittal dimensions to 12 x 9 mm sagittal dimension. A similar effect is also noted at other levels as well. An epidural mass with perivertebral extension at the L2, L3 and L4 vertebral body levels is redemonstrated and appears to have regressed somewhat but not resolved. It extends into the left L2-3, L3-4 and L4-5 the neural foramina and encroaches on the exiting nerve roots. It also extends into the perivertebral space as well as the left lateral aspect of the spinal canal at these levels.There is a smaller right-sided perivertebral mass adjacent to the L2 vertebral body which involves right-sided exiting nerve roots at the lateral aspect of the right L2-3 neural foramen.There is a large mass present involving the left iliac bone which is not entirely included on this exam. This measures appears larger. Incidental note is made of multiple perineural cysts in the sacrum which were also present on the prior exam and are stable.", "output": "1.There is diffuse skeletal metastases present throughout the visualized lumbar spine, sacrum and iliac bones. These have mildly regressed since the January exam.2.Epidural and left perivertebral mass involving the neural foramina at L2-3, L3-4 and L4-5 - where it involves exiting nerve roots - as well as the spinal canal at these levels has mildly regressed since the prior exam but is not resolved. This is likely metastatic.3.A large left-sided iliac bone mass is incompletely visualized on the current exam. Please refer to MRI of the pelvis of the same date for further comments. This is likely metastatic."}
{"instruction": "Generate impression based on findings.", "input": "Buttock pain with left leg radiculopathy and weakness in left leg Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of lumbar lordosis. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc desiccation and mild bulge. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation and mild bulge. No spinal canal or neural foraminal stenosis.L4-L5: There is disc bulge eccentric to the left without significant spinal canal stenosis. Previously seen left foraminal and extraforaminal disc protrusion is slightly less prominent and the previously seen annular fissure is no longer appreciated. There is mild left neural foraminal stenosis with contact of the exiting left L4 nerve root. No significant right neural foraminal narrowing. L5-S1: Disc desiccation, loss of height, and mild bulge. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.", "output": "1. Disc bulge eccentric to the left at the L4-L5 level which contacts the exiting left L4 nerve root. There is mild left-sided neural foraminal stenosis which was also present on prior study from 2004.2. Remainder of the spinal canal or neural foramina are patent."}
{"instruction": "Generate impression based on findings.", "input": "Pain. Question of rotator cuff tear or frozen shoulder. ROTATOR CUFF: The tendons and muscles of the rotator cuff are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. The coracohumeral ligament is intact, but thickened. The subcoracoid fat pad is partially obscured; these findings likely represent \"frozen\" shoulder. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a subchondral cyst within the humeral head.The labrum is grossly intact.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL", "output": "Findings likely represent \"frozen\" shoulder. No evidence of a rotator cuff tear. "}
{"instruction": "Generate impression based on findings.", "input": "64 year old man with new bi-ventricular heart failure, referred for further evaluation of inducible ischemia and viability.MEDICATIONS: Aspirin, Lipitor, Lasix, Lisinopril, Toprol XL First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was a small area of late gadolinium enhancement at the RV insertion point. Otherwise there was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. LV mass is mildly increased. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 160 ml/m2 (normal range: 74+/-15), the LVEDV is 264 ml (normal range 142+/-34), the LV end systolic volume index is 129 ml/m2 (normal range 25+/-9), the LVESV is 213 ml (normal range 47+/-19), the LV mass index is 123 g/m2, and the LV mass is 209 g. LV dysfunction is global with regional variation. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 26%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 168 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 124 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size. On LGE imaging, there is a thrombus noted in the right atrial appendage. Aortic ValveThe aortic valve opens widely and there is mild to moderate aortic regurgitation.Mitral ValveThe mitral valve has bi-leaflet tethering. There is mild 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (24mm).Venous AnatomyThe SVC and IVC 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. No perfusion defects/ \"ischemia\" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable. Small area of late gadolinium enhancement noted at the RV insertion point.3. Severely dilated LV with severely reduced LV ejection fraction (LVEF 19%). There is global hypokinesis with regional variation.4. Normal RV size with severely reduced systolic function (RVEF 26%).5. Thrombus in the right atrial appendage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Right shoulder pain The examination is limited by motion artifact.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon with retraction to the level of the glenoid. A full-thickness tear of the infraspinatus tendon is also evident. There is moderate fatty atrophy and edema of both the supra and infraspinatus muscles. The teres minor and subscapularis tendons and muscles are intact.SUPRASPINATUS OUTLET: There is moderate arthrosis of the acromioclavicular joint with a small amount of fluid present. Fluid is also present within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding as a result of a chronic rotator cuff tear. There is absence of the portions of the superior and anterior labrum which is likely degenerative in nature.BICEPS TENDON: Evaluation of the biceps tendon is limited secondary to motion artifact. The intra-articular portion of the biceps tendon is poorly visualized which may reflect some tearing although the extra-articular portion of the biceps is intact. ADDITIONAL", "output": "1. Full-thickness tears of the supraspinatus and infraspinatus tendons with retraction of the supraspinatus to the level of the glenoid. There is atrophy and edema of the associated rotator cuff musculature.2. Moderate osteoarthritis of the acromioclavicular joint with glenohumeral joint effusion.3. Poor visualization of the intra-articular biceps tendon which may in part be secondary to motion artifact although the presence of biceps tendon tear is not excluded."}
{"instruction": "Generate impression based on findings.", "input": "History of right ovarian artery and left uterine artery embolization for fibroids. PELVIS:UTERUS, ADNEXA: Myomatous uterus.The large reference intramural posterior mid body myoma measures 4.7 x 4.8 x 4.1 cm (TR by AP by cc), compared to 6.3 x 5.6 x 5.1 cm previously. There are no regions of T2-hyperintensity, compatible with necrosis. On postcontrast imaging there is no significant postcontrast enhancement of the majority of the fibroid, significantly decreased from the prior study.The reference subserosal pedunculated fibroid arising off the anterior fundus measures 1.6 cm (series 7/24), unchanged. This fibroid demonstrates postcontrast enhancement, unchanged.The endometrium appears very thickened with multiple fluid signal intensity foci compatible with adenomyosis.The reference fluid collection in the right vaginal introitus measures 2.7 x 2.4 cm compared to 2.8 x 2.1 cm previously compatible with a Gartner's/Bartholin's duct cyst. Multiple small nabothian cysts are again noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple nonspecific bilateral inguinal and femoral lymph nodes measure less than 1 cm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Interval decrease in the size of the dominant fibroid with interval decrease in enhancement.2.Diffuse adenomyosis. "}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other disturbances of skin sensationClinical question: Evaluate for etiology of R facial numbnessSigns and Symptoms: R facial numbness, acute onset The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "MRI of the brain is within normal limits. There is no intracranial mass lesion or other explanation for the facial numbness. There is no evidence for acute ischemic cerebral infarction."}
{"instruction": "Generate impression based on findings.", "input": "History of noncontact injury of left ankle TENDONS: The peroneal, extensor, flexor, and Achilles tendon are intact.LIGAMENTS: The medial and lateral ligament complexes are intact.ARTICULAR SURFACES AND BONE: No fractures are identified. There is a small' cylindrical focus of bone marrow signal abnormality within the distal tibia within an additional similar focus of signal abnormality within the posterior calcaneus compatible with osseous defect from prior external fixation device. Small subchondral cysts are present within the posterior aspect of the distal tibia with associated reactive bone marrow edema. There is ossification of the distal tibiofibular syndesmosis which may reflect old injury. There is mild cartilaginous thinning along the posterior aspect of the tibiotalar joint. Visualized cartilage is otherwise grossly intact.ADDITIONAL", "output": "1.Mild-moderate osteoarthritis of the tibiotalar joint.2.Sequela of prior ankle injury as described above."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old male post fall. Evaluate for fracture. Right knee: Swelling of the anterior soft tissues of the knee which limits evaluation of the extensor mechanism. No fracture line is evident. If there is clinical concern for internal derangement of the knee, MRI can be obtained. Eccentric lucent lesion with sclerotic rim in the distal femoral metadiaphysis compatible with a benign nonossifying fibroma.Right tibia/fibula: We see no fracture.Right ankle: We see no acute fracture. 5 mm cortical ossicle seen dorsal to the head of the talus may represent old trauma.", "output": "No acute fracture. Other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "75 year old female with left leg weakness. There is no evidence of intracranial hemorrhage, mass or edema. Extensive, periventricular hypodensities consistent with small vessel disease common age indeterminate. If there is clinical concern for acute ischemia an MRI may be considered. Prominence of the sulci may be within normal limits for the patient's age.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": "Small vessel disease, age indeterminate, if there is clinical concern for acute ischemia an MRI may be considered."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old woman with history of pelvic pain. PELVIS:UTERUS, ADNEXA: Fibroid uterus with largest measuring a subserosal fibroid measuring 14 x 11 mm located in the posterior body of the uterus (801/16). Endometrial stripe normal in size. Junctional zone within normal limits, no evidence of adenomyosis. Ovaries appear normal with small follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Suboptimal evaluation on this nondedicated exam but located posterior to the rectum and in the presacral space is a rounded complex fluid and T1 hyperintense signal containing focus that measures 19 x 12 mm (image 206 series 1502). Appears to communicate with adjacent rectum via dominant fistulous tract located approximately 8 cm from the anal verge and measuring approximately 15 mm in length, image 16 series 1401 and image 15 series 801. These findings demonstrate associated restricted diffusion and, particularly with respect to the aforementioned rounded structure, delayed rim enhancement. Difficult to exclude postcontrast enhancement within this lesion due to inherent T1 hyperintense signal. More subtle appearing perianal fistulous linear tract arising from the 12 o'clock position on image 11 series 1401 nonspecific, may be artifactual. Visualized terminal ileum (imaged on coronal T2 imaging sequence) unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Suboptimal assessment on this nondedicated exam but findings suspicious for perirectal abscess formation, please refer to discussion above. Also among differential considerations rarer entities such as tailgut cyst formation. Correlation with patient's clinical history/physical exam and laboratory values recommended.2.Visualized terminal ileum (only imaged on coronal T2 imaging sequence) unremarkable.3.Fibroid uterus as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "62 years Male (DOB:5/10/1954)Reason: History of stage IIIA NSCLC s/p induction chemo and surgery. Surveillance brain MRI given + KRAS mutation History: NonePROVIDER/ATTENDING NAME: RENUKA J. MALIK RENUKA J. MALIK The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.No evidence for brain metastases.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Dysphagia. Facial and uvula asymmetry. Also, exaggerated right bicep reflexes. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses. There are small retention cysts in the nasopharyngeal mucosa.Cervical spine: There is minimal retrolisthesis of C3 on C4 and C4 on C5. The vertebral bodies are preserved in height. There is mild degenerative marrow signal along the C6-C7 and to lesser extent C5-C6 endplates. There is also a subcentimeter probable hemangioma in the C3 vertebral body. At C3-C4, a disc-osteophyte complex and facet and uncovertebral arthropathy result in mild right neural foraminal narrowing. At C4-C5, there is mild spinal canal stenosis caused by a disc-osteophyte complex and mild-to-moderate left neuroforaminal stenosis caused by uncovertebral and facet arthropathy. At C5-C6, a disc-osteophyte complexes causes mild-to-moderate spinal canal stenosis and uncovertebral arthropathy results in mild-to-moderate bilateral neural foraminal stenosis. At C6-C7, there a small disc-osteophyte complex that results in mild spinal canal narrowing and mild right neural foraminal stenosis caused by uncovertebral arthropathy. The spinal cord displays normal signal. The paravertebral soft tissues are unremarkable.", "output": "1. No evidence of intracranial hemorrhage, mass, or acute infarct. Uvular asymmetry without a mass may have been present since 2006.2. Multilevel cervical spondylosis, with mild-to-moderate spinal canal and bilateral neural foraminal stenosis at C5-6.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "66 year old female with history of orthotopic heart transplant in 6/2015 for non ischemic cardiomyopathy, hypertension, anxiety and GERD now presenting with chest pain, a small pericardial effusion, neck stiffness, and possible meningitis. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 75 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is dilated consistent with transplant morphology.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 91 ml/m2 (normal range 69+/-14), the RVEDV is 181 ml (normal range 110+/-24), the RV end systolic volume index is 49 ml/m2 (normal range 22+/-8), and the RVESV is 98 ml (normal range 35+/-13). 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 mild 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 drain normally into the right atrium. PericardiumSmall pericardial effusion. There is evidence for pericardial inflammation by T2stir images and delayed enhancement in the pericardium. No myocardial extension of inflammation was noted.Extracardiac FindingsPost heart transplant surgery findings. Small bilateral pleural effusions. Parenchymal lung process, most prominent in LLL. 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. Normal biventricular size and systolic function.2. Small pericardial effusion with evidence for pericardial inflammation.3. Abnormal lung MRI findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question : Status post craniotomy for removal of a seizure focus. Now with seizures. Signs and symptoms: Possible. Nonenhanced head CT:Examination the most postoperative changes of a large right frontal /temporal craniotomy. Epidural fluid -- air collection under the craniotomy flap is present. This finding is within the expected postop changes. There is evidence of partial right anterior temporal lobectomy with residual air and minimal postoperative hemorrhage. There is a area of low-attenuation in the inferior aspect of right frontal lobe and to a lesser degree of the left frontal lobe consistent with areas of encephalomalacia as was noted on prior MRI examination from 3 -- 24 -- 11.Superior to the surgical site focal area of edema is noted in the right frontal lobe. Residual small amount of subarachnoid blood within the cortical sulci of bilateral cerebral hemispheres are noted. A thin CSF density right parafalcine subdural measures approximately 2 mm in thickness. Prominent bilateral basal ganglial calcification and left frontal periventricular calcification is noted.", "output": "1.Expected postoperative changes of a large right frontal and temporal craniotomy.2.Small area of edema lungs immediately superior to the surgical site which may be postop change.3.Residual subarachnoid blood from surgery both in supero-and infratentorial spaces.4.Extensive bilateral basal ganglial calcification.5.Extensive inferior bifrontal encephalomalacia unchanged since prior studies. "}
{"instruction": "Generate impression based on findings.", "input": "Male 21 years old with history of fibula Ewings with pulmonary metastases status post resection and radiation. Now with c/o great toe pain and swelling over lower leg. VIEWS: Right first toe oblique and lateral (2 views) 5/26/2015 at 11:08Right foot AP, oblique, and lateral (3 views) 5/26/2015Right tibia/fibula AP and lateral (2 views) 5/26/2015 Chest PA and lateral 5/26/2015 Right tibia/fibula: Postoperative changes of proximal fibular resection are seen with a metallic density projecting posterior to the fibula at the resection site. A small remnant of fibular head is present. Minimal irregularity of the mid fibula near the surgical clips, this may be related to postsurgical change but attention to this area on subsequent follow-up is recommended. Periosteal reaction is seen on the AP view along the lateral aspect of the remaining fibula. This may be related to prior radiation but correlation with previous imaging or further evaluation with MRI is recommended to exclude recurrence or second primary in this location.Right foot and right great toe: The bones are normal. No soft tissue swelling or evidence of fracture.Chest: Postoperative changes are again seen in the right upper and lower lobes. The cardiomediastinal silhouette is normal. There is no focal pulmonary opacity, pleural effusion, or pneumothorax.", "output": "1.Periosteal reaction along the lateral aspect of the remaining fibula. This may be related to prior radiation but correlation with previous imaging or further evaluation with MRI is recommended to exclude recurrence or second primary in this location.2.Minimal irregularity of the mid fibula at the resection site may be postsurgical but attention to this area on subsequent follow-up is recommended.Findings were discussed via phone with Dr. Drum at the time of this dictation."}
{"instruction": "Generate impression based on findings.", "input": "Female 48 years old Reason: Evaluate back hardware from surgery and spinal structure History: LBP with radiculopathy. The vertebral column alignment is within normal limits. There is mild developmental narrowing of the spinal canal with prominence of the dorsal epidural fat. The vertebral body and disc space heights are preserved with the exception of L5-S1. At L5-S1 there is complete loss of disc height as seen previously. There is a round low T1, high T2 focus in the posterior aspect of the L5 vertebral body, likely representing hemangioma, which is stable to slightly increased in size compared to the prior exam in 2013. Mild multilevel facet arthropathy. The vertebral bone marrow signal is otherwise unremarkable. Interspace observations:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is no significant compromise to spinal canal or neural foramina.L5-S1: Evidence of a prior small right laminectomy. Within the L5 vertebral body is a lobulated lesion, which appears to be an atypical hemangioma. This lesion disrupts the posterior cortex of the vertebral body protruding posteriorly into the epidural space approximately 2 mm. Lesion is stable to minimally increased in size compared to prior exam There are posteriorly projecting endplate osteophyte without significant spinal canal stenosis at this level. Small right paracentral extrusion mildly narrows the right lateral recess and contacts the right S1 nerve root. The degree of narrowing is similar compared to prior exam in 2013. Bilateral facet arthropathy. Mild bilateral neural foraminal narrowing.", "output": "1.Degenerative and postsurgical changes of L5-S1 with complete loss of disc height, small right paracentral disc extrusion, and mild bilateral neural foraminal narrowing. There is no central canal stenosis and the overall appearance is not significantly changed.2.Lesion in the posterior L5 vertebral body likely represents an atypical hemangioma. This lesion disrupts the posterior cortex of the vertebral body and has mild epidural extension. This is stable to minimally increased in size compared to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "preop planning There is irregular wall enhancing intra axial mass (20.3mm x 25.2mm x 26mm) with surrounding edema on the right pre central gyrus. There is no other abnormal enhancing lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage.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": "Right pre central intra axial mass with peripheral enhancement indicating malignant brain tumor."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out radiculopathy. Signs and symptoms: Cramping of the lower extremities with right sciatica. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column and with unremarkable signal intensity.T11-T12 demonstrate mild degenerative changes and unremarkable otherwise.T12-L1 demonstrate mild degenerative changes and unremarkable otherwise.L1-L2 is unremarkable.L2-L3 demonstrate mild degenerative disc disease and mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis. A shallow right lateral disc-osteophyte is present with resultant mild right neural foraminal compromise and patent left neural foramina.L3-L4 demonstrate mild degenerative disc disease and facet/ligamentum flavum hypertrophy without central spinal stenosis. Degenerative changes however results in mild to moderate right and mild left neural foraminal compromise.L4-L5 demonstrate mild disc disease and mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise however hypertrophic changes of posterior elements results in left lateral recess compromise.L5-S1 demonstrate mild disc disease and moderate right and mild left facet hypertrophic changes. No spinal stenosis or neural foraminal compromise. Mild left lateral recess compromise is noted.Incidental note is made of partially visualized cysts in bilateral kidneys (left larger than right) and unremarkable paraspinal soft tissues otherwise.Visualized SI joints are unremarkable..", "output": "1.Mild degenerative disc disease and mild to moderate hypertrophic changes of facets and ligamentum flavum as detailed per level above.2.No evidence of central spinal stenosis at any level.3.Multilevel mild neural foraminal and lateral recess compromise as detailed per level above.4.Partially visualized cyst and bilateral kidneys (left greater than right)."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Prostate cancer and headaches and abnormal bone scan in occipital area. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates normal anatomical morphology and signal intensity brain parenchymal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal.Post enhanced images are negative for any abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the orbits in including axial fat sat post enhanced series.Calvarium demonstrate no convincing evidence of an enhancing metastatic lesion as was seen on prior bone scan. There is also no detectable focus of bony expansion or abnormal epidural enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.", "output": "1.Pre-and post enhanced brain MRI demonstrate no detectable intracranial abnormalities.2.There is no convincing evidence of an abnormal calvarial enhancement to suggest metastatic lesion.3.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic lung cancer. The enhancing left cerebellar lesion has decreased in size, measuring up to 11 mm, previously 16 mm. In addition, the surrounding vasogenic edema has diminished. There is unchanged mild nonspecific periventricular white matter T2 hyperintensity. There is no evidence of new intracranial lesions. 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.", "output": "The left cerebellar metastasis has decreased in size and the surrounding vasogenic edema has diminished."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old female with bilateral lower extremity paresthesias, evaluate for cord compression. Right apical mass Please note that exam was terminated due to patient discomfort.There is a paravertebral soft tissue lesion which is hyperintense on STIR images and hypointense on T1 images along the left pleura and neural foramina extending from T6 to T8 with invasion into the spinal canal. The CSF is effaced at these levels and there appears to be mass-effect on the cord. Signal within the cord at these levels is difficult to evaluate and subtle signal abnormalities cannot be excluded. Signal within the remainder of the cord is normal.Multilevel degenerative changes throughout the spine with degenerative marrow signal abnormalities. There is a chronic appearing compression fracture at L1 with endplate deformities at T11 and T12. Mild scoliosis, otherwise alignment is anatomic. Focal areas of increased STIR signal within the T2 and T4 vertebral bodies are suspicious for metastatic foci. There are multilevel disk bulges within the lower lumbar spine, most severe at L4-L5, producing narrowing of the central canal which is incompletely evaluated.Right adnexal lesion with cystic components is partially visualized measuring up to 6.4 cm (501/16). Right apical mass is partially visualized and better evaluated on prior CT.", "output": "1.Left paravertebral lesion from T6 to T8 with extension into the spinal canal through the neural foramina producing compression of the spinal cord. Exam was terminated due to patient discomfort, however dedicated thoracic spine MRI is recommended for further evaluation.2.Lesions within the T2 and T4 vertebral bodies are suspicious for metastatic foci.3.Known right apical mass and left adnexal lesion are partially visualized.4.Multi-level degenerative changes including a mild compression fracture at L1.5.Findings suggest spinal stenosis at L4-5. Please correlate with clinical history.Findings discussed with admitting team, Dr.Kallepalli, at 9:45 a.m. on 1/20/2015."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old male with left knee pain MENISCI: Small cysts are noted anterior to the anterior horn of the lateral meniscus, but we see no underlying meniscal tear. The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is superficial degeneration of the articular cartilage of the lateral facet of the patella. There is also a linear focus of low signal intensity traversing the articular cartilage of the femoral trochlea centrally that may represent a cartilaginous fissure. The articular cartilage of the tibiofemoral compartment appears intact.LIGAMENTS: The ACL appears intact, but there are small linear foci of increased signal intensity between its bundles that may reflect mild mucoid degeneration. There is thickening of the proximal fibers of the MCL with ossification within its proximal fibers at its femoral attachment indicating prior injury, but we see no findings to indicate an acute tear. The PCL appears intact. The LCL appears intact.EXTENSOR MECHANISM: Subjectively, the quadriceps tendon appears slightly thickened with enthesophyte formation at its insertion on the patella, but we see no tear. The patellar tendon appears intact.ADDITIONAL", "output": "1. Patellofemoral cartilage degeneration with a borderline tibial tubercle trochlear groove distance.2. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Sacral chordoma, restaging Note that the examination is limited by motion artifact, particularly the pre and postcontrast sequences.There are surgical changes of a partial sacrectomy extending from the level of S2 down with displacement of the rectum posteriorly, appearing similar to the prior study. There is fluid signal surrounding the rectum, likely representing a small amount of physiologic free fluid which has decreased from the prior exam and is probably of no significance.Edema-type signal within the bodies of the pubic bones adjacent to the symphysis may be degenerative in etiology but is also less prominent on the current exam.Numerous nodular masses are again noted within the gluteus maximus musculature bilaterally as well as within the adjacent subcutaneous fat of the buttocks bilaterally. Additional nodular masses are situated along the posterior column of the acetabula adjacent to the obturator internus muscles, more so on the left than on the right. These masses are hypointense to skeletal muscle on T1 sequences and heterogeneously hyperintense to skeletal muscle on T2 sequences. Following contrast administration, they demonstrate heterogeneous enhancement. One of the larger masses within the left gluteus maximus muscle again measures approximately 6 cm obliquely on series 9, images 9 through 12. A second mass within the subcutaneous fat between the intergluteal cleft and the medial margin of the left gluteus maximus (series 6 image 29) measures approximately 2.8 x 1.8 cm, similar to the prior exam. A smaller mass within the medial fibers of the right gluteus medius muscle (series 8 image 23) measures approximately 2 x 1.4 cm also similar to the prior exam upon remeasurement (the previous measurement of this lesion [1.5 x 1 cm] is suspected to have been placed erroneously). Multiple additional lesions are seen which appear similar in size and extent to the prior exam and although the enhancement appears more prominent, this may be secondary to technical factors and the timing of contrast administration.", "output": "Multiple masses within the posterior soft tissues as described above, representing multifocal chordoma. When compared to the prior exam, overall these lesions appear similar in size and extent."}
{"instruction": "Generate impression based on findings.", "input": " MRI brain: There are multiple small foci of restricted diffusion in the right parietal lobe mostly along the postcentral gyrus and superior parietal lobule with associated T2 signal abnormality consistent with early subacute infarcts. There is a linear foci of restricted diffusion with associated T2 signal in the posterior aspect of the middle frontal gyrus involving the left frontal lobe. There are no associated enhancement. There are scattered foci of susceptibility in the left parietal, left frontal, left cerebellum and perhaps a tiny focus in the right cerebellum due to hemosiderin staining from prior hemorrhage.There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There are chronic lacunar infarcts in the left posterior frontal lobe, right parietal lobe and in the bilateral cerebellar hemispheres. Ventricles and sulci are mildly prominent, consistent with mild age-related volume loss. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.MRI of the spinal cord: The study is limited due to patient motion and scoliotic curvature of the spine. Also, this is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.There are mild scattered spondylotic changes in the cervical spine, most conspicuous at C4-C5 and C5-C6. In the lumbar spine, there is disc bulge at L4-L5.Subsegmental atelectatic changes in the right lung base posteriorly.", "output": "1. Several small foci of restricted diffusion with associated T2/FLAIR signal in the right parietal lobe mostly along the postcentral gyrus and superior parietal lobule consistent with early subacute infarcts. Additional focus of subacute infarct in the left frontal lobe.2. Chronic lacunar infarcts in the left posterior frontal lobe, right parietal lobe and in the bilateral cerebellar hemispheres. Mild chronic small vessel ischemic disease.3. No evidence of metastatic lesions in the brain parenchyma.4. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine."}
{"instruction": "Generate impression based on findings.", "input": " There is normal anatomic alignment of the basion, C1 and C2/dens articulations on the neutral, flexion and extension views. There is trace anterolisthesis of C2 on C3 without evidence of dynamic instability. Postoperative findings related to Chiari decompression with suboccipital craniectomy and occiput-C2 posterior fusion are again seen. There is mild loss of T2 disk signal in the C2-3, C4-5 and C5-6 disks without significant herniation, spinal canal or neural foraminal narrowing.There is diminished CSF spaces at the foramina magnum ventrally related to mild retroversion of the dens. Dens abuts the medulla, unchanged from prior, without evidence of impingement on the medulla on the flexion or extension views. Dorsal CSF flow is not seen on the CSF flow sequence secondary to susceptibility artifact from the hardware. T2 sequences however do demonstrate good dorsal CSF space.", "output": "1.Stable postoperative findings of Chiari decompression and occiput to C2 fusion. No MR evidence of dynamic instability.2.No syrinx in the cervical cord."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with left hip and groin pain for 2 months with positive impingement signs. Evaluate for left hip labral tear. ACETABULAR LABRUM: There is linear increased signal abnormality traversing the anterior and superior acetabular labrum, extending from the 3 o'clock to the 2 o'clock position, indicating a tear.ARTICULAR CARTILAGE AND BONE: No articular cartilage defects are identified. No bone marrow signal abnormality is seen. No convincing CAM deformity is identified. The largest alpha angle measures 50 degrees.SOFT TISSUES: The imaged musculature is normal in appearance. ADDITIONAL", "output": "Anterosuperior acetabular labral tear."}
{"instruction": "Generate impression based on findings.", "input": " ORBITS: The optic nerves are symmetric and normal in size and signal intensity. There is no intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is minimal mucosal thickening within the maxillary sinuses. The midline structures and craniocervical junction are within normal limits. There is questionable mild T2 hyperintensity within the upper cervical spinal cord versus artifact.", "output": "1. Unremarkable brain and orbit MRI. No abnormal T2 signal or enhancement of the optic nerves or chiasm.2. Questionable mild T2 hyperintensity within the upper cervical spinal cord, possibly artifact. Otherwise unremarkable brain and orbit MRI.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for Chiari malformation, syrinx, tether cord: scoliosis. There is moderate thoracolumbar dextroscoliosis centered at T12-L1. There is deformity of the lower spinal cord due to the scoliosis, but the spinal cord signal is unremarkable and the conus medullaris is positioned at the L1-2 level. The cerebellar tonsils are not low-lying. There is no spondylolisthesis. The vertebrae appear to be intact. There is no evidence of mass lesions associated with the spine. There is no significant spinal canal or neural foramen stenosis. The paraspinal soft tissues are unremarkable.", "output": "Moderate thoracolumbar dextroscoliosis centered at T12-L1, but no evidence of vertebral segmentation anomalies, spine tumors, or Chiari malformation. Deformity of the lower spinal cord is attributable to the scoliosis, but the conus medullaris is normally positioned at the L1-2 level. "}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Benign neoplasm of brainClinical question: h/o 4th ventricular mass and shuntSigns and Symptoms: surveillance The patient is status post ventriculostomy tube with associated shunt placement. The ventriculostomy tube courses through the right occipital lobe into the right lateral ventricle and has its tip against the septum pellucidum.There is a 8 x 6 mm axial dimension and 12 x 7 mm sagittal dimension mass located inferior aspect of the fourth ventricle which appears stable when compared to the previous exam. There is associated susceptibility effect. This lesion is known to be calcified based on the CT scan from 11/8/2007. It is located in the region of the foramen of Magendie.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.A fourth ventricular calcified lesion is stable and compared to the prior exam from 11/28/2012 as well as exams dating back as far as 2008.2.The patient's shunt catheter is in stable position. There is no convincing evidence for ventriculomegaly"}
{"instruction": "Generate impression based on findings.", "input": "Metastatic urothelial cancer with CT scan showing brain lesions, evaluate in preparation for radiation therapy: nausea/vomiting, CT with brain lesions. There is an ovoid lesion in the left frontal lobe centrum semiovale that measures up to 19 mm. 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": "Treatment planning MRI demonstrates a left frontal lobe centrum semiovale lesion that measures up to 19 mm, which likely represents a metastasis. "}
{"instruction": "Generate impression based on findings.", "input": "44 years Female (DOB:2/18/1972)Reason: PRE-OP STEALTH MRI, in CCD at 6am morning of surgery. Please page neurosurgery resident to place fiducials. History: PRE-OP MRI, go to OR after MRIPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is a 10 x 6 mm axial dimension lesion which has a hemosiderin ring around it located along the anterior aspect of the left temporal lobe. On the January exam this measured 21 x 15 mm axial dimensions. At that time the blood products appear to be in the subacute phase.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The cerebellar tonsils appear to be low lying.", "output": "1.There is a left temporal lobe lesion present compatible with cerebral cavernous malformation. It is smaller on the current exam when compared to the prior.2.The cerebellar tonsils are low lying3.Examinations performed the purpose of stereotactic guidance during surgery."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out stroke. Signs and symptoms: As above. Nonenhanced brain MRI:Diffusion-weighted images demonstrate no evidence of an acute ischemic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination for patient's stated age of 32.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable images through the orbits.Unremarkable calvarium and soft tissues of the scalp.Mild chronic sinusitis is noted.Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.", "output": "Unremarkable nonenhanced brain MRI."}
{"instruction": "Generate impression based on findings.", "input": "Reason: h/o suprasellar meningioma History: surveillance There is redemonstration of a homogeneously enhancing slightly lobulated dural based mass along the posterior planum sphenoidale with extension into the suprasellar cistern. It currently measures 1.5 cm transverse x 1.5 cm CC x 2.0 cm AP, compared to previous 1.5 x 1.5 x 1.9 cm, respectively. Comparing to outside remote exam from February 2013, there has been no significant interval change allowing for differences in technique, with only perhaps very slight increased size. There is again significant mass effect upon the optic chiasm and pituitary tissue within the sella. There is abutment of the right cavernous sinus without frank invasion. There is similar degree of abutment of the supraclinoid right internal carotid artery as well as the bilateral A1 segments.The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is no new pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.", "output": "Continued stable appearance of planum sphenoidale/suprasellar enhancing extra-axial mass most compatible with meningioma, with similar degree of localized mass effect on the optic chiasm and pituitary tissue. Compared back to baseline 2013 exams, minimal if any increase in size."}
{"instruction": "Generate impression based on findings.", "input": "65 years Male (DOB: 10/3/1950)Reason: evaluate for causes of right paresthesia and weakness History: right paresthesia and weaknessPROVIDER NAME: PELEG M HOROWITZ EDWIN RAMOS MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. The right vertebral artery is larger than on the left vertebral artery.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine.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 a small disc bulge associated with uncovertebral osteophytes bilaterally at this level and some mild narrowing of the neural foramina. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level. There is narrowing of the neural foramina bilaterally with some mild encroachment of the exiting nerve roots bilaterally. This encroachment appears to be worse on the right when compared to the left side at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At C5-6 there is loss of disc space height, disc desiccation, disc bulge and endplate and uncovertebral osteophytes associated with effacement of spinal fluid ventral and posterior the spinal cord and mild to moderate degree of spinal stenosis. There is narrowing of the neural foramina bilaterally due to uncovertebral osteophytes at this level associated with encroachment of the left-sided exiting nerve roots.At C6-7 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with the small uncovertebral osteophytes and mild narrowing of the 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.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal lesions are identified in the thoracic spine.", "output": "1.There are degenerative changes present in the cervical spine worse at C4-5 and C5-6 where there is encroachment of right-sided exiting nerve roots at C4-5 and left-sided exiting nerve roots at C5-6 and mild to moderate spinal stenosis at these levels.2.There is no compromise to the thoracic spinal canal.3.No spinal cord lesions are identified.4.There is no evidence for intracranial cerebrovascular occlusive disease."}
{"instruction": "Generate impression based on findings.", "input": "Lung cancer staging. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a developmental venous anomaly in the left middle frontal gyrus. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "No evidence of intracranial metastases. "}
{"instruction": "Generate impression based on findings.", "input": "History of ileal Crohn's disease. 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: Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild circumferential low T2-weighted signal wall thickening of approximately 3 cm of the terminal ileum (series 4/21) without associated early enhancement, restricted diffusion or proximal dilatation. During the course of the examination this region demonstrates normal dispensability. The small and large bowel is normal caliber, wall thickness and enhancement. There is no abnormal restricted diffusion. No free fluid collection. No significant fibrofatty proliferation.BONES, SOFT TISSUES: Mild thoracolumbar curvature.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.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": "No evidence of active bowel inflammation. Stigmata of prior/chronic inflammatory changes of approximately 3 cm of the terminal ileum which demonstrates normal distensibility and no pre-stenotic dilatation. "}
{"instruction": "Generate impression based on findings.", "input": " Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Old ischemic changes are again identified within the right cerebellar hemisphere. Left supraclavicular adenopathy is no longer evident.C2/3: Mild posterior osteophyte disc complex, mild left facet hypertrophy, and moderate right facet hypertrophy. There is mild bilateral neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is intrinsic abnormal T2 hyperintensity within the cord at this level, extending inferiorly, associated with focal cord atrophy. There is moderate central, moderate to severe left neural foraminal, moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy (right much greater than left). There is subtle intrinsic T2 hyperintensity within the cord as well as focal cord atrophy. There is mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex eccentric to the left causing anterior left hemicord flattening without intrinsic cord signal abnormality. There is also slight ligamentum flavum thickening and bilateral uncinate hypertrophy. There is no central stenosis, however there is moderate to severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex eccentric to the right causes anterior right hemicord flattening without intrinsic cord signal abnormality. There is also ligamentum flavum thickening and bilateral uncinate hypertrophy. There is borderline central, moderate severe left neural foraminal, and severe right neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex, severe ligamentum flavum thickening (left greater than right), and endplate spurring. There is cord flattening anteriorly as well as posterolaterally (bilaterally) with effacement of CSF but no intrinsic cord signal abnormality. Overall, there is moderate central, severe left neural foraminal, and moderate right neural foraminal stenosis.T1/2: Bilateral facet hypertrophy encroaches bilateral neural foramina.", "output": "1.C2/3: Mild bilateral neural foraminal stenosis.2.C3/4: There is intrinsic abnormal T2 hyperintensity within the cord at this level, extending inferiorly, associated with focal cord atrophy, a pattern most suggestive of myelomalacia. There is moderate central, moderate to severe left neural foraminal, moderate right neural foraminal stenosis.3.C4/5: There is subtle intrinsic T2 hyperintensity within the cord as well as focal cord atrophy, a pattern most suggestive of myelomalacia. There is mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.4.C5/6: Moderate to severe bilateral neural foraminal stenosis.5.C6/7: Borderline central, moderate severe left neural foraminal, and severe right neural foraminal stenosis.6.C7/T1: Moderate central, severe left neural foraminal, and moderate right neural foraminal stenosis.7.T1/2: Bilateral facet hypertrophy encroaches bilateral neural foramina."}
{"instruction": "Generate impression based on findings.", "input": "Global developmental delay, please evaluate for brain parenchymal abnormalities. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions diffusely within the paranasal sinuses.", "output": "1. No evidence of gross parenchymal abnormalities.2. Secretions diffusely within the paranasal sinuses may indicate sinusitis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Arlene E Pappalardo is a 59 year old female with a personal history of right breast mastectomy in 2011 for IDC/DCIS followed by radiation and left breast mastopexy. She has no current breast related complaints. Prior MRI showed a left breast intramammary lymph node. MAMMOGRAM: Three standard views and the 2 additional spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Questionable interval increase in size of the focal asymmetry in the right upper outer breast, posterior depth, on the full field views though less so with compression and demonstrates central fat component on spot compression views. This is compatible with the intramammary lymph node which was also characterized as a benign lymph node on the prior MRI in 2013. Postsurgical change including calcified fat necrosis in the left breast is noted.There are no suspicious microcalcifications or areas of architectural distortion identified in the left breast.", "output": "No mammographic evidence of malignancy in the left breast. Benign intramammary lymph node in the upper outer left breast. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Multiple sclerosis, follow up for progression with weakness. Brain: There are numerous T2 hyperintense lesions in the cerebral white matter, although some of the lesions appear to be less conspicuous on T2-weighted sequences. Many of the lesions demonstrate T1 hypointensity, but no associated abnormal enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size and configuration, with evidence of mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.Cervical Spine: The images are degraded by patient motion. There are multiple T2 hyperintense lesions in the cervical spinal cord without evidence of associated enhancement. 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 paravertebral soft tissues are unremarkable.", "output": "1. Chronic multiple sclerosis lesions with associated cerebral volume loss.2. Multiple demyelinating lesions in the cervical spinal cord without evidence of enhancement."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old male with persistent right shoulder pain. ROTATOR CUFF: There is partial thickness undersurface tearing of the supraspinatus at the level of the insertion on the greater tuberosity involving less than one half of the tendon width. There is bursal surface fraying of the distal supraspinatus at the level of its insertion as well. There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is a tiny insertional tear of the anterior fibers of the infraspinatus measuring approximately 3 mm in AP dimension The infraspinatus muscle and tendon otherwise appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is a small glenohumeral joint effusion with foci of low signal intensity internally, suggesting a synovitis. Mild osteoarthritis affects the glenohumeral joint. There are subchondral cysts within the humeral head.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is circumferential fluid within the tendon sheath of the long head of the biceps indicating a tenosynovitis ADDITIONAL", "output": "1. Partial-thickness tearing and bursal surface fraying of the supraspinatus without evidence of a full-thickness rotator cuff tear or retraction.2. Small glenohumeral joint effusion with findings indicating a synovitis.3. Osteoarthritis of the right shoulder."}
{"instruction": "Generate impression based on findings.", "input": "Reason: degenerative disc disease? History: neck pain with neuropathic arm pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature present. There is multilevel disk desiccation.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. There are uncovertebral osteophytes present at this level right more than left with some mild encroachment of the right-sided exiting nerve rootsAt C4-5 there is loss of disk space height a diffuse disk bulge and endplate and uncovertebral osteophytes resulting in effacement of spinal fluid ventral posterior the spinal cord and some deformity of the spinal cord . There is some posterior ligamentous hypertrophy present. Overall there is a moderate degree of spinal stenosis at this level.At C5-6 there is no significant compromise to the spinal canal . There are bilateral virtual osteophytes present at this level associated with disk material and encroachment of the exiting nerve roots bilaterally.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.At T1-T2 and T2-T3 there disk bulge is present associated with some minor narrowing of the neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is larger than the left vertebral artery and is suspected to have an aortic arch origin.", "output": "1.There are multilevel degenerative changes present in the cervical spine which are worse at C4-5 where there is a moderate degree of spinal stenosis and bilateral neural foramen encroachment due to degenerative changes as detailed above. There is some encroachment of exiting nerve roots at the C3-4 and C5-6 due to degenerative changes as well."}
{"instruction": "Generate impression based on findings.", "input": "Male, 18 years old, with hypogonadism. History of pituitary adenoma. A 3 x 3 x 3 mm well-defined linear focus of hypoenhancement is evident within the midline posterior aspect of the pituitary gland. This lesion is mildly T2 hypointense, and is barely cerebral on T1 precontrast images.The pituitary gland itself is otherwise normal in size and morphology. The pituitary stalk enhances normally and deviates very slightly towards the left. The suprasellar cistern is not compromised.", "output": "A 3 mm hypoenhancing lesion is evident within the posterior midline pituitary gland. This would be compatible with the stated history of pituitary adenoma, though based solely on its imaging appearance, a Rathke's cleft cyst can also be considered."}
{"instruction": "Generate impression based on findings.", "input": "Neurofibromatosis type 1 presenting with back pain. Evaluate for tumor. The lack of intravenous contrast limits evaluation of small lesions.Cervical spine:The vertebral body and intervertebral disc heights are maintained. There is straightening of the cervical lordosis which is likely positional. Mild scalloping of the posterior cervical vertebrae secondary to dural ectasia. No bone marrow signal abnormalities.The spinal cord is normal in morphology and signal throughout. No masses are identified. No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.Thoracic spine:The vertebral body and intravertebral disc heights are maintained. The alignment is anatomic. No bone marrow signal abnormalities.The spinal cord is normal in morphology and signal throughout. No masses are identified. No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.Lumbar Spine:The vertebral body and intravertebral disc heights are maintained. The alignment is anatomic. No bone marrow signal abnormalities. No fracture is evident.The spinal cord is normal in morphology and signal throughout. The conus medullaris terminates at the mid L2 level. No masses are identified. No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.", "output": "Essentially normal MR spine. No neurofibromas or plexiform tumors are identified. No findings to account for the patient's lumbar back pain."}
{"instruction": "Generate impression based on findings.", "input": "94 years Female (DOB:9/22/1922)Reason: recurrent episodes of dizziness/unawareness; possible TIA History: recurrent episodes of dizziness/unawareness; possible TIAPROVIDER/ATTENDING NAME: DIANE L. ALTKORN DIANE L. ALTKORN MRI of the brainThere is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of T2 and FLAIR signal hyperintensity are present in the cerebellum and brainstem. The lesion in the right middle cerebellar peduncle is associated with susceptibility effect.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells demonstrate opacities in the right mastoid more than the left. These are nonspecific. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are very small. The right vertebral artery is larger than the left vertebral artery.", "output": "1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 19 years old, with new onset persistent frontal and left temporal headache with associated left eye pressure. Also complaining of left pupil asymmetry x2 on two separate occasions. Normal neuro and limited funduscopic and pupillary exam. Prior history of concussion x3 with loss of consciousness. The morphology and signal characteristics of the brain are within normal limits. No focal lesions are seen. No evidence of any large parenchymal or extra-axial enhancement is observed. There is a small incidental left frontal lobe developmental venous anomaly. No findings are seen to suggest any intracranial hemorrhage, including no evidence of microhemorrhage. Diffusion-weighted images are within normal limits. No abnormal extra axial fluid collections are demonstrated. The ventricles are normal in size and morphology. A mucous retention cyst is present in the right maxillary sinus.", "output": "Unremarkable evaluation with no specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Male, 59 years old, with left hemiparesis. Restricted diffusion is evident within the right MCA distribution including a large confluent area involving the right middle frontal gyrus, operculum, and insula. Scattered smaller foci restricted diffusion are also seen more posteriorly and inferiorly within the right parietal and temporal lobes.The areas of restricted diffusion demonstrate corresponding T2 hyperintensity with mild associated edema. There may be slight effacement of the right lateral ventricle, but no significant generalized mass effect is seen. No evidence of hemorrhagic conversion is detected. A few scattered foci of non-diffusion-restricting T2 hyperintensity are seen within the cerebral white matter, likely indicating chronic microvascular ischemic disease.The right ICA flow void is absent through the carotid canal with reconstitution intracranially. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are otherwise normal in size and morphology.Mucosal inflammation is evident in the paranasal sinuses and there are fluid levels within the maxillary sinuses. Patchy fluid opacification is seen in the mastoid air cells.", "output": "Acute infarction in the right MCA distribution involving primarily the right middle frontal gyrus, operculum and insula. No evidence of hemorrhagic conversion is seen. No significant generalized mass effect is noted."}
{"instruction": "Generate impression based on findings.", "input": "History of AML with possible CNS involvement now with worsening left temporal hemianopsia and headaches. Rule out leptomeningeal disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia in the right occipital lobe with involvement of the visual cortex, predominantly gyriform areas of susceptibility effect, and ex vacuo dilatation of the right occipital horn. There is also mild encephalomalacia in the left occipital lobe. There are also a few scattered foci of susceptibility effect within the cerebral hemispheres and left cerebellar hemisphere, which are nonspecific, but may represent chronic microhemorrhages. There is no evidence of abnormal intracranial enhancement or acute infarction. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are unremarkable.", "output": "Bilateral occipital lobe encephalomalacia, right greater than left, but no evidence of intracranial mass or leptomeningeal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 47 years old Reason: newly diagnosed rectal cancer History: rectal cancer Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: Wedge-shaped T2 hypointense foci in bilateral mid gland peripheral zones demonstrating restricted diffusion, particularly on the right. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes outside the mesorectal fascia: At least nine lymph nodes are identified. The largest is in the posterior left mesorectal fascia measuring approximately 2.8 x 2.2 cm (series 5, image 10).BOWEL, MESENTERY: Rectal Tumor:Size: 4.0 x 3.0 x 6.0 cmTumor appearance on T2-weighted images: T2 isointense lesionTumor location: Posterior rectal wall with invasion into the posterior perirectal fat.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 6 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 3 cmCircumference of the rectum involved: 180 degreesRelationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): Nonapplicable.MRI T-stage: T3c - Tumor invades >1cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: The tumor extends above the level of the mesorectal fascia. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Indeterminate mid gland peripheral zone prostate lesions. Correlation with PSA is recommended.2.Upper rectal mass with mesorectal lymphadenopathy as described above. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 23 years old, history of acoustic neuroma status post resection two years ago. Follow-up exam. Deformity of the right squamous and mastoid temporal bone is seen compatible with prior surgical access for resection of a right IAC tumor. On the present study, enhancement is seen within the right IAC measuring 9 mm in length by 5 mm in thickness. This enhancement has increased from the prior examination of 2012 where only minimal if any was present. No extracanalicular extension is seen.The remainder of the brain demonstrates normal signal intensity and morphology. No evidence of pathologic parenchymal or extra enhancement is seen. No significant intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology.", "output": "Sequelae of right IAC tumor resection are seen. Since the prior examination from 2012, enhancement within the right IAC has increased. This finding could represent either postoperative granulation or residual/recurrent tumor."}
{"instruction": "Generate impression based on findings.", "input": "Female, 61 years old. Left shoulder pain ROTATOR CUFF: There is moderate tendinopathy of the supraspinatus tendon, without discrete tear evident. The supraspinatus muscle appears normal. The infraspinatus, teres minor, and subscapularis tendons and muscles appear normal.SUPRASPINATUS OUTLET: There is mild acromioclavicular joint osteoarthritis. There is trace fluid within the subacromial bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: There is diffuse mild cartilage loss involving the glenohumeral joint as well as osteophyte formation. Within the limits of nonarthrographic exam, there is diffuse irregularity of the glenoid labrum, compatible with degeneration.BICEPS TENDON: The tendon of the long head of the biceps is normal in course and morphology. ADDITIONAL", "output": "1.Supraspinatus tendinopathy without rotator cuff tear identified.2.Osteoarthritis of the glenohumeral and acromioclavicular joints as above."}
{"instruction": "Generate impression based on findings.", "input": "65 year old woman with history of hypertension presents for a stress cardiac MRI to evaluate for ischemic etiology of chest pain.MEDICATIONS: Toprol XL 25mg, Multi-vitamin, COQ10 First Pass PerfusionDetection of perfusion defect during hyperemia was non-diagnostic due to technical limitations related to poor breath-holds and likely displacement of the surface coil.Viability/ Myocardial ScarThere is probably no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 77%, the LV end diastolic volume index is 46 ml/m2 (normal range: 65+/-11), the LVEDV is 74 ml (normal range 109+/-23), the LV end systolic volume index is 10 ml/m2 (normal range 18+/-5), the LVESV is 17 ml (normal range 31+/-10), the LV mass index is 34 g/m2, and the LV mass is 55 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 75 %, the RV end diastolic volume index is 47 ml/m2 (normal range 69+/-14), the RVEDV is 77 ml (normal range 110+/-24), the RV end systolic volume index is 12 ml/m2 (normal range 22+/-8), and the RVESV is 19 ml (normal range 35+/-13). 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. Mild atherosclerosis is noted in the descending thoracic aorta.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 a trivial pericardial effusion.Extracardiac FindingsThyroid enlargement is noted 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. Detection of perfusion defect during hyperemia was non-diagnostic due to technical limitations 2. No obvious prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 77%) without obvious evidence of myocardial fibrosis, infiltration, or inflammation.4. Normal RV size and systolic function (RVEF 78%).5. See extra-cardiac findings.6. Study is technically limited due to poor image quality."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with chronic right lower extremity wound with swelling TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Severe degenerative changes at the tibiotalar joint and subtalar joints. No abnormal bone marrow signal to suggest osteomyelitis. ADDITIONAL", "output": "No specific evidence of osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "Ultrasound performed to follow-up on MRI findings: possible satellite lesions. A targeted left ultrasound was performed for the area of known malignancy and potential satellite lesions. The index malignancy is well seen, today measuring 2.1 x 2.1 cm. Additionally, located about 8 mm medial to the index malignancy, at the 11:30 position, is a hypoechoic mass measuring 1.4 x 0.7 cm. This correlates positionally and in size to the superior-medial satellite seen on MRI. At the 9:00 position, a vague hypoechoic area with apical vascularity measuring 5 x 5 mm may be a correlate to the inferior satellite, though this is less certain.", "output": "1.4 cm sonographic finding is a clear correlate to the superior medial satellite lesion. Vague 5 mm hypoechoic area may be a correlate for the inferior satellite lesion. The patient is on schedule for ultrasound-guided biopsy.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "42 year-old female with probable hemangioma seen on recent CT examination. ABDOMEN:LIVER, BILIARY TRACT: There is a 1.9 x 1.7 cm fluid signal intensity lesion in the dome of the liver, which demonstrates discontinuous, peripheral nodular enhancement, with progressive enhancement on delayed contrast-enhanced sequences, consistent with a hemangioma, corresponding to the findings on recent CT examination. Additionally, a second smaller hemangioma is identified in segment 4A of the liver.No intra-or extrahepatic biliary ductal dilation.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Hepatic hemangiomas, as detailed above. "}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with history of renal cell carcinoma. Surveillance imaging. 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: Interval left nephrectomy.Numerous round right renal lesions of variable size and signal intensity, most likely represent a combination of simple and complicated cysts. Multiple lesions have become larger or have a different T2 signal intensity. Some of the lesions are new. Without intravenous contrast, the possibility of renal cell carcinoma cannot be excluded.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": "Numerous right renal cysts as detailed above, for which the possibility of renal cell carcinoma cannot be excluded without administration of intravenous contrast."}
{"instruction": "Generate impression based on findings.", "input": "Reason: right knee pain, evaluate for meniscus tearing History: above MENISCI: There is a full-thickness radial tear of the posterior horn of the lateral meniscus near its root with extension into the body of the meniscus. The posterior root of the lateral meniscus appears thickened which may represent a flipped meniscal fragment (image 17; series 7). There is intrasubstance degeneration of the posterior horn and deformity which may reflect degenerative tearing. There is a horizontal tear of the anterior horn of the lateral meniscus with small parameniscal cyst formation. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus with degenerative subchondral signal abnormality. There is full thickness degeneration of the lateral tibial plateau as well with underlying degenerative subchondral signal abnormality. There is subjective thinning of the medial tibiofemoral compartment. There is a full-thickness articular cartilage cleft along the medial facet of the patella with underlying subchondral signal abnormality. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Tearing of the lateral meniscus as described above.2. Osteoarthritis of the right knee including full-thickness articular cartilage degeneration most pronounced along the lateral tibiofemoral compartment as described above.3. Moderate size joint effusion with a lobulated Baker's cyst which may reflect a synovitis."}
{"instruction": "Generate impression based on findings.", "input": "59 year old female, with a history of congenital heart disease, s/p tetralogy of Fallot repair, s/p bioprosthetic pulmonary valve replacement. She is referred for cardiac MRI for follow-up evaluation. Left VentriclePostsurgical findings compatible with tetralogy of Fallot repair.The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 61 ml/m2 (normal range: 65+/-11), the LVEDV is 117 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 69 ml (normal range 31+/-10), the LV mass index is 34 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is borderline flattening of the interventricular septum noted at end-diastolic phase, in retrospectively similar to prior cardiac MRI on 12/24/12 This might be indicative of a mixture of elevated right ventricular volume and pressure overload. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic dysfunction. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 107 ml/m2 (normal range 69+/-14), the RVEDV is 206 ml (normal range 110+/-24), the RV end systolic volume index is 65 ml/m2 (normal range 22+/-8), and the RVESV is 124 ml (normal range 35+/-13). There is apical hypokinesis, unchanged.Right AtriumThe right atrium is normal. 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 ValveThere is a bioprosthetic valve in the pulmonic location generating susceptibility artifact. No significant pulmonic insufficiency was noted.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated as 40 mm, which is stable from prior study.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a 10mm right breast nodule located right of the nipple. This is unchanged compared to prior exam. No mammograms are noted in this PACS. Correlation with physical examination and mammogram is recommended. Small hiatal hernia is noted.", "output": "1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%.2. The right ventricle is mildly dilated with mildly reduced systolic dysfunction.3. Postsurgical findings of repaired Tetralogy of Fallot. There is a bioprosthetic valve in the pulmonic location with stable caliber of the pulmonary artery. No significant pulmonic insufficiency was noted.4. Stable right breast nodule since last MRI; correlation with physical exam and mammography is recommended. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "A 83 year old male with history hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease and prostate cancer. He has history of coronary artery disease including bypass surgery in 2001 (LIMA to LAD, SCG to OM and LP) and multiple subsequent PCI's. A recent echocardiography showed normal function of the left and right ventricles. Recently was hospitalized due to progressive dyspnea and chest pain. Referred to stress cardiac MRI for further evaluation.MEDICATIONS: aspirin, atorvastatin, budesonide, clopidogrel, insulin, lisinopril, tamsulosin. First Pass PerfusionDuring hyperemia, a perfusion defect was present at the lateral (transmural) and inferolateral (subendocardial) at the base and mid segments. The burden of the ischemia is 5/32 potential segments (16%).Viability/ Myocardial ScarThere is late gadolinium enhancement noted in the base to mid segments of the lateral and inferior walls in up to 50% of the thickness of the myocardium. This finding is compatible with prior myocardial infarction. The rest of the myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 47 g/m2, and the LV mass is 101 g. There are no regional wall motion abnormalities present. Normal myocardial T1-times.Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 49 ml/m2 (normal range 82+/-16), the RVEDV is 105 ml (normal range 142+/-31), the RV end systolic volume index is 23 ml/m2 (normal range 31+/-9), and the RVESV is 50 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is at least mild-to moderate 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 pericardial effusion.Extracardiac FindingsSternal wires were seen. 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. During hyperemia, a perfusion defect was present at the lateral (transmural) and inferolateral (subendocardial) at the base and mid segments. The burden of the ischemia is 5/32 potential segments (16%).2. There is late gadolinium enhancement noted in the base to mid segments of the lateral and inferior walls in up to 50% of the thickness of the myocardium. This finding is compatible with prior myocardial infarction. The rest of the myocardium is viable.3. Normal LV size and systolic function (LVEF 54%).4. Normal RV size and systolic function (RVEF 53%)."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question to be answered coned rule out intracranial process. Signs and symptoms: Newborn with apnea. Poor quality exam secondary to extensive motion artifact. No definitive abnormalities detected. However poor quality of examination can obscure subtle findings. Repeat exam or an MRI is recommended. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No definitive calvarial abnormality.", "output": "No gross abnormality in this limited examination of brain due to extensive motion."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old female status post fall; evaluate for fracture/dislocation BRAIN:There is no evidence of acute intracranial hemorrhage, mass or edema. Several bilateral lacunar infarctions in the basal ganglia. Multiple nonspecific foci of attenuation are seen in the periventricular and subcortical white matter which may represent small vessel ischemic disease, appearing similar to the previous MRI.Ventriculomegaly out of portion with age-related volume loss and may represent normal pressure hydrocephalus, unchanged. Prominence of the cortical sulci consistent with age-related volume loss. Atherosclerotic calcifications are seen in the internal carotid arteries, most prominently at the carotid bifurcations.The calvaria and skull base are radiographically normal without evidence of depressed skull fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CERVICAL SPINE:There is reversal of the normal cervical lordosis with grade 1-2 anterolisthesis of C3 on C4. There is also grade 1 retrolisthesis of C4 on C5 and of C5 on C6. The vertebral body heights are grossly maintained. Prevertebral soft tissues are grossly unremarkable.Multilevel extensive degenerative changes are seen throughout the cervical spine with uncal vertebral joint hypertrophy, osteophyte formation, disk space narrowing, and neuroforamina narrowing. If high clinical concern for cord or ligamentous injury, MRI may be obtained for further evaluation.", "output": "1. No acute intracranial hemorrhage. No evidence of acute fracture.2. Stable ventriculomegaly. 3. Bilateral lacunar infarcts and likely small vessel ischemic disease of indeterminate age, appearing similar to the previous exam.4. Reversal of normal cervical lordosis extensive multilevel degenerative changes. If high clinical concern for spinal cord or ligamentous injury, MRI may be obtained for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": " There are no residual enhancing intracranial lesions. There are unchanged punctate foci of susceptibility effect in the left cerebellar hemisphere, left globus pallidus, and bilateral thalami. There is no mass-effect or significant midline shift. There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse cerebral volume loss and extensive areas of T2 hyperintensity within the cerebral white matter. There is also a chronic lacunar infarct in the left caudate head. The skull and extracranial soft tissues are unremarkable. However, there is degenerative spondylosis in the imaged portions of the upper cervical spine.", "output": "Post-treatment findings without evidence of residual enhancing metastases."}
{"instruction": "Generate impression based on findings.", "input": "Female, 75 years old, with worsening weakness. Evaluate for new CVA, neurosyphilis, demyelination. Brain:Patchy T2 hyperintensity is seen in the periventricular white matter with scattered small foci also evident in the basal ganglia and thalami and in the pons. The pattern and morphology of these lesions are nonspecific. No evidence of parenchymal edema or mass effect seen. No restricted diffusion is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. No pathologic intracranial enhancement is seen. The ventricles and sulci are mildly and proportionately prominent compatible with underlying volume loss.C-spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema, replacement or pathologic enhancement is seen. The visualized spinal cord demonstrates normal signal intensity and morphology and is likewise free of pathologic enhancement. No epidural lesions are detected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. No foraminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. No foraminal narrowing. C5-6: No spinal canal stenosis or neuroforaminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.", "output": "1.Patchy white matter signal abnormality is seen, predominantly in the periventricular regions and to a lesser extent the basal ganglia, thalami and pons. The pattern and morphology of the lesions are nonspecific. Although demyelination is not excluded from the differential diagnosis, chronic small vessel ischemic disease would be a statistically more likely possibility.2.Mild degenerative findings in the cervical spine with no evidence of significant spinal canal or foraminal compromise. The spinal cord itself is within normal limits."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with history of lung cancer with brain metastases presenting with intermittent aphasia concerning for TIA/stroke. Evaluate for hemorrhage or stroke. Extensive low-attenuation is seen within the subcortical and periventricular white matter, compatible with prior therapy for brain metastasis versus small vessel ischemic disease. No intracranial hemorrhage or definite cortical stroke is evident, though contrast enhanced MRI is recommended for further evaluation if clinical suspicion remains high. The remaining cerebral and cerebellar hemispheres and brainstem demonstrate normal attenuation and morphology. The ventricles are midline, with normal alignment morphology. No abnormal extraction fluid collections are evident.The calvarium and other osseous structures are normal in appearance, with no evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Diffuse white matter disease which may be due to prior therapy for brain metastases or small vessel ischemic disease. If clinical concern for acute stroke remains, MRI is recommended."}
{"instruction": "Generate impression based on findings.", "input": "64 year old male with prostate cancer- staging exam. PROSTATE:Prostate Size: 5.5 x 4.4 x 4.5 cm, TR x AP x CCPeripheral Zone: There is a T2 hypointense enhancing lesion in the right mid gland that measures 8 x 7 mm (series 801, image 17).Central Gland: T2 hypointense enhancing lesion in the left anterior prostate close to its inferior margin measures 13 x 9 mm (series 801, image 10). Seminal Vesicles: No significant abnormality noted. Extracapsular Extension: Both lesions described above appear to abut and extend across the capsule. The lesion in the right mid gland also invades the adjacent extracapsular neurovascular bundle. 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.T2 hypointense enhancing lesion in the left anterior/inferior prostate that appears to abut/extend across the prostatic capsule, suspicious for neoplasm.2.Additional T2 hypointense lesion in the right mid gland that extends across the capsule, with invasion of the adjacent extracapsular neurovascular bundle. Findings are also suspicious for neoplasm at this site. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Chiari History: surveillance Again seen are postoperative changes of Chiari decompression. There is mildly diminished CSF space ventrally at the cervicomedullary junction, appearing similar to prior study. There is normal biphasic flow of CSF at the foramen magnum both ventrally and dorsally. No appreciable change in appearance of the cervical spinal cord syrinx. For example the syrinx measures 2 mm at C6 level, also 2 mm previously. Focus of high T2 signal and slight volume loss in the right hemicord at C2-3 level is also unchanged and compatible with myelomalacia. There is unchanged multilevel nerve root expansion with associated neural foramen widening. There is no significant intraspinal extension or associated spinal cord compression. Vertebral body and disc heights are preserved. Cervical lordosis is preserved. Alignment is anatomic. Vertebral body marrow signal is benign.", "output": "1. Again seen are postsurgical changes of Chiari decompression with unchanged appearance of the cervical syrinx and areas of myelomalacia.2. No appreciable change in appearance of the peripheral nerve sheath tumors involving the neural foramina throughout the cervical spine."}
{"instruction": "Generate impression based on findings.", "input": "Male, 41 years old. Reason: assess for RTC tear History: left shoulder pain ROTATOR CUFF: There is increased T2 signal along the anterior aspect of the supraspinatus at the musculotendinous junction, compatible with degenerative change and indicating tendinopathy. Additionally, there is a full-thickness tear of the supraspinatus tendon at its insertion. The other visualized rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint and glenoid labrum appear normal. A small amount of fluid is seen within the joint.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "1.Full-thickness tear of the supraspinatus tendon at its insertion, without retraction. Additional supraspinatus tendinopathy at the musculotendinous junction.2.Small amount of fluid within the shoulder joint and the subdeltoid/subacromion bursa."}
{"instruction": "Generate impression based on findings.", "input": "Female, 49 years old, with brain metastases, radiosurgery planning. Postoperative findings are seen compatible with tumor resection from the left frontal region. A rim-enhancing structure at the operative site is unchanged. Edema in the surrounding parenchyma is also unchanged.Multiple intracranial lesions are redemonstrated without significant interval change. These include a lesion at the posterior medial right temporal lobe, along the inferior left temporal lobe, and multiple lesions in the cerebellum. No new intracranial lesions are appreciated.", "output": "1.Stable postoperative findings in the left frontal region.2.Multiple other metastatic lesions are redemonstrated without significant interval change. No new lesions are appreciated."}
{"instruction": "Generate impression based on findings.", "input": "Male, 15 days old, history of ECMO, assess for hypoxic ischemic injury. Brain parenchymal morphology is within normal limits. The degree of gyral development as well as the pattern of white matter myelination are appropriate for the stated age. No evidence of focal signal abnormality is seen including no evidence of restricted diffusion.The corpus callosum is fully formed and intact. The pituitary region is normal. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed and unremarkable.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.", "output": "Unremarkable evaluation of the brain. Specifically, there is no evidence of hypoxic-ischemic injury or any other acute abnormalities."}
{"instruction": "Generate impression based on findings.", "input": " Orbits: Previously seen multiple small enhancing lesions involving the bilateral extraocular muscles have resolved. Small enhancing lesion involving the right frontal scalp appears decreased in conspicuity although there remains mild residual enhancement in this region. Small lesions in the right infratemporal fossa and left masticator space also appear to have resolved. Previously seen enhancing lesion in the right malar region is no longer definitively appreciated although there is artifact in this region on the current study which limits assessment. No new lesions. Bilateral globes and retrobulbar fat are unremarkable. Bilateral optic nerves are normal in signal.Brain: No evidence of intracranial mass or parenchymal edema. No abnormal parenchymal or meningeal enhancement. No extra-axial collections. Ventricles and sulci are within normal limits.There are punctate foci of susceptibility in the left cerebellar hemisphere as well as the right posterior paramedian frontal lobe. The left cerebellar focus was present previously. The right posterior frontal focus was not definitively present on prior study although this may reflect technique differences.There are frothy secretions within the left maxillary sinus as seen on recent CT. There is also mucosal thickening involving the left frontal sinus and mild bilateral ethmoid opacification. There is overall improvement in paranasal sinus opacification since recent CT from 12/3/2016.There is mild opacification of the bilateral mastoid air cells which is new since prior MRI from 9/23/2016.", "output": "1. There is no evidence of active infection or leukemia involving the brain.2. There are two punctate foci of susceptibility effect in the right posterior frontal lobe and in the left cerebellum. These may represent chronic microhemorrhages or mineralization and although nonspecific may represent sequela of treated infection.3. Images of the orbits demonstrate interval resolution of the previously seen small enhancing lesions in the extraocular muscles. Additional lesions involving the maxillofacial soft tissues have also resolved or nearly resolved. Please see additional comments above."}
{"instruction": "Generate impression based on findings.", "input": "39 year old male with a history of left ventricular hypertrophy, syncope, SVT, atypical chest pain. Negative coronary angiogram. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%. There is mild concentric hypertrophy(IVSd=11 mm). The LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 187 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 79 ml (normal range 47+/-19), the LV mass index is 48 g/m2 (normal range 85+/-15), and the LV mass is 115 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native pre-contrast myocardial T1 relaxation time ranges between 950-1050 ms (normal), extra-cellular volume fraction is normal (27%), T2-ratio is 1.6 (normal), global relative enhancement ration is 1.1 (normal). No evidence of myocardial iron overload based on normal T2-star relaxation time. All of these suggest that there is no underlying myocardial fibrosis, inflammation, or infiltration. Left AtriumThe left atrium is normal in size (75ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 110 ml/m2 (normal range 82+/-16), the RVEDV is 258 ml (normal range 142+/-31), the RV end systolic volume index is 60 ml/m2 (normal range 31+/-9), and the RVESV is 140 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 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. Normal left ventricular size and normal systolic function (LVEF 58%) with mild concentric left ventricular hypertrophy. No evidence of underlying myocardial fibrosis inflammation or infiltration based on multiple quantitative myocardial tissue characterization parameters.2. Normal right ventricular size with mildly reduced systolic function (RVEF 46%). 3. Mild right atrial dilationI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old woman with history of pancreas divisum and recurrent pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. Slight dropout of signal on opposed phase imaging suggests fatty infiltration of the liver. Patient is status post cholecystectomy. There is no intrahepatic pancreatic ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is pancreas divisum with a santorinicele (401/17). The main pancreatic duct is dilated up to 5 mm. On post secretin images, there is normal exocrine function of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts noted. The right kidney appears normal.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": "Pancreas divisum with santorinicele and dilated main pancreatic duct, but no exocrine abnormality on post-secretin images."}
{"instruction": "Generate impression based on findings.", "input": " There is a small focus of acute infarction in the left temporal lobe on series 501 image 208. There are additional punctate foci of acute infarction in the left occipital lobe on series 501 image 214. There are also small punctate foci of restricted diffusion in the central pons (series 501 image 206). There are other foci of increased DWI signal without definite corresponding decreased ADC signal or T2 hyperintensity in the left frontal and parietal lobes, which may represent less acute ischemia. There are foci of punctate susceptibility effect in the bilateral cerebellar hemispheres, vermis, pons, left thalamus, and left frontal lobe probably representing chronic microhemorrhages. There is diffuse confluent vasogenic pattern T2 signal abnormality in the subcortical and periventricular white matter in both supratentorial and infratentorial brain representing chronic hypertensive changes as they correspond to confluent hypodensity on prior remote CT as well. There is unchanged bifrontal encephalomalacia, left greater than right with expected ex vacuo dilatation of the frontal horns. There is a small left frontal bone defect with foci of susceptibility representing osseous fragments, unchanged from prior CT. The ventricles and sulci are unchanged.", "output": "1.Small to punctate foci of acute infarction in the left temporal lobe, left occipital lobe, and the central pons.2.Diffuse vasogenic pattern T2 confluent signal abnormality consistent with background chronic hypertensive encephalopathy as they were present on prior remote CT as well. Superimposed acute findings related to posterior reversible encephalopathy syndrome may be present in the cerebellar hemispheres bilaterally due to possible mild mass effect suspected in the cerebellar hemispheres, although it is difficult to distinguish the acute findings from the background of extensive chronic hypertensive findings.3.Bifrontal encephalomalacia, left greater than right, with small left frontal calvarial defect and tiny foci of bone within the left frontal region of encephalomalacia, unchanged.Findings were discussed with cardiology intern Dr. Zhang over the telephone at 5:10 p.m. today."}
{"instruction": "Generate impression based on findings.", "input": "Male 51 years old Reason: ? SLAP tear, ? Rotator cuff tear History: pain ROTATOR CUFF: Rotator cuff is intact.SUPRASPINATUS OUTLET: There is a type I acromion. No significant abnormality.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is irregularity of the anterior superior labrum most consistent with degeneration. No discrete tear of the labrum. Bone island is situated within the glenoid anterior humeral head.BICEPS TENDON: The biceps tendon is situated in the bicipital groove. No significant abnormality. ADDITIONAL", "output": "Irregularity of the anterior superior labrum consistent with degeneration without discrete tear."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with right knee pain, history of right knee arthroscopy with medial and lateral partial meniscectomies, grade 3 chondromalacia of the patella was chondroplasty, extensive microfracture of the patella, medial femoral condyle and lateral tibial plateau (6/4/2015) MENISCI: Linear intrasubstance signal abnormality within the posterior horn of the medial meniscus extending to the femoral articular surface consistent with a tear. Interval increase in degree of extrusion of the body of the medial meniscus. Intermediate signal within the inner edge of the body of the medial meniscus reflective of a radial tear.New globular intermediate signal within the anterior horn of the lateral meniscus extending to the femoral articular joint may represent degenerative tearing.ARTICULAR CARTILAGE AND BONE: Grade IV chondromalacia of the medial tibiofemoral compartment with joint space narrowing, bulky osteophytosis, subchondral sclerosis, and thinning of the articular cartilage. Focal fissuring/laminar tearing is noted along the posterior medial femoral condyle. Focal full-thickness signal abnormality in the posterior medial femoral condyle cartilage with underlying subchondral edema type signal.Grade 1-2 chondromalacia of the lateral tibiofemoral compartment with focal full-thickness chondral defect of the tibial articular cartilage measuring 7 mm in the AP dimension, worsened in the interval. A focal delamination defect is present along the medial aspect of the femoral trochlea. Edema type marrow signal is noted within and around the lateral tibial spine.Grade 2-3 chondromalacia of the patellofemoral compartment worst along the patellar ridge. Postsurgical appearance of microfracture of the lateral facet of the patella.LIGAMENTS: The cruciate ligaments are intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1.New tearing of the body and posterior horn of the medial meniscus with interval increase in degree of extrusion. 2.New globular intermediate signal within the anterior horn of the lateral meniscus extending to the femoral articular joint may represent degenerative tearing.3.Focal fissuring/laminar tearing is noted along the posterior medial femoral condyle is new. Focal delamination defect is present along the medial aspect of the femoral trochlea.4.Worsened focal full-thickness chondral defect in the lateral tibial articular cartilage measuring 7 mm in the AP dimension.5.Severe osteoarthritis affects the right knee, worst at the medial tibiofemoral compartment. 6.Interval resolution of joint effusion. Interval decrease in size of Baker's cyst now containing a 7 mm loose body."}
{"instruction": "Generate impression based on findings.", "input": "Left knee pain MENISCI: There is mild increased signal within the medial meniscus representing intrasubstance degeneration however there is no discrete medial or lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: There are areas of partial-thickness and perhaps full-thickness articular cartilage loss within the medial femoral condyle, particularly posteriorly. There is focal edema within the medial femoral condyle posteriorly and the overlying tendon of the head of the gastrocnemius appears thickened, suggesting tendinosis. There is a small adjacent cyst/ganglion and mild soft tissue edema as well. There is partial thickness degeneration of the articular cartilage of the medial facet of the patella with associated degenerative marrow signal. The lateral compartment appears normal. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Mild intrasubstance degeneration of the medial meniscus without evidence of medial or lateral meniscal tear.2. Cartilage degeneration as described above. 3. Focal edema within the medial femoral condyle posteriorly which may be secondary to overlying tendinosis of the medial head of the gastrocnemius.4. Edema within Hoffa's fat pad and slight lateral patellar translation, the combination of which may represent a patellar tracking abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Evaluation of mass in R parietal lobe found on CT scan of OSH. Seizures, altered mental status. There is an ill-defined infiltrative T2 hyperintense lesion in the inferior right temporal lobe predominantly involving the white matter. However, there are scattered foci of signal abnormality also involving the cortex extending into the insula and to the parieto-temporal junction. A T2 hyperintense lesion is present in the posterior medial right thalamus. The right amygdala and hippocampus appears thickened and mildly T2 hyperintense. There is no obvious postcontrast solid nodular enhancement. However, there is substantial sulcal enhancement both in the vicinity of the mass and rather diffusely in the right cerebral hemisphere. At least some of this enhancement appears to be related to increased vascularity however leptomeningeal enhancement is not entirely excluded. There is effacement of the temporal horn of the right lateral ventricle, otherwise the ventricles appear nondistended. No definite acute intracranial hemorrhage is identified. There is no midline shift.", "output": "There is an ill-defined T2 hyperintense process involving the right temporal lobe, insula, parieto-temporal cortex, posterior right thalamus,and questionably the medial temporal structures. Although there is no definite solid nodular enhancement, there is significant sulcal enhancement some of which is at least in part related to increased vascularity in the region. Although the differential considerations are broad and include neoplastic as well as nonneoplastic etiologies, the possibility of a malignancy, including higher grade primary brain tumors, would need to be considered."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic thyroid cancer to lung. Evaluate disease. CT of the soft tissues of the neck:Images through the skull base including cavernous sinuses remain within normal limits. Paranasal sinuses and mastoid air cells are unremarkable. Images through the rest of soft tissues of the neck demonstrate no evidence of a mass or pathologic adenopathy. No residual enhancing thyroid tissue is seen.A lytic soft tissue lesion erodes the spinous process of the C6 vertebra, measuring 20 x 19 mm, previously 13 x 11 mm. This lesion lesion appears to narrow spinal canal. MRI of the cervical spine could be obtained for further evaluation. Degenerative disk disease most severely affects C5-6 and C6-7, with uncovertebral osteophytes at these levels. Limited images of the apices of the lungs again demonstrate scattered pulmonary nodules. Please review dedicated report of CT of chest for details. CT of brain with infusion.No evidence of metastatic lesion to the brain, leptomeninges or the calvarium is detected. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.", "output": "1.Lytic lesion affecting the C6 spinous process may narrow the spinal canal. Cervical spine MRI can be obtained for further evaluation if indicated.2. Partial visualization of multiple pulmonary nodules. Please refer to chest CT scan day for further detail."}
{"instruction": "Generate impression based on findings.", "input": "Glioblastoma treated with Avastin+/- AMG 386. There are post-treatment findings, include right temporooccipital craniotomy with an underlying resection cavity. There is no significant interval change in the degree of linear enhancement and confluent T2 hyperintensity surrounding the resection cavity, accounting for differences in technique. There are minimal residual punctate foci of restricted diffusion along the margins of the resection cavity. There is no evidence of acute territorial infarct. There is no midline shift or herniation. The ventricles are unchanged in size and configuration. The skull and scalp tissues appear unchanged. The orbits and paranasal sinuses appear unremarkable.", "output": "No evidence of tumor progression."}
{"instruction": "Generate impression based on findings.", "input": "Male, 27 years old. SCT patient with swollen painful wrist. LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is grossly intact.TENDONS: The tendons of the wrist are normal. BONES: There is edema type signal throughout the lunate, which may reflect avascular necrosis. This area of abnormal signal does not appear to enhance. There is a mild negative ulnar variance.ADDITIONAL", "output": "Bone marrow edema of the lunate likely reflects avascular necrosis."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with change in mental status following craniotomy. Evaluate for hemorrhage. Postoperative changes status post bifrontal craniotomy, with pneumocephalus, surgical hardware, and skin staples evident. Previously described partially calcified lesions along the anterior interhemispheric fissure just right of midline and along the high left frontal convexity are unchanged. There is marked low attenuation within the frontal lobes, right greater than left, corresponding to edema seen on MRI. An area of focal low attenuation is seen in the medial left frontal lobe, concerning for ischemia. Punctate high attenuation in the medial left frontal lobe may represent calcification or hemorrhage, though thrombus within the anterior cerebral artery may have this appearance.A small curvilinear focus of high attenuation is seen in the medial right frontal lobe inferior to the partially calcified lesion, which may represent a small focus of hemorrhage. The degree of leftward midline shift has slightly increased, with ventricular volumes unchanged. The remainder of the cerebral and cerebellar hemispheres and brainstem demonstrate normal morphology and attenuation. Postoperative changes affect the frontal bones, with the remainder of the calvarium and osseous structures appearing intact. There is partial opacification of the left anterior ethmoid air cells, with the remainder the visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. Focal low attenuation in the medial left frontal lobe, suspicious for anterior cerebral artery territory or venous infarction.2. Extensive postoperative changes with residual tumor and mass effect as described."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for gray/white matter changes. Signs and symptoms: Vegetative state. Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. The gray -- white matter differentiation is preserved. The cortical sulci, ventricular system and all CSF cisterns remain within normal. No detectable parenchymal volume loss. In comparison to the prior examination there is no evidence of interval change.Calvarium is intact.Limited views of the orbits, mastoid air cells and middle ear cavities are unremarkable.The visualization of fluid and soft tissue density within the sphenoid sinus with interval worsening since prior exam. This may be secondary to instrumentation an NG tube placement.Considering provided clinical date of follow-up with an MRI examination is recommended.", "output": "1.Essentially unremarkable CT of brain and unchanged since prior examination from 4 -- 26 -- 2010.2.Further follow-up with an MRI is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Multiple sclerosis. There are multiple, greater than 10, T2 hyperintensity white matter lesions, primarily in a periventricular distribution. There is no evidence of intracranial hemorrhage, mass, 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, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.", "output": "No significant interval change in the intracranial demyelinating lesions, accounting for differences in technique."}
{"instruction": "Generate impression based on findings.", "input": "65yr old male with history of DLBCL evolved from CLL s/p SCT and heart failure presenting for cardiac evaluation. MEDICATIONS: lisinopril, furosemide, carvedilol First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarNo evidence of myocardial infarction. There is no definitive late gadolinium enhancement noted to suggest that there is replacement fibrosis, inflammation, or infiltration. However, the native T1 times are significantly elevated at 1150-1225 ms (nl <1050ms) diffusely, which suggest the presence of diffuse interstitial myocardial fibrosis or edema. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 213 ml (normal range 142+/-34), the LV end systolic volume index is 67 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 91 g/m2, and the LV mass is 148 g. The LV dysfunction is global. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 115 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 89 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (30 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a partially loculated pericardial effusion which is moderate in size along the mid to apical RV free wall. There is a much smaller circumferential pericardial effusion. 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. No perfusion defects/ \"ischemia\" present during hyperemia.2. No evidence of myocardial infarction. There is no late gadolinium enhancement noted to suggest the presence of replacement fibrosis, inflammation, or infiltration. However, the native T1 times are significantly elevated at 1150-1225 ms (nl <1050ms) diffusely, which would suggest the presence of diffuse interstitial fibrosis or edema. 3. Moderately dilated LV size and mildly reduced systolic function (LVEF 48%).4. Normal RV size and systolic function (RVEF 52%)."}
{"instruction": "Generate impression based on findings.", "input": "Low grade astrocytoma. There are postoperative findings related to biopsy of a heterogenously enhancing stellate-shaped mass centered in the left peritrigonal white matter extending to left pre and postcentral gyri and left thalamus that measures up to approximately 4 cm. The mass also contains areas of susceptibility effect that correspond to calcifications and is surrounded by confluent areas of high T2 signal. Some portions of the mass appear to have gradually increased in size. Furthermore, there is now a small patchy area of enhancement in the right paracentral lobule with surrounding high T2 signal, as well as a punctate focus of enhancement in the left splenium of the corpus callosum in an area of increased high T2 signal and swelling. There are otherwise unchanged T2 hyperintense lesion in the periventricular and subcortical white matter and in the brainstem, which are nonspecific. 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": "Findings suggestive of gradual progression of the mass centered in the left peritrigonal white matter extending to left pre and postcentral gyri and left thalamus, as well as development of what appears to be additional enhancing tumor in the left paracentral lobule and splenium of the corpus callosum. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for progression of MS. Signs and symptoms: Imbalance. Pre- and post enhanced brain MRI:Negative diffusion-weighted images.Examination demonstrates interval significant decreased size of several of demyelinating plaques in bilateral cerebral hemispheres since prior exam. There is no convincing evidence of any new demyelinating lesions since prior exam. Multiple previously noted enhancing demyelinating plaques demonstrate significant interval decreased size as detailed above. There is persistent trace enhancement in the left anterior frontal cingulate gyrus similar to prior exam (axial post enhanced series 1101 image 16). There is no associated FLAIR or T2 signal abnormality with this finding which is a similar observation is prior study. This tiny foci of enhancement also has remained stable when compared with earlier exams and including MRI exam from 9-3-2011 and likely representing a tiny developmental venous anomaly.The cortical sulci, ventricular system and CSF spaces are unremarkable for stated age.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses and mastoid air cells.", "output": "1.No convincing evidence of new demyelinating plaque or enhancement.2.Significant interval decreased size of multiple previously noted demyelinating lesions and resolution of enhancement.3.Moderate supratentorial findings of chronic demyelinating disease.4.Tiny focus of parenchymal enhancement without associated FLAIR hyperintensity in the left anterior cingulate gyrus has remained stable since multiple prior exams including study from 2011 and likely representing a tiny developmental venous anomaly."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Secondary cause of memory loss. Signs and symptoms: Memory loss. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate normal anatomical development and morphology of the brain parenchyma. There are mild punctate foci of FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres which considering patient's stated age likely representing microvascular ischemic changes of mild degree. The signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. Mild prominence of cerebral cortical sulci is noted in bilateral parietal lobes and unremarkable otherwise for patient's stated age.The ventricular system remains within normal and with maintained midline.CSF spaces are unremarkable.Signal void of all major intracranial arterial branches are identified.Unremarkable images through the orbits and with normal appearing calvarium and soft tissues of the scalp.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities are unremarkable.", "output": "1.No acute intracranial process.2.Findings suggestive of mild chronic small vessel ischemic strokes.3.Mild bilateral prominence of cortical sulci mostly in the parietal lobes and unremarkable exam otherwise."}
{"instruction": "Generate impression based on findings.", "input": " Cervical: There is evidence of osseous metastatic disease in the cervical spine with more diffuse marrow infiltration noted involving the C4 vertebral body extending into the posterior elements on the right. This lesion is new since prior MRI cervical spine from 2/20/2014. No evidence of epidural tumor in the cervical spine. No compression fractures in the cervical spine. Vertebral body heights and alignment are maintained. No cord signal abnormality. There are mild degenerative changes in the cervical spine including multilevel facet arthropathy. No significant spinal canal or neural foraminal stenosis is appreciated although motion degradation slightly limits evaluation. Thoracic: There is evidence of multifocal osseous metastatic disease. There is a small osseous lesion involving the the anterior inferior T1 vertebral body. There is a larger lesion involving the dorsal aspect of the T2 vertebral body. Small scattered lesions are seen throughout the thoracic spine more inferiorly as well with larger lesions involving the T8 and T9 vertebral bodies. Posterior element involvement is noted at multiple levels as well. No new compression fractures are demonstrated. Minimal irregularity/compression deformity involving the superior T3 endplate and mild wedging of the T6 and T7 vertebral bodies are unchanged.Compared to 2/20/2014, T8 and T9 lesions appear similar. Small T1 lesion is new/larger. There are multiple small new lesions involving the T2 T3, T4, T5, and T6 levels with posterior element involvement at multiple levels. There is extensive enhancing epidural tumor which extends from the C7-T1 level to the T3-T4 level with significant narrowing of the spinal canal from T1-T2 through the T2-T3 level and deformity of the cord. No cord signal abnormality is appreciated. These findings are new since 2/20/2014.Prominence of the epidural fat in the thoracic spine is again noted narrows the thoracic spinal canal more diffusely. No high-grade stenosis in the thoracic spine at additional levels however is demonstrated. There is narrowing of the left T2-3 neural foramen as well as the right T2-T3 and T9-T10 neural foramina. Otherwise no significant foraminal stenosis is appreciated. Prominent right posterior medial 9th and 10th rib involvement is again noted. Right lower lobe consolidation and small right pleural effusion noted. Please refer to prior chest CT.", "output": "1. Compared to prior cervical and thoracic spine MRI from 2/20/2014, there is progression of metastatic disease with new C4 lesion as well as multiple new upper thoracic lesions.2. There is interval development of extensive epidural tumor which extends from the C7-T1 level to the T3-T4 level with significant narrowing of the spinal canal from T1-T2 through the T2-T3 level with deformity of the cord. No cord signal abnormality is appreciated. 3. Subtle irregularity involving the superior endplate of the T3 vertebral body and mild wedging of the T6 and T7 vertebral bodies are similar to prior. No new pathologic compression fractures."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male. Cirrhosis. HCC screening, high AFP. ABDOMEN:LUNG BASES: Small subcentimeter nodular opacity in the right lung base. Previously there was nonspecific streaky opacity in this region, which has decreased.LIVER, BILIARY TRACT: Widening of the fissures and mildly nodular contour of the liver consistent with cirrhotic morphology. Cholelithiasis.No suspicious focal hepatic mass.No biliary ductal dilatation. Patent hepatic vasculature.SPLEEN: No significant abnormality noted. Two small splenules are 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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace scattered abdominopelvic ascites.", "output": "1. Cirrhosis with no suspicious lesions.2. Small nodular opacity in the right lung base which can be better characterized with CT."}
{"instruction": "Generate impression based on findings.", "input": " Cervical spine:6-7 mm cerebellar ectopia is noted with the left demonstrate normal rounded morphology and the right a minimally pointed morphology. Biphasic CSF flow is noted at the level of the cerebellar tonsils.The odontoid tip is mildly retroflexed.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Minimal disc bulge without significant mass effect or resulting stenosis. There is focal right uncinate hypertrophy without significant mass effect on the adjacent neural foramen.C4/5: Minimal disc bulge without significant mass effect or resulting stenosis.C5/6: Mild disc bulge and right uncinate hypertrophy without significant mass effect or resulting stenosis.C6/7: Mild disc bulge and right uncinate hypertrophy without significant mass effect or resulting stenosis.C7/T1: UnremarkableThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.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 no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment.", "output": "1.MRI evidence for acute Chiari malformation as described in detail above.. Biphasic CSF flow is noted at the level of the cerebellar tonsils.2.No spinal cord syrinx.3.Mild degenerative changes without significant resulting stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Cervical spine disc herniation on left side, sciatica. Lumbago, cervicalgia Cervical spine: Examination of the cervical spine is slightly motion degraded. No abnormal signal is definitively appreciated within the cervical cord. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of normal cervical lordosis with with mild retrolisthesis of C5 on C6 and C6 on C7. Bone marrow signal is benign with signal changes related to degenerative disease. There is loss of disc height throughout the cervical spine, worst at the C6-C7 level. Multilevel degenerative changes, as described below:C2-3: No significant compromise to the spinal canal or left neural foramen. Minimal right neural foraminal narrowing. Bilateral facet arthropathy.C3-4: There is mild spinal canal stenosis with partial effacement of the ventral and dorsal thecal sac. Mild to moderate left and mild right neural foraminal narrowing. Bilateral facet arthropathy.C4-5: There is moderate spinal canal stenosis related to disc osteophyte complex and ligamentum flavum thickening effacing the ventral and dorsal thecal sac. There is mild bilateral neural foraminal stenosis. There is facet arthropathy on the right with mild surrounding inflammatory changes.C5-6: There is moderate spinal canal stenosis related to disc osteophyte complex and ligamentum flavum thickening effacing the ventral and dorsal thecal sac. There is moderate to severe bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C6-7: There is moderate spinal canal stenosis related to disc osteophyte complex and ligamentum flavum thickening effacing the ventral and dorsal thecal sac. There is moderate to severe left and moderate right neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C7-T1: No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing. Facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar spine: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of normal lumbar lordosis. Alignment is otherwise within normal limits. There is significant loss of disc height at the L5-S1 level. Bone marrow signal is benign. The conus medullaris is normal in position.There appears to be congenital narrowing of the lumbar spinal canal with superimposed multilevel degenerative changes as described below: L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is mild to moderate degree of spinal canal stenosis related to examination of disc bulge, ligamentum flavum thickening, epidural fat, and facet arthropathy. There is mild right and mild to moderate left neural foraminal stenosis.L3-L4: There is moderate degree of spinal stenosis stenosis related to disc bulge, facet arthropathy, ligamentum flavum thickening, and epidural fat. There is mild to moderate bilateral neural foraminal stenosis.L4-L5: There is mild to moderate spinal canal stenosis related to ligamentum flavum thickening, facet arthropathy, and mild disc bulge. Effacement of the left lateral recess is also noted. There are small foraminal disc protrusions. There is moderate left and mild to moderate right neural foraminal stenosis. L5-S1: Severe loss of disc height. No significant spinal canal stenosis. Mild facet arthropathy. There is mild to moderate left and mild right neural foraminal stenosis.Paraspinous soft tissues are within normal limits.", "output": "1. Moderate degenerative changes throughout the cervical spine with moderate spinal canal stenosis at C4-C5, C5-C6, and C6-C7. There is also multilevel neural foraminal stenosis, worst at C5-C6 where there is moderate to severe bilateral neural foraminal stenosis. Facet arthropathy is also noted at multiple levels which may also be contributing to patient's neck pain.2. Multilevel degenerative changes in the lumbar spine with superimposed on congenital narrowing of the lumbar spinal canal. There is moderate degree of spinal canal stenosis at the L3-L4 levels and mild to moderate degrees of neural foraminal narrowing as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old woman with right wrist pain. Evaluate right wrist ganglion cyst LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact.TENDONS: No significant abnormality noted. BONES: There is a 2-3 mm round focus within the capitate which features highly T2 and low T1 signal, consistent with a small cyst or benign enchondroma. A punctate focus within the lunate has the same imaging characteristics. No fracture is evident.ADDITIONAL", "output": "No evidence of a dorsal ganglion of the wrist."}
{"instruction": "Generate impression based on findings.", "input": "27 years, Female, aphasia, headache. Brain parenchyma is within normal limits for age. No significant parenchymal signal abnormality. No restricted diffusion to suggest acute ischemia; although artifact (related to hair weave) slightly obscures assessment of the left anterior frontal lobe. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are grossly clear. Bone marrow signal and extracranial soft tissues are within normal limits.", "output": "Brain MRI is within normal limits. Specifically, no evidence of acute infarct or intracranial mass."}
{"instruction": "Generate impression based on findings.", "input": "History of prostate cancer status post robotic-assisted laparoscopic prostatectomy on 5/27/2016. His final pathology revealed Gleason 4+5 disease with positive margins at the L peripheral and L apex, 2/19 node involvement on the right with largest lymph node tumor being 15 mm with extranodal invasion, tumor volume 65%, pT3bN1MxR1. Recent PSA is 0.29, post-operatively was 0.11. Preoperatively PSA=11.85 ng/ml PELVIS:PROSTATE:Prostate Size: Patient is status post prostatectomy.Peripheral Zone: Patient is status post prostatectomy.Central Gland: Patient is status post prostatectomy.Seminal Vesicles: Patient is status post prostatectomy.Extracapsular Extension: Patient is status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Left external iliac T2 hyperintense lesion measuring 2.4 x 1.1 cm (series 1901 image 95). This lesion has no internal enhancement and favor lymphocele. Previously seen right external iliac lymph node is not definitely seen on current study and may have been surgically removed. Tiny nonspecific periprostatic lymph node.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Left external iliac T2 hyperintense lesion without internal enhancement, favor lymphocele. 2.Tiny nonspecific periprostatic lymph node, but no specific evidence of disease recurrence.PI-RADS\u2122 v2 Assessment Categories:PIRADS 1 \u2013 Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 \u2013 Low (clinically significant cancer is unlikely to be present)PIRADS 3 \u2013 Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 \u2013 High (clinically significant cancer is likely to be present) PIRADS 5 \u2013 Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf"}
{"instruction": "Generate impression based on findings.", "input": "Unspecified convulsions [R56.9], Reason for Study: ^Reason: new onset seizure, eval for structural/ischemic abnormality History: 80F with anemia who presented with new onset seizure, currently AA0x3 without focal deficits There is no evidence of acute ischemic or hemorrhagic lesion.There are scattered low somewhat patchy FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. Mild to moderate nonspecific small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "Prostate cancer PELVIS:PROSTATE:Prostate Size: 5.6 cm in transverse dimension by 4.3 cm in AP dimension by 3.8 cm in craniocaudal dimension.Peripheral Zone: Ill-defined abnormal signal in peripheral zones bilaterally at level of base. On right, focus of signal abnormality measures approximately 2.2 cm in transverse by 1.4 cm in AP by 0.8 cm in craniocaudal dimensions. On left, focus of signal abnormality measures approximately 1.5 cm in transverse x 1.7 cm in AP by 1.3 cm in craniocaudal dimensions. Corresponding low ADC and T2 hypointense signal seen and associated extracapsular extension and seminal vesicle invasion present. Additional subcentimeter low ADC signal seen in right-sided peripheral zone at level of midgland laterally, nonspecific. Areas of T1 hyperintensity in gland likely reflect postbiopsy hemorrhage.Central Gland: Moderate BPH-related changes. Seminal Vesicles: Invasion present.Extracapsular Extension: Present.BLADDER: Underdistended, making evaluation suboptimal, but no definite bladder invasion delineated.LYMPH NODES: Subcentimeter inguinal lymph nodes with fatty hila, subcentimeter pelvic sidewall nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Colonic diverticulosis.", "output": "1. Areas in prostate base suspicious for malignancy with associated seminal vesicle invasion as described. Additional small signal abnormality in right midgland peripheral zone, nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "6-year-old female with history of GBM status post radiation therapy. Redemonstrated is a large focus of T2 hyperintensity in the posterior pons and extending superiorly into the right cerebral peduncle and inferiorly bulging into dorsal aspect of the upper medulla. Although the transverse aspect has slightly decreased, there is a new focus of T2 hyperintense extension involving previously uninvolved anterior right paramedian pons. As before, there is irregular peripheral enhancement with a large central focus of non-enhancement, associated with susceptibility abnormality. Overall, the peripheral enhancement appears thicker, and more nodular, and there is new enhancement extending into the aforementioned new T2 hyperintense abnormality as well as new enhancement extending into the left cerebral peduncle. As before, there is mass effect with flattening and posterior displacement of the fourth ventricle and mild supratentorial ventricular enlargement which is stable. The cortical sulci remain within normal for stated age and midline is maintained. There is no additional foci of parenchymal signal abnormality or parenchymal/leptomeningeal abnormal enhancement. Expected vascular flow voids are demonstrated. New fluid is present within a few dependent left mastoid air cells, and mild inflammatory change in the right mastoid air cells appear stable.", "output": "Redemonstrated is a necrotic pontine mass with a thick irregular rim of enhancement and surrounding edema. Overall, the peripheral enhancement appears thicker, and more nodular, and there is new enhancement extending into a region of new T2 hyperintense abnormality, as well as new enhancement extending into the left cerebral peduncle. The differential diagnosis would include tumor progression versus radiation necrosis."}
{"instruction": "Generate impression based on findings.", "input": " The thoracic spine is in normal alignment, with a normal thoracic kyphosis. There is T1 shortening in the upper thoracic vertebrae compatible with postradiation change. There is minimal loss of height of the upper thoracic vertebral bodies with no associated edema to suggest recent compression fracture. The disk heights are well maintained. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.There is a 10 x 8 mm enhancing lesion involving the posterior inferior aspect of the pedicle at the right T11 level which is nonspecific (best seen on sagittal T1, STIR and sagittal postgad sequences). No associated soft tissue mass.LUMBAR SPINE", "output": "1.10x8 mm enhancing lesion within the right pedicle of the T11 vertebral body is nonspecific, however, metastasis is not excluded.2.No additional spinal lesions, pathologic compression fractures, or epidural or leptomeningeal tumor."}
{"instruction": "Generate impression based on findings.", "input": "Locoregional synovial sarcoma of spine (C2-T2) with cardiac extension; pulmonary relapse March 2016; surveillance imaging. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is also a mild effusion within the left mastoid air cells.Spine: There are postoperative findings related to C2-T2 laminoplasty and tumor debulking. There is interval decrease in size of the enhancing left paraspinal tumor with encasement of the left vertebral artery at these levels, with invasion of each neural foramen and minimal extension into the intraspinal epidural space, measuring up to 20 mm in thickness at the C3-4 level, previously 25 mm. There is persistent patchy heterogeneous marrow replacement throughout the cervical spine and upper thoracic spine, but the vertebral body heights are preserved. There is a kyphotic curvature at the cervico-thoracic junction, but no spondylolisthesis. The spinal canal is narrowed from C3-C7, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. There is associated mild spinal cord flattening in this region, without spinal cord signal abnormality. The posterior paraspinal tissues are unchanged. There are nodules within the partially imaged right lung. There is a small right apical pneumothorax.", "output": "1. Slight interval decrease in size of the treated residual tumor.2. Persistent patchy heterogeneous marrow replacement throughout the cervical spine and upper thoracic spine, but the vertebral body heights are preserved. 3. The spinal canal is narrowed from C3-C7, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. 4. No evidence of intracranial metastases.5. Pulmonary metastases and small right apical pneumothorax. Please refer to the separate chest CT report for additional details."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with bradycardia, slurred speech, and right facial droop. Please evaluate for intracranial process. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Small osseous deformity at the right lamina papyracea is likely from old trauma and appears similar to prior studies from 2009. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Normal brain CT."}
{"instruction": "Generate impression based on findings.", "input": "56 year old female with pulmonary hypertension, interstitial lung disease, sarcoidosis, NIDDM, diastolic hypertension referred for cardiac MRI to assess for cardiac involvement. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%. The LVEDV is 176 ml (normal range 109+/-23), LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), LVESV is 95 ml (normal range 31+/-10), and LV end systolic volume index is 46 ml/m2 (normal range 18+/-5). The LV mass is 97 g (normal range 114+/-24) and the LV mass index is 47 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is <1000 ms suggestive of absence of underlying diffuse fibrosis or infiltration.There is myocardial iron overload. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%, the RVEDV is 148 ml (normal range 110+/-24), the RV end diastolic volume index is 71 ml/m2 (normal range 69+/-14), the RVESV is 85 ml (normal range 35+/-13), and the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is mild 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 enlarged and there is enlargement of both right and left pulmonary arteries (MPA: 48mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMediastinal adenopathy noted. 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.The left ventricle is mildly dilated with mildly reduced systolic function. LVEF 46%.2.The right ventricle is normal in size with mildly reduced systolic function. RVEF 43%3.No regional wall motion abnormalities. 4.No late gadolinium enhancement to suggest cardiac sarcoidosis.5.Signs of pulmonary arterial hypertension."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental statusClinical question: acute brainstem ischemiaSigns and Symptoms: episode of unresponsiveness There is generalized brain atrophy present with some disproportionate enlargement of the lateral ventricles relative to the sulci.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional high signal foci on T2 and FLAIR MRI are present in the thalami and brainstem.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. Another possibility is it is related to no degenerative process. 2.A moderate degree of Lesions present in the thalami and brainstem are also likely vascular related.3.There is no evidence for acute ischemic cerebral infarction appreciated.4.Ventriculomegaly is a nonspecific finding. Although this could be related to atrophy, it could also be related to normal pressure hydrocephalus.5.Examination is somewhat degraded by patient motion. This may obscure more subtle abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "Male 51 years old Reason: Med Meniscus Tear, Patella Chondromalacia History: Pain, Loss ROM Left knee pain MENISCI: There is small radial tear of the posterior horn/body junction of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is fibrillation and near full-thickness cartilage loss involving the medial patellar facet with a small amount of underlying degenerative marrow signal. Similar but less severe findings are noted along the lateral facet as well as the trochlea.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Radial tear of the posterior horn/body junction of the medial meniscus.2. Moderate joint effusion and synovitis.3. Varying degrees of cartilage loss and thinning of the patellofemoral articulation with areas of near full-thickness loss along the medial facet."}
{"instruction": "Generate impression based on findings.", "input": "63 years, Female, right CSF otorrhea. Evaluate brain. 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. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Partially empty sella is noted which can be seen as a normal variant but can be associated with intracranial hypertension in the appropriate clinical setting. Cerebellar tonsils are low-lying without clear evidence of Chiari I reformation. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is diffuse opacification of the right-sided mastoid air cells. There is osseous defect involving the right tegmen mastoideum and compatible with history of CSF leak. Osseous defect and better seen on recent outside CT from 2/2/2016 as well as prior temporal bone CT from 12/8/2010. Minimal if any protrusion of the brain parenchyma is seen through this right temporal defect. There is asymmetrically increased enhancement of the overlying dura which may be reactive. No edema or clear evidence of encephalomalacia in the right temporal lobe is evident.Thinning of the roof of the left middle ear is also suspected as well as undulation of the left lateral temporal bone surface as well as the left greater sphenoid wing, better appreciated on outside CT and suggesting arachnoid pits. There is minimal opacification of the left-sided mastoid air cells.", "output": "1. Diffuse opacification of the right mastoid air cells with osseous defect involving the right tegmen mastoideum, which is better seen on recent CT. There is evidence of a meningocele at this level. There is minimal if any protrusion of the brain parenchyma through this right temporal bone defect. Dedicated temporal bone MRI can be considered for higher resolution visualization of this region if clinically indicated. There is asymmetrically increased enhancement of the overlying dura which may be reactive. No parenchymal edema or clear evidence of encephalomalacia in the right temporal lobe or elsewhere is appreciated.2. There is undulated appearance the floor of the contralateral left middle cranial fossa including the left sphenoid and left temporal bones with suggestion of \"arachnoid pits\". There are areas of osseous thinning/dehiscence in the left tegmen tympani. These osseous findings are better appreciated on prior temporal bone CT. 3. Partially empty sella which can be normal variant but can also be seen with intracranial hypertension. 4. Minimal nonspecific left mastoid air cell opacification."}
{"instruction": "Generate impression based on findings.", "input": "Male, 73 years old, status post craniotomy for tumor resection. Compared to 2/19/2016, there has been evolution of postsurgical changes with decrease in blood products in the posterior fossa. Compared to 2/19/2016, there has been interval increase in heterogeneously enhancing tissue surrounding the resection cavity. The degree of FLAIR hyperintensity is minimally increased involving the cerebellar vermis and right greater than left cerebellar hemispheres. Partial effacement of the fourth ventricle is again seen. Ventricles remain not significantly changed in size with mild prominence, likely related to volume loss. No new lesions are seen elsewhere in the brain. A nonspecific focus of T2 hyperintensity within the white matter adjacent to the left frontal horn is unchanged. No evidence of significant intracranial mass effect, midline shift, or herniation.", "output": "Compared to 2/19/2016 there has been interval increase in heterogeneously enhancing tissue surrounding the cerebellar resection cavity, which given history of recent radiation may reflect posttreatment change, but suggest close follow-up to exclude the possibility of true tumor progression."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted an outside study for review. Submitted for review is an MRI performed on 4/15/2016. For comparison,prior MRI from 10/20/2015 is available. MRI was performed as per outside protocol. No paperwork is submitted however. There is mild background parenchymal enhancement. An extreme amount of fibroglandular tissue is present. There is been significant interval decrease in the degree of abnormal enhancement in the left breast. Clumped discontinuous nonmass enhancement now extends over a total of 5.0 x 2.1 x 2.8 cm in the left inner breast. The overall volume of enhancing tissue is significantly decreased. The biopsy-proven metastatic lymph node is significantly decreased in size, now measuring up to 1.1 cm. No new suspicious enhancing lesion in either breast or axilla.", "output": "Significant interval decrease in left breast enhancement since the prior MRI. Left axillary adenopathy is also improved. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male patient with right shoulder pain. There is cyst formation in the humeral head near the insertion of the rotator cuff, as seen on prior MRI. Mild osteoarthritis affects the glenohumeral joint.", "output": "Mild osteoarthritis and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "evaluate for avm. HIV, history of CNS toxoplasmosis. MRI of the brainHeterogeneous signal present along the medial right parietal lobe with a gyriform T1 signal hyperintensity and T1 hypointensity as well as a 10 x 15mm irregular ring enhancing lesion with eccentrically thickened wall. This ring enhancing component is adjacent to the trigone of the right lateral ventricle. On the T2 imaging there is a surrounding white matter signal change in the mild asymmetry in the size of the trigone of the right lateral ventricle with right larger than left.A small focus of encephalomalacia is present at the right centrum semiovale.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. Right vertebral artery is hypoplastic distally and predominantly supplies the right posterior inferior cerebellar artery. The right posterior cerebral artery slightly larger than the left posterior cerebral artery. There is a narrowing of the right posterior cerebral artery as it courses through the right medial occipital lobe lesion.There is fenestration of the right internal carotid artery at the ophthalmic segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is somewhat irregular in appearance which may be a result of its course. The left A1 segment is larger than the right A1 segment. The posterior communicating arteries are readily identified", "output": "1.There is a right occipital lobe lesion which is ring enhancing. Given the patient's clinical history, it is suspected this may represent a reactivation of prior infection such as toxoplasmosis with some dystrophic calcifications. Presence of associated acute hemorrhage is less uclear. A comparison with a prior exam may be helpful. This finding was discussed with Dr Ardelt at the time of this dictation. It is of course concerning at this is immediately adjacent to the right lateral ventricle.2.No evidence for AVM.3.No evidence for intracranial aneurysm. The intercommunicating artery appears somewhat irregular however.4.There is narrowing of the right posterior cerebral artery adjacent to the right occipital lobe lesion.5.Incidental load is made of fenestration of the right internal carotid artery at the ophthalmic segment"}
{"instruction": "Generate impression based on findings.", "input": "53 year old female with alcoholic cirrhosis and HCC status post resection presenting with right upper quadrant pain. Evaluate for recurrence. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has nodular contours consistent with cirrhosis. New hyperattenuating focus seen only on arterial phase measures 1 x 1 cm on image 39 series 9. Although no definite washout is identified which favors benignity, continued follow up or MRI is suggested for further characterization of this lesion. The patient has undergone interval resection of a portion of the left lateral segment. There is a small perihepatic fluid collection which is likely postsurgical in etiology. No new lesions are identified.Cholelithiasis and pericholecystic fluid. If there is clinical concern for acute cholecystitis, a right upper quadrant ultrasound may be obtained. 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: Borderline enlarged retroperitoneal lymph nodes are stable.BOWEL, MESENTERY: Appearance of intussusception in the duodenum may be transient and is of uncertain clinical significance. Multiple colonic diverticula with retained hyperattenuating foci likely represent retained contrast. No evidence of obstruction, intra-abdominal free air, or abscess is identified.BONES, SOFT TISSUES: Postsurgical changes are identified in the right anterior abdominal wall from the incision.OTHER: Extensive collateral vessels inferior to the spleen at the splenic hilum consistent with portal hypertension.", "output": "1.New 1 cm enhancing focus in the right lobe of liver seen only on arterial phase without definite washout for which continued follow-up or MRI for further characterization is suggested. 2.Cirrhosis and portal hypertension as described above.3.Cholelithiasis and pericholecystic fluid. If there is clinical concern for acute cholecystitis, a right upper quadrant no may be obtained.4.Postoperative and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Nystagmus. There are multiple, greater than 10, T2 hyperintense lesions in the bilateral cerebral white matter, predominantly in a periventricular distribution. Many of the lesions also display T1 hypointensity. There are also T2 hyperintense lesions in the middle cerebellar peduncles and cerebellar white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "The supratentorial and infratentorial white matter lesions are suggestive of a demyelinating disease, such as multiple sclerosis."}
{"instruction": "Generate impression based on findings.", "input": " The ventricles are mildly prominent, as are the anterior subarachnoid spaces. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is left mastoid air cell and middle ear fluid opacification. Incidental note is made of a small oval-shaped T2 hyperintense structure along the left lateral supraorbital region, along the adjacent frontozygomatic suture, which measures 11 x 6 mm in greatest axial dimensions on 601/17. This demonstrates dropout of signal on axial fat saturated postcontrast images without enhancement. It demonstrates heterogeneous T1 hypointense signal and mild diffusion restriction.Anterior to the expected location of the anterior fontanelle, just the right of midline, there are some asymmetrically prominent cortical veins along the dural surface, as seen on 1403/75 and 1402/32-33. Fontanelle patency is difficult to assess on MRI. Probable benign enlargement as arachnoid spaces of infancy.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. The right vertebral artery is dominant. There is no evidence of flow-limiting stenosis or aneurysm", "output": "1. Unremarkable contrast enhanced MRI of the brain and noncontrast MRA head.2. Incidental small probable left lateral orbital dermoid/epidermoid.3. Probable benign enlargement of subarachnoid spaces of infancy which should resolve by 2 years of age. Follow-up imaging may be obtained as clinically indicated.4. Anterior to the expected location of the anterior fontanelle, incidental note made of asymmetrically prominent cortical veins to the right of midline. Please correlate with physical exam."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female with previous oral surgery for recurrent tongue cancer including neck dissection There are new postprocedural changes involving the left neck, including ill-defined enhancement throughout the operative region with associated STIR T2 hyperintensity. However, previously demonstrated prominent left level 1B and level 2A lymph nodes are no longer present.Previously demonstrated nodular enhancement along the dorsal margin of the surgical flap in the right oral tongue has decreased in conspicuity. There is also decreased T2 signal (as best visualized on coronal STIR technique).There is increased T2 signal involving the left oral tongue (as best visualized on coronal STIR technique) suggesting postprocedural changes, however a previously demonstrated 7 mm diameter enhancing nodule in the left sublingual space is significantly smaller and is no longer measurable.Redemonstrated are postoperative findings related to right glossectomy with flap reconstruction and neck dissection. Previously demonstrated enhancing nodules within the right parotid gland have overall decreased in size, although the largest is unchanged measuring up to 14 mm when measured on diffusion imaging at the same location utilized previously (previously 14 mm).There is no new clinically significant lymphadenopathy.Mild mucosal thickening in the maxillary sinuses is unchanged. The osseous structures appear to be grossly intact. The thyroid gland, orbits, and imaged intracranial structures are unremarkable.", "output": "1.There are new postprocedural changes involving the left neck, including ill-defined enhancement throughout the operative region with associated STIR T2 hyperintensity. However, previously demonstrated prominent left level 1B and level 2A lymph nodes are no longer present.2.Previously demonstrated nodular enhancement along the dorsal margin of the surgical flap in the right oral tongue has decreased in conspicuity. There is also decreased T2 signal.3.There is increased T2 signal involving the left oral tongue suggesting postprocedural changes, however a previously demonstrated 7 mm diameter enhancing nodule in the left sublingual space is significantly smaller and is no longer measurable.4.Previously demonstrated enhancing nodules within the right parotid gland have overall decreased in size, although the largest is unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Worsening of meningoma causing compression: TIA symptoms. Brain MRI: There is an area of restricted diffusion and high T2 signal in the right frontal lobe that measures up to 20 mm. There are also punctate foci of restricted diffusion in the left frontal lobe. There is a background of chronic lacunar infarcts in the left postcentral gyrus, bilateral basal ganglia, and right corona radiata, as well as scattered foci of cerebral white matter T2 hyperintensity without restricted diffusion. There is a punctate focus of susceptibility effect in the right periventricular white matter, which may represent a chronic microhemorrhage. There is an enhancing, dural-based mass in the left cavernous sinus region, with extension into the left orbital apex, sella, and sphenoid sinus, measuring up to approximately 50 mm overall. There appears to be compression of the left optic nerve. There are postoperative findings related to left pterional craniotomy with left anterior temporal lobe encephalomalacia. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Brain MRA: There is significant loss of flow related enhancement in the left internal carotid artery, with reconstitution distally at the circle of Willis. There may also be mild narrowing of the ophthalmic segment of the right internal carotid artery. There is no evidence of significant steno-occlusive lesions involving the rest of the intracranial arteries. There is no evidence of cerebral aneurysms.Neck MRA: There is relatively diminished enhancement of the left internal carotid artery attributable to downstream compromise of the vessel. There is otherwise no evidence of significant steno-occlusive lesions in the neck arteries.", "output": "1. Bilateral frontal lobe recent infarcts, right larger than left, without hemorrhagic transformation or midline shift, superimposed upon chronic lacunar infarcts and small vessel ischemic disease.2. Left cavernous sinus region meningioma with significant compression of the intracranial left internal carotid artery.3. No evidence of significant steno-occlusive cervical artery lesions."}
{"instruction": "Generate impression based on findings.", "input": " MRI BRAIN:There are no T2/FLAIR abnormalities. Ventricular size is normal. No evidence of mass effect or edema. There is no midline shift. Basal cisterns are patent. The vascular flow voids are normal. There are no diffusion abnormalities. There is no gross elevation of the optic nerve heads.MRV BRAIN:The deep and superficial venous systems are patent with no evidence of sinus vein thrombosis.", "output": "1. No acute abnormalities. No evidence of mass effect or edema.2. No evidence of superficial and deep venous abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "52 years Female (DOB: 11/3/1963)Reason: ? Nerve root compression History: neck painPROVIDER/ATTENDING NAME: ADAM S. CIFU ADAM S. CIFU The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature with mild reversal of the normal cervical curvature. There is multilevel disc desiccation 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. There is a disc bulge present at this level associated with mild narrowing of the neural foramina bilaterally.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present this level associated with some uncovertebral osteophytes and narrowing of the neural foramina bilaterally.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, disc desiccation and endplate reactive change at this level. The endplate reactive change is more prominent on the right versus the left side of the disc. Endplate reactive changes low signal on T1 and high signal on T2. There are endplate and uncovertebral osteophytes present this level. There is narrowing of the neural foramina bilaterally at this level with some encroachment of the exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level associated with endplate and uncovertebral osteophytes and some encroachment of the exiting nerve roots within the 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.", "output": "1.There are multilevel degenerative changes present in the cervical spine with encroachment of the exiting nerve roots bilaterally at C5-6 and C6-7 due to osteophytes and disc material."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal PET scan with enhancement of cervical lymph nodes, being worked up for possible paraneoplastic syndrome with resultant seizure like spells. There is no evidence of mass lesions or significant cervical lymphadenopathy. For example, a right level 2 lymph node measures 7 mm in short axis and a left level 2 lymph node measures 5 mm in short axis. The thyroid and major salivary glands are unremarkable. The major cervical arterial flow voids are intact. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable.", "output": "The lymph nodes in the neck are not particularly enlarged."}
{"instruction": "Generate impression based on findings.", "input": "Female, 60 years old, with bilateral arm tingling from the shoulders to the hands and some motor loss. Assess for spinal stenosis. Straightening of cervical lordosis is seen. No evidence of worrisome marrow replacement is detected. Mild degenerative loss of vertebral body height is seen at C5 and C6. The spinal cord shows normal morphology and signal characteristics as visualized on sagittal imaging. Disc osteophyte formation is evident at most levels but without any significant or high-grade spinal canal stenosis. No cord impingement is suspected.", "output": "1.This examination was terminated early at the patient's request due to discomfort during the scan.2.On the limited images acquired, there is evidence of disc osteophyte disease at multiple levels, but no high-grade spinal canal stenosis or cord impingement is suspected."}
{"instruction": "Generate impression based on findings.", "input": "70 year old female with right shoulder pain. Evaluate rotator cuff. ROTATOR CUFF: There is a focal partial-thickness tearing of the undersurface fibers of the supraspinatus tendon just proximal to its insertion on the greater tuberosity. The tear involves approximately 50% of tendon thickness. The tear propagates slightly along the longitudinal axis of the supraspinatus as an interstitial tear, in total, measuring 6 mm in length. The bursal surface fibers of the supraspinatus tendon are intact. The supraspinatus muscle is intact. There is a small cyst in the greater tuberosity at the site of the insertion of the infraspinatus tendon. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint. There is abnormal signal intensity within the superior glenoid labrum, indicating a tear that propagates down the anterior labrum and is associated with paralabral cyst formation along the anterior glenoid. There is a small amount of fluid within the glenohumeral joint but no frank effusion.BICEPS TENDON: There is increased signal intensity within the long head of the biceps tendon at its transition from the intertubercular sulcus to the rotator interval likely representing degenerative tearing and tendinosis with associated small subchondral cysts in the humeral head.", "output": "1. Small undersurface tear of the supraspinatus tendon as described above.2. Glenohumeral and acromioclavicular joint osteoarthritis with tearing of the glenoid labrum as described above.3. Tendinosis and probable degenerative tearing of the long head of the biceps tendon."}
{"instruction": "Generate impression based on findings.", "input": " There are postoperative findings related to L5-S1 interbody fusion. The vertebral body and disc space heights are otherwise preserved. There are facet degenerative changes at L4-L5 and L5-S1. There is no significant spinal canal or neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology and the conus terminates at L1-L2. There is no evidence of intraspinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable.", "output": "1.No evidence of lumbar spine metastasis.2.Postoperative findings related to L5-S1 interbody fusion.3.Mild to moderate facet arthropathy at L4-L5 and L5-S1 without evidence of spinal canal or neural foramen stenosis."}
{"instruction": "Generate impression based on findings.", "input": "65 year old man with history of cirrhosis, paroxysmal atrial fibrillation, CAD s/p CABG in February 2015 (LIMA to LAD, VG to PDA and VG to OM1) with new LV dysfunction noted on echocardiography. He was referred for cardiac stress MR to evaluate for ischemia and viability.MEDICATIONS: atorvastatin, coumadin, dofetilide, metoprolol, nifedipine, fish oil, diovan, nitroglycerin as needed First Pass PerfusionDuring hyperemia, there was a moderate to severe defect in the basal, mid and apical inferoseptum and a moderate defect in the mid inferior wall. The inferoseptal defect was present at rest and appeared mild. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 95 ml/m2 (normal range: 74+/-15), the LVEDV is 180 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 43 g/m2, and the LV mass is 82 g. There is abnormal septal motion consistent with the history of LBBB conduction abnormality and previous surgery. There is also tardokinesis of the mid-distal inferior wall. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. . The overall RV ejection fraction is 51%, the RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVEDV is 195 ml (normal range 142+/-31), the RV end systolic volume index is 50 ml/m2 (normal range 31+/-9), and the RVESV is 96 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. There is mild thickening of the valve leaflets. There is at least mild-moderate mitral regurgitation noted.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation, which appears eccentric.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 FindingsSternotomy wires are present. There is nonspecific esophageal thickening. Cirrhosis again noted. No gross hepatic lesion of the study was not optimized for such an evaluation. 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. At rest there was a mild defect in the inferoseptum which worsened with stress to a moderate to severe perfusion defect in the basal, mid and apical inferoseptum. With hyperemia, there was also a moderate perfusion defect in the mid inferior wall. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and mildly reduced systolic function (LVEF 54%).4. Normal RV size and systolic function (RVEF 51%).5. At least mild-moderate mitral regurgitation.6. At least mild tricuspid regurgitation.7. Severe left atrial dilation. "}
{"instruction": "Generate impression based on findings.", "input": "12-year-old male in auto accident with loss of consciousness Calvarium remains within normal limits and no evidence of posttraumatic fracture. Mastoid air cells are well pneumatized and unremarkable. Limited view of the paranasal sinuses demonstrates complete opacification of left chamber of the sphenoid sinus with no bony fracture which is believed to represent chronic sinus disease.Images through intracranial space demonstrates no evidence of post traumatic findings in particular no evidence of intra-axial or extra-axial hemorrhage is detected. No definitive evidence of edema is present. There is however multiple periventricular and subcortical area of low attenuation which appear old. These findings are suspicious for multiple foci of encephalomalacia which are nonspecific however differentials includes demyelinating disease, multiple areas of encephalomalacia from a prior infectious process or ischemic. There is no evidence of any abnormal intracranial calcification. There are no old films available for comparison. Further evaluation with a dedicated MRI is recommended.", "output": "1.No definitive evidence of any post traumatic findings intracranially or of the calvarium.2.Multiple small foci of low attenuation which appear old and needs further evaluation with a dedicated MRI of brain. Please see above comments."}
{"instruction": "Generate impression based on findings.", "input": "History of RCC and metastases. History of horseshoe kidney status post partial resection of the right moiety and left nephrectomy. Status post left distal pancreatectomy. Local recurrence and vascular invasion. ABDOMEN:LIVER, BILIARY TRACT: Stable segment 7 flash-filling hemangioma and small subcentimeter cysts. No suspicious liver lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: Status post partial distal pancreatectomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The patient has a history of horseshoe kidney status post partial resection of the right moiety and total resection of the left moiety. The previously described lesion arising from the mid/inferior pole of the right moiety demonstrates mild interval decrease in size now measuring 4.8 x 2.6 cm (series 602/297) and marked decrease in central enhancement with only residual peripheral enhancement compatible with treatment response necrosis. This extends into the right renal vein and IVC, unchanged.Simple appearing cystic structure inferior to the lesion is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable appearance of the third portion of the duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Interval mild decrease in size of the residual/recurrent tumor involving the mid/inferior portion of the right renal moiety with marked interval decrease in central enhancement compatible with treatment response necrosis. No evidence of metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female with history of aneurysm, surveillance imaging. History of right MCA stroke and thrombectomy on Jun 8 2012 Brain MRI:No evidence of acute ischemia. Redemonstrated is FLAIR hyperintensity and volume loss involving the right frontal, parietal, and temporal lobes as well as the posterior insula consistent with prior right MCA infarct. Small infarcts involving the right frontal corona radiata and anterior caudate also again seen. Mild FLAIR hyperintensity involving the bilateral periventricular white matter is compatible with chronic small vessel ischemic changes. Chronic right inferior cerebellar infarct is also again seen. These findings are unchanged.Again seen are foci of susceptibility effect adjacent to the central sulcus in the region of the chronic infarct and unchanged indicative of chronic blood products. Additional scattered foci of chronic microhemorrhages in the right frontal lobe and in the right parietal periatrial white matter also unchanged. No intracranial mass or mass-effect. No extra-axial collections. No hydrocephalus. As before, there is diffuse opacification of the left mastoid air cells as well as mucosal thickening involving the right maxillary sinus.Brain MRARedemonstrated is a left PCOM artery aneurysm measuring 3.2 mm at the neck and 6 mm in length. No evidence of interval enlargement. The left posterior communicating artery arises in its medial and inferior aspect. Aneurysm projects posteriorly and inferiorly.There is bulbous appearance at the right superior cerebellar artery origin which is unchanged. There are atherosclerotic changes involving the cavernous and supraclinoid internal carotid arteries with ectasia of the anterior genu of the left cavernous carotid artery. The anterior communicating and bilateral posterior communicating arteries are patent. No additional aneurysmal dilatations or flow-limiting stenoses are evident in the anterior-posterior circulation.", "output": "1.Stable encephalomalacia involving the right frontal, temporal, and parietal lobes consistent with chronic right MCA territory infarct. No new infarcts. 2.Stable multiple foci of chronic microhemorrhage including within the area of prior infarct are unchanged.3.No significant change in left posterior communicating artery aneurysm measuring up to 6 mm in length and 3 mm at the base.4.Persistent opacification of the left mastoid air cells as well as mucosal thickening involving the right maxillary sinus."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old man with history of PSA of 10.7 and 2 prior negative prostate biopsies. PELVIS:PROSTATE:Prostate Size: 5.7 x 4.0 x 6.6 cm.Peripheral Zone: Hazy low T2 signal in the left peripheral zone with mildly decreased ADC signal is felt to be due to artifact or possibly mild prostatitis secondary to biopsy. Unfortunately, an underlying lesion cannot be excluded due to diffuse signal changes.Central Gland: Hyperplastic nodules in the transitional zone are compatible with benign prostatic hyperplasia. Seminal Vesicles: The seminal vesicles are unremarkable.Extracapsular Extension: None.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.Hazy low T2 signal in the left peripheral zone with mildly decreased ADC signal felt to be artifactual or possibly related to mild prostatitis secondary to biopsy. An underlying neoplastic lesion cannot be excluded due to diffuse signal changes.2.Hyperplastic nodules in the transitional zone consistent with benign prostatic hyperplasia."}
{"instruction": "Generate impression based on findings.", "input": "CNS recurrence of DLBCL status post 2 cycles of MTR chemotherapy, in need of restaging. There has been interval decrease in size of the infiltrative enhancing mass involving the bilateral basal ganglia, hypothalami, columns of the fornices, and perhaps the anterior commissure, now measuring up to approximately 22 mm, previously 32 mm. There are right transfrontal post-biopsy findings with associated areas of susceptibility effect. There is no evidence of acute infarct. There is decreased effacement of the anterior third ventricle. The lateral ventricles are not significantly changed. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unchanged.", "output": "Interval decrease in size of the CNS lymphoma, indicated treatment response. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: ACL recon assessment. History: right knee pain Evaluation of the knee is slightly limited by metallic susceptibility artifact related to the patient's ACL reconstruction.MENISCI: A small amount of intrasubstance signal is seen within the posterior horn of the medial meniscus, but no discrete tear is identified. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: We see no fluid-filled articular cartilage defects. There is mild edema of the lateral tibial plateau posteriorly.LIGAMENTS: The patient has undergone ACL reconstruction with expected surgical changes in the distal femur and proximal tibia. The graft appears intact. Low signal intensity anterior to the graft has the appearance of metal artifact rather than arthrofibrosis. The PCL and remaining ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Surgical changes of ACL reconstruction. The graft appears intact.2. Focal edema in the posterior aspect of the lateral tibial plateau may reflect a bone contusion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval for TFCC tear History: ulnar sided wrist pain The images are slightly limited by patient motion artifact.LIGAMENTS: No contrast extends into the midcarpal joint. There are small foci of increased signal intensity within the scapholunate ligament which may reflect mild degeneration, but we see no findings to suggest a full-thickness tear of the scapholunate or lunotriquetral ligaments.TRIANGULAR FIBROCARTILAGE COMPLEX: Contrast extends from the radiocarpal joint into the distal radial ulnar joint through a tear in the articular disc of the triangular fibrocartilage, situated approximately 2 to 3 mm from its radial attachment.TENDONS: The flexor and extensor tendons appear intact. BONES: There are tiny cysts within the lunate proximally suggesting ulnocarpal abutment.ADDITIONAL", "output": "Tear of the triangular fibrocartilage complex and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old male with a proximal hamstring injury. Assess for stress fracture. Presents with left leg pain. There is peripheral increased signal abnormality along the anterior aspect of the semimembranosus and biceps femoris at the level of the myotendinous junction consistent with a strain. There is a punctate focus of increased fluid signal abnormality within the semimembranosus tendon at the level of its insertion on the left inferior pubic ramus consistent with a small interstitial tear (image 55, series 9). The hamstring musculature and tendons otherwise appear intact. There is no evidence of a full-thickness or near full-thickness tear of the hamstring tendons. The remainder of the visualized musculature of the thigh is normal in appearance. No bone marrow signal abnormality is identified to suggest a stress reaction/fracture.", "output": "Findings consistent with a strain of the semimembranosus and biceps femoris muscles as well as a very small interstitial tear of the semimembranosus tendon as described above, without evidence of a full-thickness or near full-thickness tear. No evidence of stress reaction/fracture."}
{"instruction": "Generate impression based on findings.", "input": "Reason: left MCA ischemic stroke NIHSS 19 History: NIHSS 19, right sided weakness, global aphasiaFLUOROSCOPY TIME: 115.9 minutesFrontal: 2784.03 mGyLateral: 1909.21 mGyOPERATORS: Greg Christoforidis Left common carotid artery: There is no evidence for carotid stenosis on the basis of NASCET criteria. There is a cobblestone appearance to the left ICA with broad pseudoaneurysms.Left internal carotid arteryThere is opacification of the left anterior cerebral arteries. There is occlusion of the left middle cerebral artery at the distal left mm1 segment with grade 4 leptomeningeal collaterals. The anterior temporal artery is proximal to the occlusion site.Intraprocedural arteriograms:Early on the microcatheter was noted to bulge into the left cavernous sinus, when the microcatheter was placed in the left M2 segment.There was a carotid cavernous fistula that developed during the procedure at the site of a 1 mm aneurysm.There is progressive recanalization of the left middle cerebral artery territory with TICI 2B reperfusion. Initially 70% of the territory reperfused, by the time the CCF was treated 95% of the territory had reperfused.There was progressive occlusion of the left sided direct cavernous carotid fistula.Left internal carotid artery following the procedure:There is recanalization of the left middle cerebral artery including superior and inferior divisions with some slow flow in a couple M5 branches.The cavernous carotid fistula was occluded at the end.Right common iliac artery: No contraindications to closure device.", "output": "1.Left middle cerebral artery distal m1 occlusion.2.Embolectomy with recanalization and reperfusion of the left middle cerebral artery using the Trevo embolectomy device.3.Direct carotid cavernous fistula development at site of a 1mm aneurysm at the ascending portion of the left cavernous internal carotid artery.4.Successful occlusion of left direct cavernous carotid fistula.5.Successful retrieval of prematurely detached embolic occlusion coil.6.Findings were discussed with Dr Cueva at the end of the procedure."}
{"instruction": "Generate impression based on findings.", "input": "59 years Female (DOB:8/6/1956)Reason: AMS s/p liver transplant. MR Brain w/o to assess for PRES or other CNS pathology per neuro recs History: as abovePROVIDER/ATTENDING NAME: CHRISTINE TROTTER JOHN F. RENZ The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam T2 and FLAIR signal hyperintensity involving the globus pallidus I has mildly regressed but not resolved.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the sphenoid sinus as well as some mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Susceptibility weighted imaging is degraded by motion artifact. Axial T1 and coronal T2 imaging is degraded by patient motion artifact.", "output": "1.Since the prior exam abnormal signal within the globus pallidus I has regressed. This is nonspecific but could relate to a toxic or metabolic process.2.No new lesions are appreciated intracranially.3.Exam is degraded due to patient motion which may obscure more subtle abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "Reason: s/p L rotator cuff repair, eval for healing vs re-tear History: see above. ROTATOR CUFF: Interval postsurgical changes of a rotator cuff repair. Full-thickness tear of the supraspinatus tendon with retraction and fluid in the subacromial subdeltoid bursa, measuring 1.9 cm in AP dimension. Full thickness tear involves the anterior fibers of the infraspinatus tendon. The subscapularis and teres minor are intact. Supraspinatus and infraspinatus fatty muscle atrophy has increased compared to prior.SUPRASPINATUS OUTLET: Fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding, otherwise glenohumeral joint alignment is anatomic. Irregularity of the anterior and posterior labrum compatible with degeneration.BICEPS TENDON: The biceps tendon is intact.ADDITIONAL", "output": "1.Interval postsurgical changes of a rotator cuff repair.2.Full thickness tear of the supraspinatus and infraspinatus tendons with retraction. Increased fatty muscle atrophy.3.Labral degeneration. "}
{"instruction": "Generate impression based on findings.", "input": "77 year old woman with ischemic cardiomyopathy. She is referred to evaluated for ischemia and viability.MEDICATIONS: ASA, clopidogrel, enalapril, furosemide, metoprolol, atorvastatin. First Pass PerfusionDuring hyperemia, two perfusion defects were noted: One in the basal anterolateral wall and another involving much of the inferoseptum and inferior walls. Viability/ Myocardial ScarThere was late gadolinium enhancement involving the basal and mid anterolateral and inferolateral walls. The pattern was consistent with a large sub-endocardial myocardial infarction. These segments have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is likely to be viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 158 ml/m2 (normal range: 65+/-11), the LVEDV is 273 ml (normal range 109+/-23), the LV end systolic volume index is 113 ml/m2 (normal range 18+/-5), the LVESV is 195 ml (normal range 31+/-10). There is global hypokinesis with regional variation.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with moderately reduced systolic function. Right AtriumThe right atrium is mild to moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation with bileaflet tethering.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA nodule is noted (1.3x1.4cm) in the posterior aspect of the right lung apex. A smaller nodule is also noted in the left upper lung. These nodules were not present on a CT scan from 2007; however, a previously noted lipoma in the right upper lung is noted once again today. 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. Two perfusion defects are noted during hyperemia. The smaller one involves the basal anterolateral wall, and a larger one involves most of the inferoseptal and inferior walls. The diagnostic sensitivity of vasodilator stress testing in individuals with severe LV dysfunction may be limited.2. A large non-transmural myocardial infarction is noted in the basal and mid anterolateral and inferolateral walls. These segments have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is likely to be viable.3. Severe LV dilation with severely reduced systolic function (LVEF 29%).4. Moderate RV dilation with moderately reduced systolic function.5. Moderate mitral regurgitation. 6. Severe left atrial dilation.7. Mild dilation of the main pulmonary artery.8. Lung findings as described above. Consider dedicated chest CT imaging if clinically indicated.These findings were conveyed to Dr. Polonsky."}
{"instruction": "Generate impression based on findings.", "input": "48 years, Male, seizures, brain lesion. Examination is limited to sequences for operative planning. Again seen is an expansile mass with T2 hyperintensity and no significant enhancement in the right frontal lobe. Mass is centered at the right middle frontal gyrus and measures 4.8 x 3.8 x 4.6 cm in the AP, transverse, and craniocaudal dimensions. Small areas of central cystic change are noted. There is local mass effect and trace leftward midline shift. No uncal herniation.", "output": "Examination for operative planning. There is a 4.8 x 3.8 x 4.6 cm nonenhancing right frontal lobe mass likely representing a glioma, favor low-grade."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for steno-occlusive disease, etiology of TIA: episode of aphasia and amnesia. Brain MRI: There is no evidence of intracranial hemorrhage or acute infarct. There two punctate fat signal intensity lesions in the midline of the posterior suprasellar cistern and interpeduncular cistern. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a small left maxillary sinus retention cyst. There is fluid within the pneumatized left petrous apex. Brain MRA: The vertebrobasilar system is relatively diminutive diffusely. Otherwise, there is no evidence of significant steno-occlusive lesions or saccular aneurysms.Neck MRA: There is a two vessel arch. There is no evidence of significant steno-occlusive lesions.", "output": "1. No evidence of intracranial hemorrhage or acute infarct. 2. The vertebrobasilar system is relatively diminutive diffusely, but without focal steno-occlusive lesions.3. No evidence of significant steno-occlusive lesions in the major neck arteries.4. Two punctate lipid-containing lesions in the midline of the posterior suprasellar cistern and interpeduncular cistern are compatible with lipomas or dermoids. 5. Left petrous apex effusion."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with left shoulder pain and limited range of motion Please note that images are suboptimal due to patient body habitus.ROTATOR CUFF: There is high-grade articular surface partial thickness tearing with regions of full-thickness tearing involving the anterior supraspinatus tendon and posterior fibers of the subscapularis tendon approximately 1 cm from the supraspinatus insertion measuring approximately 1.8 cm in AP dimension. A small amount of fluid is seen in the subacromion subdeltoid bursa. The remaining supraspinatus tendon has diffuse increased T2 signal suggesting tendinopathy. Teres minor and infraspinatus tendons are intact. There is mild generalized atrophy.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: No abnormal marrow edema. The glenoid labrum is grossly intact. There may be mild thickening of the inferior glenohumeral ligament. Small osteophytes are present.BICEPS TENDON: Biceps tendon is intact. ADDITIONAL", "output": "1.Full-thickness tear of the supraspinatus and subscapularis tendons.2.Thickening of the inferior glenohumeral ligament may be secondary to synovitis or fibrosis."}
{"instruction": "Generate impression based on findings.", "input": "13-year-old female with history of a cavernous malformation, status post resection Redemonstrated are changes from prior suboccipital craniotomy for resection of a left anteromedial cerebellar cavernous malformation. Postoperative changes include a resection cavity with a mild amount of adjacent parenchymal hemosiderin staining. Redemonstrated is the associated prominent developmental venous anomaly.The remainder of the brain demonstrates no additional cavernous malformations, or other mass or mass effect. There is mild hypoplasia involving the inferior cerebellar vermis. Brain parenchyma is otherwise unremarkable for age. There is no restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Sella and orbits are within normal limits. The paranasal sinuses and mastoid air cells are clear.", "output": "Redemonstrated are changes from prior suboccipital craniotomy for resection of a left anteromedial cerebellar cavernous malformation. Postoperative changes include a resection cavity with a mild amount of adjacent parenchymal hemosiderin staining."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with history of pain. Left hip: Mild osteoarthritis affects the left hip. There is faint sclerosis of the left femoral head likely representing avascular necrosis which was evident on the prior MRI exam. There is no evidence of subchondral fracture or articular surface collapse.Right hip: Mild osteoarthritis affects the right hip. Alignment is anatomic. There is no specific evidence of avascular necrosis.Pelvis: Redemonstrated are the aforementioned findings of avascular necrosis in the left femoral head and bilateral degenerative changes. There is a right common iliac stent. Surgical clips project over the lower right ischium.Left fifth toe: There is a nondisplaced transverse fracture through the proximal diaphysis of the fifth proximal phalanx in near-anatomic alignment. Mild soft tissue swelling about the toe.", "output": "1.Fifth toe fracture as above.2.Osteoarthritis of bilateral hips with findings suggestive of avascular necrosis of the left femoral head.Findings discussed with Dr. Kang at 1630 on 1/19/15."}
{"instruction": "Generate impression based on findings.", "input": "3-year-old female with a history of epilepsy presents with increased seizure activity. Brain parenchyma is unremarkable for age. No evidence of cortical dysplasia, gray matter heterotopia, or other 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. Myelination is age-appropriate. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.", "output": "MRI of the brain within normal limits. No findings to suggest seizure focus."}
{"instruction": "Generate impression based on findings.", "input": "Left arm and face weakness. Assess for stroke. There is restricted diffusion in the mesial dorsal pons where there is also increased T2 signal compatible with an acute to subacute infarct. Scattered foci of T2 hyperintensity in the periventricular and subcortical white matter compatible with chronic small vessel ischemic changes. This is associated with a small right thalamic and right corona radiata chronic lacunar infarcts. Note is made of a prominent perivascular space in the left insula. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. Note is made of a 13 mm ovoid lesion in the subcutaneous tissues overlying the left zygoma compatible with sebaceous cyst.MRA head:The intracranial carotid arteries demonstrate mild atherosclerotic irregularity. The PCOM arteries are diminutive bilaterally. The V4 segment of the right vertebral artery is completely occluded from the level of the arch of C1. No significant intracranial aneurysm. MRA neck:Conventional arch anatomy. The carotid arteries are widely patent with normal contour and caliber throughout. The left vertebral artery is moderately stenotic at its origin but returns to a normal caliber and contour for the remainder of its course. The right vertebral artery is markedly narrowed and irregular throughout with complete occlusion of its intracranial portion. This is compatible with a dissection of indeterminate age. There is a subcutaneous lipoma incidentally noted in the right posterior paraspinal soft tissues.", "output": "1. Acute to subacute infarct involving the mesial dorsal pons.2. The right vertebral artery is markedly narrowed and irregular throughout with complete occlusion of its intracranial portion. This is compatible with a dissection of indeterminate age.3. Moderate stenosis of the origin of the left vertebral artery which is otherwise normal in caliber and contour. Mild atherosclerotic irregularity of the intracranial internal carotid arteries.4. Chronic white matter small vessel ischemic changes as well as chronic lacunar infarcts in the right thalamus and right corona radiata."}
{"instruction": "Generate impression based on findings.", "input": "Reason: new ms plaque History: LLE weakness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disk desiccation present .There is a signal hyperintensity present along the posterior aspect of the spinal cord at the C2 vertebral body level posteriorly and along the midline visualized portions of the cerebellum there is a hypointense lesion on all pulse sequences which appears to be new since the prior exam from 2013 but is present on the recent MRI from yesterday.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. There are left-sided uncovertebral osteophytes present at this level which are associated with some disk material and some encroachment of the left-sided exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes levelAt C5-6 there is no significant compromise to the spinal canal . There are endplate portable osteophytes present at this level with mild narrowing of the neural foramina bilaterally.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.", "output": "1.A spinal cord lesion at the C2 through body level is stable compared to prior exams. There is no evidence for acute plaque formation appreciated.2.A small hemorrhagic focus in the inferior aspect of the right cerebral hemisphere is more conspicuous than on 2013. Please refer to MRI of the brain to further comments. The pattern of microhemorrhages on MRI is suggestive of hypertensive related microhemorrhages."}
{"instruction": "Generate impression based on findings.", "input": "Epilepsy. The left hippocampal head appears to have slightly indistinct internal architecture and slightly volume loss with minimal signal abnormality. There is unchanged minimal asymmetry of the temporal horns of the lateral ventricles. There is also unchanged slight prominence of the bilateral lateral cerebellar hemisphere folia. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. 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": "Suggestion of mild left medial temporal sclerosis, but no evidence of acute intracranial tumor."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old with known breast cancer on therapy, assess disease response. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Mild motion artifact does not significantly limit this exam.No residual suspicious enhancement is seen at the site of biopsy proven malignancy. Hydromark clip artifact is well seen in the location of the previously biopsied mass. No suspicious enhancement elsewhere in either breast. The previously noted highly likely benign focus in the left lower outer breast is less conspicuous on this exam, and certainly not enlarged. No abnormal lymph nodes are identified in either axillary region.", "output": "No residual suspicious enhancement at the site of biopsy proven malignancy post treatment.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with a history of squamous cell carcinoma of the nasopharynx status post surgery and chemoradiation therapy with probable metastatic disease to the brain. Evaluate for shift. There is a heterogeneous soft tissue density in the right ethmoid sinus with associated destruction and invasion through the overlying right lamina papyracea consistent with the patient's history of sinonasal squamous cell carcinoma. Additionally, there is an air-fluid level in the left frontal sinus and left ethmoid sinus mucosal thickening.There is a 3-cm isodense mass in the right frontal lobe (10; series 4) with extensive surrounding vasogenic edema highly suspicious for metastatic disease, previously 2 cm on outside MRI examination, significantly enlarged. Additionally, note is made of a 9 x 13 mm focus of hyperdensity in the posterior aspect of the aforementioned mass which likely represents hemorrhage adjacent to the tumor. There is associated local mass-effect with a 6-mm local leftward midline shift of the inferior right frontal cortex. There is no evidence of extra-axial fluid collection. There is preservation of the gray-white matter interface. There is no evidence of acute territorial infarct. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells are within normal limits.", "output": "1. 3 cm mass in the right frontal lobe with extensive surrounding vasogenic edema consistent with intracranial extension of tumor from the ethmoid air cells. There is a hyperdense focus in the posterior aspect of the aforementioned mass which likely represents hemorrhage. There is associated local mass-effect with a focal leftward midline shift of the inferior right frontal cortex. 2. There is a heterogeneous soft tissue density in the right ethmoid sinus with associated destruction and invasion through the overlying right lamina papyracea consistent with the patient's history of sinonasal squamous cell carcinoma. Additionally, there is an air-fluid level in the left frontal sinus and left ethmoid sinus mucosal thickening."}
{"instruction": "Generate impression based on findings.", "input": "Multiple myeloma not having achieved remission [C90.00], Reason for Study: ^Reason: myeloma with compression fracture L3 and screws for surgery L5/S1 with persistent pain at that site History: see above Cervical spine:Normal cervical lordosis has been lost but straightened. Multifocal cervical vertebral bodies show high signal intensity on T2 and FLAIR imaging could indicate myeloma involvement. However, there is no evidence of acute compression fracture. There is no evidence of abnormal spinal cord signal intensity on the scan.There is a central focal protrusion of C34, C4-5 which abuts the thecal sac. In addition, at the level of C5-6 and C6-7 shows diffuse broad-based disc protrusion which results mild to moderate spinal canal stenosis.Thoracic spineNormal thoracic kyphotic angulation is seen.Spinal cord signal intensity is normal.Vertebral bodies show multifocal T2/FLAIR high signal foci which may indicate possible myeloma involvement. There is no evidence of neuroforaminal stenosis or spinal canal stenosis.Lumbar spine MRIThere is about 30% vertebral height reduction of L1 vertebral body with bone marrow edema indicating acute/subacute compression fracture.There is no evidence of retropulsion.There is evidence of prior PMMA injection at the level of L3.There is also evidence of L5-S1 external fixation with screws and rods. The conus medullaris terminates at the level of T12. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. Bone marrow edema with about 30% of vertebral height reduction indicate acute/subacute compression fracture.L2-L3: diffuse bulging of disc with bilateral ligamentum flavum thickening results mild to moderate spinal stenosis. L3-L4: diffuse bulging of disc with bilateral ligamentum flavum thickening results mild to moderate spinal stenosis. L4-L5: diffuse bulging of disc with bilateral ligamentum flavum thickening results mild to moderate spinal stenosis. L5-S1: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis.", "output": "1. Acute/subacute compression fracture at the level of L1.2. Multifocal multilevel cervical and thoracic vertebral body lesions indicating possible myeloma involvement. 3. Spinal cord signal intensity is normal.4. Mild to moderate spinal stenosis at the level of C56 and C67.5. Mild to Moderate spinal canal stenosis, from L23 to L45.6. Post PMMA injection status of L3 and external fixation with rods and screws between L5 and S1."}
{"instruction": "Generate impression based on findings.", "input": "Early onset of tics. Patient has complex motor tics and speech and fine motor delay. Brain parenchyma appears within normal limits. No parenchymal signal abnormality in the basal ganglia or elsewhere in the brain. No evidence of cortical dysplasia, gray matter heterotopia, or other findings to suggest a possible seizure focus. No intracranial mass or mass effect. Myelination is appropriate for age. No evidence of infarct or hemorrhage. Ventricles are within normal limits without evidence of hydrocephalus. No extra-axial collections. Borderline low cerebellar tonsils are incidentally noted but within normal limits for age; no evidence of Chiari I. Posterior fossa structures and craniocervical junction appear otherwise unremarkable. Bone marrow signal is within normal limits. Extracranial soft tissues are unremarkable.", "output": "Brain MRI examination is within normal limits for age."}
{"instruction": "Generate impression based on findings.", "input": "Generalized muscle weakness There is mild edema signal within the abductor musculature of the thigh bilaterally, right slightly greater than left. There is also mild edema type signal within the anterior compartment of the distal femur. There is mild diffuse fatty atrophy of the pelvic and lower extremity musculature.Scattered foci of increased marrow signal are noted within the proximal femora bilaterally, particularly on the right. These may represent areas of early bone infarction. Additional areas of osteonecrosis are seen within the right distal femur and proximal tibia. There is a moderate-sized joint effusion of the knee.", "output": "1. Mild edema within the abductor muscles and anterior compartment of the distal femur compatible with mild myositis. There is also mild diffuse fatty atrophy of the pelvic and lower extremity musculature.2. Osteonecrosis of the distal femur and proximal tibia with scattered areas of abnormal marrow signal within the proximal femora which may reflect early bone infarction."}
{"instruction": "Generate impression based on findings.", "input": "Female, 87 years old. Reason: eval for osteomyelitis History: left ankle with open wound, purulence, exposed tendon, and CRP 240 There is extensive soft tissue edema about the ankle with associated obliteration of the normal pre-Achilles fat posterior to the ankle joint. Mild heterogeneous soft tissue enhancement diffusely suggests an ongoing inflammatory process. On postcontrast images, an area of low signal in the superficial soft tissues anterior to the distal tibia with peripheral enhancement may reflect a fluid collection within the soft tissues. A small amount of fluid is noted within the retrocalcaneal bursa. Increased T2 signal within the sinus tarsus may reflect additional inflammation.The underlying osseous structures are intact, with and normal cortical thickness and bone marrow signal. The visualized tendons of the ankle are intact. The anterior talofibular ligament is not well visualized. A small ankle joint effusion is noted.", "output": "1.Diffuse soft tissue inflammation/edema, without evidence of osteomyelitis.2.Possible small fluid collection in the superficial soft tissues anterior to the distal tibia."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female patient with history of sickle cell anemia and severe bilateral knee pain. Evaluate for avascular necrosis. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is patchy ill-defined increased signal intensity in the distal femoral metaphysis. Increased T1 signal intensity is noted in the lateral femoral condyle, extending to the subarticular surface. Similar findings are seen to a lesser degree in the medial femoral condyle. Within the medial femoral condyle there is an area of increased T1 signal intensity with peripheral low T1 signal intensity, compatible with a bone infarct. This measures up to 3 cm in AP dimension. A similar appearing small lesion is noted in the distal femoral metaphysis (series 7 image 11).There are no focal articular cartilage defects. LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament complex, and medial collateral ligament are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1.Multifocal small bone infarcts in the distal femur. 2.Abnormal marrow signal secondary to sickle cell anemia.3.Small joint effusion."}
{"instruction": "Generate impression based on findings.", "input": "Male 56 years old Reason: fall on 3/21; radiograph negative but severe pain; cannot bear weight BONE MARROW: There is a T1 hypointense linear signal through the right sacral ala, with corresponding T2 hyperintense signal, consistent with nondisplaced sacral fracture. There is also T1 hypointense linear signal with corresponding T2 hyperintense signal through the right ischium near the pubic symphysis, and as well as in the right ischial tuberosity consistent with additional nondisplaced fractures.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL", "output": "Nondisplaced right sacral, and right ischial fractures as described above."}
{"instruction": "Generate impression based on findings.", "input": "36 years Female (DOB:6/6/1980)Reason: MS; f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED There is redemonstration of multiple periventricular and subcortical T2 and FLAIR signal hyperintense lesions as well as punctate lesions in the posterior limbs of internal capsules and the couple lesions in the right cerebellar hemisphere and in the brainstem. These lesions were present on the prior exam and have not changed substantially.Incidental note is made of cavum septum pellucidum and cavum vergae.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There are multiple lesions scattered throughout the periventricular and subcortical white matter and to a lesser degree posterior fossa which are stable compared to the previous exam. These are now with patient's clinical diagnosis of demyelinating disorder."}
{"instruction": "Generate impression based on findings.", "input": "Reason: PRES History: evaluate progression MRI of the brainpatchy foci of T2 and flair signal hyperintensity are present subtle in the left cerebellar hemisphere, more extensive than the right occipital lobe and adjacent to right posterior temporal lobe, small region in the left occipital pole, right thalamus, bilateral frontal lobes and watershed distribution in the Frommel and parietal lobes right more than left. There are associated mild degree of periventricular white matter lesions compared these findings were present on the previous exam appeared in the extent of these lesions is not clear to have changed tiny significant degree. On the associated susceptibility weighted imaging there is no microhemorrhage appreciated associated with these lesions. On the ADC maps there is very little evidence for diffusion restriction perhaps a little bit in the right subcortical white matter adjacent to the precentral and central gyrus, however, significantly less than the T2 and flair signal abnormalities. Postcontrast imaging demonstrates small foci of patchy enhancement along the cortex of the frontal lobes bilaterally but right more than left. The enhancement is significantly less than the T2 and FLAIR abnormality. Additionally there appears to be intravascular enhancement present in some subtle leptomeningeal enhancement adjacent to the left cerebellar hemisphere and right posterior and inferior aspect of the temporal lobe and adjacent occipital lobe . Overall this pattern is not changed substantially when compared to the prior exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.Unopposed contras SPGR T1 images only there is a tubular enhancing structure which projects over the brainstem. It is suspected to represent artifact as it is not seen on any of the pulse sequences other than this one. It likely represents misregistration from the left vertebral artery.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses mainly in the sphenoid sinuses. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are asymmetric left larger than right.There is extracranial origin of the right and left posterior inferior cerebellar artery.", "output": "1.This examination of the brain has not change substantially when compared to the previous exam. There are predominantly cortical but also adjacent white matter patchy lesions involving supratentorial brain as well as left cerebellar hemisphere and right thalamus as detailed above. There is some associated leptomeningeal disease. Although one possibility is that these findings can be explained on the basis of posterior reversible encephalopathy syndrome, the interval lack of change may suggest otherwise and the imply a different etiology. Considerations may include encephalitis as well as vasculitis.2.No evidence for intracranial aneurysm or cerebrovascular occlusion or stenosis. 3.Findings were discussed with Dr Goldenberg."}
{"instruction": "Generate impression based on findings.", "input": "Male, 56 years old, status post craniotomy for tumor removal. Postoperative findings are seen compatible with right suboccipital craniotomy for resection of the previously seen right cerebellar lesion. The right cerebellar surgical cavity contains a mixture of air, fluid and blood product which is within expected postoperative limits.No definite residual enhancement is seen within the surgical cavity. Just above the resection cavity, and at a level which is apparently cranial to where the original tumor sat, there is a new 14 mm T1 hypointense cyst or nodule which contains an 8 mm enhancing focus.T2 hyperintensity within the right cerebellar hemisphere extending into the right cerebellar vermis is grossly unchanged from prior. Regional mass effect with effacement of the cerebellar fissures and partial effacement of the fourth ventricle is also unchanged.A teardrop shaped focus of T2 hyperintensity within the right upper pons is unchanged and may simply represent a dilated perivascular space. No additional significant parenchymal signal abnormality is seen supratentorially. The lateral ventricles are very slightly prominent but unchanged from the prior exam.", "output": "1.Expected findings status post resection of an enhancing right cerebellar lesion.2.No definite residual enhancement is seen within the resection cavity or at the original site of the lesion.3.Just cranial to the resection cavity, and at a position which is above the original lesion, a T1 hypointense cyst or nodule is evident containing a small central focus of enhancement. The nature of this finding is uncertain, but as it does not exactly correspond to the site of tumor on the preoperative study, some type of postoperative change is favored. Continued attention to this area on follow-up exams is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Right-sided weakness. Evaluate for hemorrhagic conversion. Reidentification of patchy asymmetric hypoattenuating area along the distribution of the left MCA corresponding to abnormality seen on MRI of 12/12/2010 and CT perfusion on 12/11/2003 is compatible with stroke. Peri-ventricular and subcortical white matter hypoattenuating foci bilaterally are consistent with chronic small vessel ischemic disease appearing similar to prior exam.Prominence of extra-axial spaces and ventricular system is compatible with parenchymal volume loss. No extra-axial fluid collections, mass, or hemorrhage. Diffuse sclerosis involves the calvarium. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. Left MCA infarct as previously described without evidence of hemorrhagic conversion.2. Small vessel ischemic disease and other findings appearing similar to prior exam."}
{"instruction": "Generate impression based on findings.", "input": "A 29 year old female with history of sickle cell disease, repeated red blood cell transfusions and iron overload. A recent echocardiography showed mildly reduced systolic function. Referred to cardiac MRI to assess function and cardiac iron overload. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 142 ml/m2 (normal range: 65+/-11), the LVEDV is 250 ml (normal range 109+/-23), the LV end systolic volume index is 76 ml/m2 (normal range 18+/-5), the LVESV is 134 ml (normal range 31+/-10), the LV mass index is 61 g/m2 (normal range 67+/-11), and the LV mass is 108 g (normal range 114+/-24). There is global mild hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No evidence of myocardial iron overload (average T2-star time above 30ms).No intracavitary thrombus was noted.Left AtriumThe left atrium is mildly dilated. The LA volume is 109 ml.Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 132 ml/m2 (normal range 69+/-14), the RVEDV is 234 ml (normal range 110+/-24), the RV end systolic volume index is 63 ml/m2 (normal range 22+/-8), and the RVESV is 111 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. 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 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 normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial pericardial effusion.Extracardiac FindingsIron overload was noted in the liver (T2-star time of 9ms). No spleen was seen, consistent with auto-splenectomy. 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. The left ventricle is severely dilated with mildly reduced systolic function, the LVEF is 46%. There is global mild hypokinesis with regional variation. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. No evidence of myocardial iron overload.4. There is biatrial mild dilation. 5. The right ventricle is severely dilated with normal systolic function, the RVEF is 52%. 6. There is moderate tricuspid regurgitation.7. Iron overload was noted in the liver."}
{"instruction": "Generate impression based on findings.", "input": "Status post fall with subdural hematoma. Evaluate presence of subdural hematoma. Nonenhanced head CT:Examination again demonstrates a thin acute subdural hematoma in the left posterior parietal region. Compared to prior exam there is evidence of reduction in density and size of these subdural. In the current exam the thickest portion of subdural measures approximately 4.7 mm compared to prior measurements of 5.8-mm.Small amount of acute subdural blood is also present along the posterior aspect of falx on the left in the occipital region. This finding was present on prior study and is believed to represent continuation of left parietal subdural as was noted on prior MRI exam. There is no evidence of new hemorrhage. A minute amount of blood in the dependent portion of occipital horn is again identified.Prominence of lateral ventricles is similar to prior study. Area of vasogenic edema in the right posterior frontal is again identified and unchanged.The left posterior temporal cortical stroke is again identified.", "output": "1.No evidence of new hemorrhage since prior exam.2.Smaller size of left parietal subdural. No significant change in the left parafalcine component of subdural.3.Stable right frontal -- parietal vasogenic edema.4.Left posterior temporal lobe cortical stroke.5.Stable prominent size of the lateral ventricles. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 66 years old, with memory loss and confusion. Assess for structural abnormalities, atrophy. Numerous small scattered foci of T2 hyperintensity are seen within the white matter of the cerebral hemispheres, largely in the subcortical regions and to a lesser degree the deep periventricular white matter. No evidence of restricted diffusion is seen. No significant edema or mass effect is detected.There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection. The sulci of the cerebral vertex are perhaps slightly prominent but there is no specific pattern or focality to this finding. Ventricular size and morphology are within normal limits.", "output": "1.No acute intracranial abnormality.2.Numerous scattered small foci of white matter signal abnormality are seen, a nonspecific finding. This carries a broad differential diagnosis which includes sequelae of microvascular ischemic disease, demyelination, migraine headache or vasculitis among many other possible etiologies.3.Prominence of the sulci is seen along the cerebral vertex suggesting the possibility of underlying parenchymal volume loss. However, there is no specific pattern or focality to this finding."}
{"instruction": "Generate impression based on findings.", "input": " Again seen is thoracic syringohydromyelia centered at the T7 vertebral body level that measures up to 6 x 7 mm in the AP and transverse dimensions, previously also 6 x 7 mm. Craniocaudally the syrinx measures proximally 2.6 cm which is also not significant changed.The conus medullaris is positioned at the L1 vertebral body level. 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 or neural foraminal stenosis. The paravertebral soft tissues are unremarkable.Limited evaluation of the craniocervical junction on the sagittal counting sequences again demonstrates ectopia of the cerebellar tonsils with a peglike configuration consistent with Chiari I malformation.", "output": "1. Compared to 2/4/2015, there is no significant change in the thoracic syrinx centered at T7 which measures 6 x 7 x 26 mm in the AP, transverse, and craniocaudal dimensions.2. Findings of Chiari I malformation better assessed on prior brain MRI."}
{"instruction": "Generate impression based on findings.", "input": "History of cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. In the right hepatic dome there is a 1.6 cm rounded lesion (series 11/33) demonstrating arterial enhancement and washout (series 12/image 31).The previously described ill-defined oblong region of arterial enhancement in the hepatic dome demonstrates no washout and measures approximately 3.2 x 1.5 cm (series 11/37), unchanged.Additional multiple peripheral wedge-shaped early enhancing lesions likely represent transient perfusion differences.Simple cyst in the left lobe of the liver.Cholelithiasis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral small renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Atherosclerotic vascular disease. Left lower thoracic wall subcutaneous soft tissue enhancing nodule may represent a small sebaceous cyst, unchanged.OTHER: No significant abnormality noted.", "output": "1.6 cm right hepatic dome lesion with arterial enhancement and washout, meeting imaging criteria for HCC. Otherwise stable examination.Cholelithiasis without cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "History of breast cancer status post neoadjuvant chemotherapy, partial mastectomy and sentinal node biopsy. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. There is post-surgical volume loss and artifact from surgical clips in the right medial breast. Mild focal enhancement near the lumpectomy bed does not have suspicious kinetics. No abnormal lymph nodes are identified in either axillary region. Post surgical changes related to the patient's axillary surgery are present. No enlarged internal mammary lymph node is seen.", "output": "Expected post-surgical changes. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Lumbar back pain. There is degenerative spondylosis consisting of facet hypertrophy and disc bulges involving L2 through S1 with resultant mild bilateral neural foraminal stenoses and spinal canal stenosis at all of these levels. There is a small intravertebral disc herniation in the inferior L2 vertebral body. The vertebral body heights are otherwise preserved. The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The imaged portion of the spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.", "output": "Degenerative spondylosis consisting of facet hypertrophy and disc bulges involving L2 through S1 with resultant mild bilateral neural foraminal stenoses and spinal canal stenosis at all of these levels, which has slightly progressed overall since 2010."}
{"instruction": "Generate impression based on findings.", "input": "Episodes of left leg numbness, weakness, and pain. Rule out cord lesion. Cervical: There is a T2 hyperintense lesion involving the right ventral aspect of the cord at the upper C2 level. Motion degradation limits evaluation however no additional lesions in the cervical cord are definitively appreciated. No abnormal enhancement in the cord or elsewhere in the cervical spine.Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained aside from some loss of cervical lordosis which may be in part positional. Bone marrow signal is benign. Multilevel degenerative changes are seen multilevel disc desiccation and up to moderate disc height loss at the C4-C5 and C5-C6 levels. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small right paracentral disc protrusion. No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex including uncovertebral hypertrophy. No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing, right relatively worse in left.C5-6: Small disc osteophyte complex. No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing, right relatively worse than left.C6-7: Small disc osteophyte complex including a right paracentral disc protrusion and uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. There appears to be a 1 cm nodule along the posterior aspect of the right thyroid gland, which is not well assessed but also appears to enhance.Partially imaged parotid glands demonstrate mild heterogeneity including multiple T2 hyperintense foci.Thoracic: There is a T2 hyperintense lesion involving the left aspect of the cord at the T4 level, best seen on axial image 8 of series 2401. This lesion appears to mildly enhance, axial series 3201 images 10-12 and sagittal series 2901 image 8. No additional thoracic cord signal abnormality is definitively appreciated. The thoracic spine is in normal alignment. The vertebral body heights are well maintained. Bone marrow signal is benign with a T1 T1 hyperintense focus involving the posterior aspect of the T2 vertebral body compatible with a small hemangioma or focus of fat. Mild degenerative changes include minimal scattered disc bulges and protrusions without significant spinal canal or neural foraminal stenosis at any level.", "output": "1. T2 hyperintense nonenhancing lesion in the right ventral cord at the upper C2 level. There is also a left T4 thoracic cord lesion which appears to enhance. Differentials include demyelinating disease as well as other inflammatory myelopathies.2. Mild heterogeneity of the parotid glands with T2 hyperintense foci which can be seen with Sjogren's and other connective tissue diseases. Unclear if this finding is related to the above mentioned cord lesions.3. Mild degenerative changes in the cervical and thoracic spine as described above, but without significant spinal canal stenosis at any level.4. Probable 1 cm nodule which appears to enhance in the posterior aspect of the right thyroid lobe. This lesion is not well imaged and may represent a thyroid nodule or a parathyroid adenoma. Ultrasound can be considered for better assessment as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for periventricular leukomalacia: Right arm spasticity. Brain: There is diffuse deficiency of bilateral cerebral white matter with associated mild periventricular signal abnormality, thinning of the corpus callosum, and prominence of the lateral ventricles. The degree of myelination is otherwise age-appropriate. The pituitary gland and infratentorial structures are unremarkable. There is no evidence of acute infarction, hemorrhage, or mass lesions. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.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 and cauda equina nerve roots display normal signal and morphology. The conus medullaris terminates at the L1-L2 level. The paravertebral soft tissues are unremarkable.", "output": "1. Findings compatible with periventricular leukomalacia.2. The spine appears to be unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "Frequent ankle sprains TENDONS: Achilles tendon is unremarkable. Fluid is noted within the tendon sheath of the posterior tibialis tendon which may reflect mild tenosynovitis. Fluid is also noted within the tendon sheath of the flexor hallucis longus which could represent additional mild tenosynovitis or extension of fluid from the tibiotalar joint. A small amount of fluid is seen along the peroneal tendons which is of unlikely clinical significance.LIGAMENTS: The anterior talofibular ligament is not seen, presumably from prior tearing. Although the fibular attachment of the calcaneofibular ligament is indistinct, distally the ligament is visualized and we suspect that it is intact. The posterior talofibular ligament is perhaps slightly attenuated but otherwise appears intact. The distal tibiofibular syndesmotic complex is intact. There is loss of the normal fatty striations of the deep tibiotalar fibers of the deltoid ligament which may reflect prior sprain. The spring ligament appears intact.ARTICULAR SURFACES AND BONE: There is focal full-thickness articular cartilage loss along the talar dome laterally with mild edema in the underlying talus and additional mild articular cartilage degeneration along the talar dome posteromedially. There is a small tibiotalar joint effusion. Additional foci of edema type signal is noted medially within the talus which is nonspecific but could represent contusions given the patient's history. A small amount of fluid is noted within the anterior and posterior recesses of the subtalar joint which is nonspecific in nature.", "output": "1. Nonvisualization of the anterior talofibular ligament likely reflecting chronic tear given the patient's history.2. Tibiotalar cartilage defects with other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Seizures and chronic gait disturbance. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There is mild 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 is a mild left maxillary sinus mucosal thickening.Cervical Spine: There is multilevel degenerative spondylosis and posterior longitudinal ligament ossification that results in spinal cord compression from C3-4 to C4-5 and substantial bilateral neural foraminal stenosis at these levels. There is also high T2 signal and volume loss in the spinal cord at C4-5. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.", "output": "1. Mild scattered cerebral white matter T2 hyperintensity is non-specific, but may represent chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. 2. Multilevel degenerative spondylosis and posterior longitudinal ligament ossification that results in spinal cord compression from C3-4 to C4-5 and substantial bilateral neural foraminal stenosis at these levels, as well as myelomalacia at C4-5. "}
{"instruction": "Generate impression based on findings.", "input": "Worsening weakness to foot, has stenosis progressed? Please note there is transitional anatomy and for the purposes of numbering, the sixth lumbarized vertebral body segment is labeled S1 to be consistent with prior MRI report. There is grade 2 anterolisthesis of L5 on S1 similar to prior and can be correlated with upright radiographs. There is also trace retrolisthesis of L1 on L2. Alignment is otherwise preserved. Vertebral body heights are normal. Bone marrow signal is benign with edematous endplate changes again seen at the L5-S1 level. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: There is a right paracentral disc protrusion which is slightly progressed in the interval but is not associated with spinal canal or neural foraminal stenosis. L2-L3: Small left foraminal protrusion and left-sided facet arthropathy. No significant spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge and mild facet arthropathy. No significant spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge and left greater than right facet arthropathy without significant spinal canal or neural foraminal stenosis.L5-S1: Grade 2 anterolisthesis as mentioned above with near complete loss of disc height. There is disc uncovering with mild cephalad extension, advanced bilateral facet arthropathy, and ligamentum flavum thickening. There is resulting severe spinal canal stenosis which appears similar to prior. There is also severe bilateral neural foraminal stenosis which is also similar to prior.S1-S2: No significant spinal canal or neural foraminal stenosis. There is bilateral facet arthropathy.Resection involving the lower sacrum is better seen on prior study. No abnormal enhancement or mass in the visualized lumbar spine or upper sacrum to suggest tumor.", "output": "1. Please note transitional lumbosacral junction anatomy. To be consistent with prior report, the most inferior well-defined disc space is labeled S1-S2. 2. Again seen is grade 2 anterolisthesis of L5 on S1 similar to prior with severe spinal canal stenosis and severe bilateral neural foraminal stenoses, not significantly changed since prior.3. Milder degenerative changes at additional levels as described above."}
{"instruction": "Generate impression based on findings.", "input": "Dysarthria. Please evaluate brain stem for infarct/lesion/other that may be causing difficulty with speaking. There is patchy T2 hyperintensity in the pons and cerebral white matter. There is no evidence of acute infarction in the brainstem, however. There are right thyroid nodules, which measure up to 11 mm. There is scattered mild to moderate mucosal thickening within the imaged paranasal sinuses. There is no evidence of significant lymphadenopathy in the neck. There is multilevel degenerative spondylosis with associated mild spinal canal stenosis. The orbits and salivary glands appear unremarkable.", "output": "1. Probable chronic small vessel ischemic disease in the pone, but no evidence of acute brainstem infarct. 2. Nonspecific thyroid nodules measuring up to 11 mm. 3. Multilevel degenerative spondylosis with associated mild spinal canal stenosis. "}
{"instruction": "Generate impression based on findings.", "input": "67-year-old man with history of rectal mass. ABDOMEN:LIVER, BILIARY TRACT: No discrete liver lesions identified. The gallbladder appears normal. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No focal renal lesion identified. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral pleural effusions noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large rectal mass, not adequately characterized on the pelvic portion of the study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Please note that due to poor quality of images, patient will be recalled for repeat pre and postcontrast imaging at no charge.2.Large rectal mass, not adequately characterized on this exam.3.No gross evidence of metastases, however this examination is limited without intravenous contrast."}
{"instruction": "Generate impression based on findings.", "input": "Female, 27 years old, 37 weeks GA, with ventriculomegaly on prenatal ultrasound. Image quality is degraded by fetal and respiratory motion. Within these limitations, the following observations are made.The lateral ventricles are dilated, measuring up to 19 mm diameter at the left atrium, and up to 14 mm diameter at the right atrium. Thinning of the brain parenchyma is seen in the peri-atrial regions.No obvious underlying etiology for the enlarged ventricles is seen. Specifically, no intracranial mass is suspected and the cerebral aqueduct appears to be patent. The third and fourth ventricles are normal in size.The cerebral hemispheres are otherwise normally formed. The corpus callosum is present. The brainstem and cerebellum are unremarkable.Fetal presentation is breech. Bilateral fetal hydroceles are evident. The fetal gallbladder is not clearly visualized.", "output": "1.Fetal ventriculomegaly with atrial diameters of 19 mm on the left and 14 mm on the right. No obvious underlying etiology is identified.2.No other definite intracranial abnormalities are detected within the limits of motion degredation.3.Incidental note is made of bilateral fetal hydroceles, which are of uncertain clinical significance. In addition, the fetal gallbladder is not visualized, which may be technical. Dedicated post-natal imaging is suggested to excluded biliary atresia. "}
{"instruction": "Generate impression based on findings.", "input": "71 year old with known left breast cancer on neoadjuvant chemotherapy. Evaluate response. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The known index cancer with an associated Hydromark biopsy clip is decreasing in size now measuring 14 x 11 x 17 mm in total, previously the mass measured 29 x 33 x 27 mm (AP x LR x CC), and overall measurement was 50 x 38 x 33 mm with non-mass enhancement. The two reference left axillary lymph nodes are also smaller. The biopsied node now measures 14 x 6 mm, previously 33 x 24 mm, and has normalized in morphology. The level 2 node now measures 13 x 6 mm, previously 28 x 13 mm.No additional suspicious or new enhancement is seen in either breast. No abnormal lymph nodes are identified in the right axillary region.A port-a-cath is noted in the right upper chest wall.", "output": "Significant response to therapy in the left breast and axilla with measurements given above.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Left arm and leg weakness, aphasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mucosal thickening and secretions in the frontal and anterior ethmoid sinuses, as well as a small bilateral maxillary retention cysts. There are also small retention cysts in the nasopharynx. There is a small defect in the cartilaginous nasal septum.", "output": "No evidence of intracranial hemorrhage, mass, or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "Female 38 years old; Reason: Achilles tear? Ankle instability. History: Ankle instability. Pain and swelling of achilles TENDONS: The anterior fibers of the distal Achilles tendon appear minimally convex with minimal streaky increased signal, which may represent minimal tendinosis, however this is equivocal and appears similar to that seen on the prior study. No Achilles tendon tear is seen. There is mild edema in the pre-Achilles fat which may reflect mild inflammation or bursitis, though this also appears similar to the prior study. There is mild edema in the superior aspect of the posterior calcaneus, which is likely reactive and related to the aforementioned soft tissue inflammation. There is perhaps a minimal Haglund deformity of the calcaneus. The remaining tendons are within normal limits. LIGAMENTS: The anterior talofibular ligament is attenuated, perhaps reflecting prior injury though appearing similar to the prior study. The calcaneofibular and posterior talofibular ligaments are intact. The distal tibiofibular syndesmosis is intact. Loss of the normal fatty striations of the deltoid ligament may reflect prior injury, however this appears similar to the prior study. ARTICULAR SURFACES AND BONE: Again seen is the small focus of increased T2 signal in the medial aspect of the talar dome, which may represent a degenerative cyst or old osteochondral defect and appears similar to that seen on the prior study. Other than the aforementioned calcaneal edema, no additional bone abnormality is seen.ADDITIONAL", "output": "1. Mild inflammatory changes in the pre-Achilles fat in the approximate location of the retrocalcaneal bursa, with mild reactive edema in the underlying calcaneus. There is perhaps minimal tendinosis of the distal Achilles tendon, however this is equivocal and is unchanged from the prior study.2. Other findings as described above, appearing similar to the prior study."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with liver lesion seen on prior CT. Further characterized by MRI. Please note multiple sequences are limited due to motion artifact.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions including in the region of interest near the falciform ligament. Though fat-sensitive sequences of this region are limited due to motion, the finding on prior CT may have been due to focal fat deposition or perfusional change.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No focal hepatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "NSCLC. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered cerebral white matter T2 hyperintense foci. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "No evidence of intracranial metastases. A few scattered cerebral white matter T2 hyperintense foci are nonspecific, but may represent chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "Low back pain after lifting heavy object with radiation down the right leg. History of MS, lumbar discectomy in 2009. 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 normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is a new right foraminal disc extrusion with mild cranial migration. There is moderate degree of right-sided neural foraminal stenosis and suspected impingement of the right exiting L3 nerve root. No significant spinal canal or left neural foraminal stenosis.L4-L5: Small right foraminal disc protrusion is also new since prior and contacts the right L4 nerve root. There is mild right-sided neural foraminal stenosis. Minimal left neural foraminal narrowing. No significant spinal canal stenosis.L5-S1: Prior right-sided laminotomy. There is a dorsal annular fissure and right paracentral protrusion. Minimal right neural foraminal stenosis. No significant spinal canal stenosis or left neural foraminal stenosis. There is bilateral facet arthropathy.", "output": "1. New right foraminal disc extrusion at the L3-L4 level where there may be impingement of the right L3 nerve root.2. Smaller, new right foraminal disc protrusion at the L4-L5 level which contacts the right L4 nerve root.3. Postoperative changes related to remote right L5-S1 discectomy."}
{"instruction": "Generate impression based on findings.", "input": "33 year old with proven left breast cancer presents for I-SPY 2 study #2. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted in the right breast.The left breast again shows diffuse abnormal enhancement of known cancer, measuring 57 x 86 x 117 mm (AP x LR x CC, previously 65 x 97 x 126 mm). Diffuse edema and skin thickening is slightly decreased. A Hydromark clip is again identified at anterior 12 o'clock position within the tumor in the left breast.A known metastatic left axillary lymph node with Hydromark clip, measures 17 mm in maximum diameter (previously 26 mm). Multiple small cysts are present in the right breast.No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in right axillary region.", "output": "Known left breast cancer with metastatic left axillary lymph node, slight decrease in size.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female 16 years old Reason: evaluation of left dorsal midfoot pain History: same A vitamin E skin marker was placed along the medial aspect of the first metatarsal cuboid joint indicating the site of patient's pain, about which the field of view was centered. TENDONS: The tendons of the midfoot are unremarkable.LIGAMENTS: The ligaments of the midfoot are unremarkable.ARTICULAR SURFACES AND BONE: There is diffuse patchy high T2 signal with associated low T1 signal, particularly within the distal tibia, talar dome, distal navicular and within the distal cuboid and proximal first metatarsal. Although this most likely represents residual red marrow, stress related marrow changes related to altered biomechanics of ballet dancing is not excluded.ADDITIONAL", "output": "1.Patchy increased high T2 signal likely most consistent with residual red marrow; however, marrow changes related to altered biomechanics from ballet dancing is not entirely excluded.2.The tendons and ligaments of the foot are unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Clinical question: Rule out right frontal lesion. Signs and symptoms: LLE numbness/weakness and anosmia. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates diffuse scattered nonspecific foci of FLAIR and T2 hyperintensity along in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in the right basal ganglia. Findings are nonhemorrhagic and demonstrate no abnormal enhancement. Although nonspecific this appearance is often result of microvascular ischemic changes considering patient's stated age.The anatomical morphology and the signal intensity of brain is otherwise within normal on all MRI sequences for patient's stated age and without detectable abnormal enhancement.The signal void in major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses remain within normal and with normal pattern of enhancement.Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.Paranasal sinuses demonstrate acute on chronic right maxillary sinus disease and mild (L>R) chronic ethmoid sinus disease and unremarkable otherwise. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.", "output": "1.No acute intracranial process.2.Findings suggestive of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter of cerebral hemispheres.3.Unremarkable pre and post enhanced brain MRI otherwise.4.Acute on chronic sinusitis as detailed."}
{"instruction": "Generate impression based on findings.", "input": "Occipital headaches. The images are partly degraded by dental brace artifacts. There is no definite evidence of intracranial hemorrhage, mass, or acute infarct. There is a punctate foci of subcortical white mater T2 hyperintensity in the right parietal lobe. The brain, brainstem, and cerebellum otherwise appear unremarkable. The pituitary gland is not enlarged. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "No evidence of posterior fossa mass or Chiari malformation. A punctate foci of subcortical white mater T2 hyperintensity in the right parietal lobe is nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "57 years, Female, Reason: 57F with dilated pancreatic duct and side branches. Please evaluate for nodules, masses using secretin protocol History: dilated duct. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Right hepatic lobe T2 hyperintensity likely represents cysts. There is a 8mm lesion in the left hepatic lobe which is dark on all sequences and likely represents calcification. Bile duct is normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: No suspicious pancreatic lesions.Pancreatic duct is ectatic and dilated within the body and tail to 1.7 cm, consistent with a main duct IPMN. No enhancing component is evident. No obstructing lesions are present. There is a blunted response to secretin. Attenuation within the pancreatic parenchyma is normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Debris within the bladder.", "output": "Findings consistent with a main duct IPMN."}
{"instruction": "Generate impression based on findings.", "input": " There are no masses, mass effect or midline shift. 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. The ventricles and sulci are normal in size. The pituitary gland is normal in size. 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": "Unremarkable MRI of the brain with no evidence of metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": " Multiple lacunar infarcts as well as a left posterior thalamic hematoma are again visualized and appear grossly similar to prior brain MRI although evaluation is limited on the provided sequences which are optimized for the vasculature. There is evidence of intracranial atherosclerotic disease with scattered areas of narrowing. The intracranial internal carotid arteries demonstrate no significant stenosis, with dense vascular calcifications involving the right cavernous ICA demonstrated on recent CT. There is mild to moderate multifocal narrowing involving the right middle cerebral artery M2 segments and minimal irregularity involving the right M1 segment. There is also at least moderate multifocal involving the right anterior cerebral artery in its distal A2 and A3 segments. Otherwise no high-grade stenosis in the anterior circulation. There is also mild irregularity involving the distal P1 as well as P2 segments of the right posterior cerebral artery as well as moderate to severe focal stenosis involving the left posterior cerebral artery at the left P2 segment. Bilateral vertebral and basilar arteries are patent. No evidence of aneurysm.", "output": "Multifocal narrowing involving the intracranial vasculature likely due to atherosclerotic disease. There is moderate to severe focal stenosis involving the left P2 segment. Additional stenoses as above. No high-grade stenosis involving the more proximal intracranial vasculature.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "68 years, Male, Reason: hx of penile mass, evaluate local extent of invasion and inguinal/pelvic lymphadenopathy History: penile mass. PELVIS: MalePROSTATE, SEMINAL VESICLES: Large lesion of the distal penis measures 6.9 x 7.7 x 5.0 cm (401/10 and 501/13). The distal corpus and urethra are not well delineated and likely replaced with tumor. The lesion extends within the subcutaneous fat of the left scrotum and abuts the left testicle (401/9 and 807/198), however no definite invasion within the testicle is evident. The base of the penis is normal appearing.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral inguinal lymphadenopathy with a right inguinal node measuring at 1.9 x 1.6 m (802/547). There are several small subcentimeter pelvic nodes. For example, a left external iliac node measures 1.5 x 0.6 cm (401/44). There is a subcentimeter node within a right fat containing inguinal hernia (401/32) which is nonspecific.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Distal penile mass. further described above, abuts and extends along the left scrotum, and underlying invasion into the scrotum is not excluded. 2.Bilateral inguinal lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "History of recurrent Rhabdomyosarcoma. On therapy. Comparison. Status post resection. Examination redemonstrates extensive postoperative changes of tumor removal via bifrontal craniotomy. CSF filled cavity within the right frontal lobe is believed to be the site of previous tumor invagination into the brain parenchyma. This is associated with surrounding vasogenic edema. Enhancement around the posterior edge of surgical cavity is believed to represent leptomeningeal scarring. No distinct tumor is identified however follow-up with an infused MRI is recommended. Expected postoperative changes of epidural thickening with minimal enhancement in bifrontal region is noted.In comparison to the prior non-infused CT of brain dated 6 -- 2 -- 2009 there is a slight increase in the soft tissue/fluid density within the paranasal sinuses.", "output": "Findings are believed to represent post operative change and not residual tumor. Follow-up with an infused MRI however is recommended for better assessment."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with a past history of CVA, tobacco abuse, possible alcoholic cirrhosis who presented with chest pain and shortness of breath, elevated troponin and BNP, ECG changes consistent with NSTEMI. Referred for a cardiac MRI to evaluate etiology of regional hypokinesis of the left ventricle in the setting of no significant coronary artery disease on cardiac catheterization. Left VentricleThe left ventricle is normal in size with moderate to severely depressed function. The overall LV ejection fraction is 30%. The LVEDV is 177 ml (normal range 142+/-34), the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVESV is 125 ml (normal range 47+/-19) and the LV end systolic volume index is 74 ml/m2 (normal range 25+/-9). The LV mass is 122 g (normal range 164+/-36) and the LV mass index is 73 g/m2 (normal range 85+/-15). There are wall motion abnormalities noted in the inferior, inferolateral and lateral walls (mid ventricular segments). There is a increased signal noted on T2 STIR imaging in the mid inferolateral, lateral walls suggestive of inflammation or edema in this area of the myocardium. There is mostly transmural late gadolinium enhancement in the mid inferior, base to mid inferolateral and lateral walls. This pattern of late gadolinium enhancement is consistent with myocardial infarction. There are also areas of microvascular obstruction noted in the inferolateral wall. Left AtriumThe left atrium is mild-moderately enlarged. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%. The RVEDV is 113 ml (normal range 142+/-31), RV end diastolic volume index is 67 ml/m2 (normal range 82+/-16), the RVESV is 57 ml (normal range 54+/-17), and the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, 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 normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsModerate left-sided 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.Normal-sized left ventricle with moderate to severely depressed function. LVEF 30%. 2.There are wall motion abnormalities noted in the inferior, inferolateral and lateral walls (mid ventricular segments). 3.There is a increased signal noted on T2 STIR imaging in the mid inferolateral, lateral walls suggestive of inflammation or edema in this area of the myocardium. 4.There is mostly transmural late gadolinium enhancement in the mid inferior, base to mid inferolateral and lateral walls. This pattern of late gadolinium enhancement is consistent with myocardial infarction. 5.There are areas of microvascular obstruction noted in the inferolateral wall. 6.Normal sized right ventricle with mildly depressed function. RVEF is 49%.7.Mild to moderate tricuspid regurgitation.8.These constellation of findings are suggestive of recent myocardial infarction. Given the normal coronary angiogram these findings could be consistent with an embolic event. Clinical correlation required.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female with shin pain, evaluate for stress fractures Left: There is thinned poorly defined intermediate signal along the posterior and medial aspect of the tibial diaphysis that may represent a very mild (grade 1) stress reaction, but this is equivocal, and we see no stress fracture. Bone marrow signal is within normal limits in the tibia and fibula. Mild edema within the subcutaneous tissue anterior to the tibia is present. Slight prominence of the left anterior tibial tubercle. Subjectively, the anterior tibial tubercle appears lateralized but this study was not protocoled for detailed evaluation of the knee.Right: There is faint intermediate signal along the posterior and medial aspect of the mid tibial diaphysis which may represent a very mild (grade 1) stress reaction, although this is equivocal and no stress fracture is seen. Bone marrow signal is within normal limits in the tibia and fibula. Subjectively, the anterior tibial tubercle appears lateralized but this study was not protocoled for evaluation of the knee. Minimal edema is noted within the subcutaneous tissue along the anterior and medial tibia.", "output": "Minimal intermediate signal along the posterior and medial aspect of the tibia bilaterally may conceivably represent grade 1 stress reaction although this is equivocal. No stress fracture is seen."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with intermittent headaches. Small cell lung cancer. Evaluate for metastases. Enhanced CT of brain:There is no evidence of normal enhancement of brain parenchymal or leptomeninges to suggest metastatic lesion. The cortical sulci, ventricular system and all CSF cisterns remain within normal limits for patient's stated age. There is heavy vascular calcification of intracranial vertebral arteries and bilateral cavernous carotid. I suspect subtle low-attenuation in the subcortical white matter of bilateral cerebral hemispheres. This findings are nonspecific however considering patients provided clinical data and heavy intracranial vascular calcification, the above findings may represent small vessel disease of indeterminate age. Follow-up with an MRI examination is recommended.Calvarium is intact. Mastoid air cells and middle ear cavities and limited view of paranasal sinuses are negative.", "output": "1.No evidence of metastatic disease to brain, leptomeninges or of the calvarium.2.Vascular calcification of bilateral intracranial vertebrals and cavernous carotids consistent with atherosclerotic disease.3.Minimal small vessel disease of indeterminate age is suspected. "}
{"instruction": "Generate impression based on findings.", "input": "32 years, Male. Reason: stricture due to Crohn's disease that is active. Is there evidence of free air? History: right shoulder pain Small amount of pneumoperitoneum seen on lateral decubitus view, and in the subhepatic space on the supine view. Prominent, gaseous colon is noted in the right upper quadrant, relative paucity of gas in left-sided colon, finding suspicious for underlying colonic stricture particularly given patient's clinical history and prior MRI exam.", "output": "Pneumoperitoneum, additional findings as above.Findings discussed with Dr. Rubin via phone at 1:50 PM on 7/14/2015."}
{"instruction": "Generate impression based on findings.", "input": "L1 metastasis status post radiation therapy. Increased lower back pain. History of polymyalgia rheumatica and degenerative joint disease. Evaluate for compression fracture. Status post bilateral total hip arthroplasty. Normal lumbar alignment is preserved. Vertebral body height is maintained, with no compression fracture identified. Multilevel disc narrowing is most severe at L1-L2. There is vacuum disc phenomenon at L3-4. The known left L1 pedicle metastasis is not identified on radiographic imaging, please see MRI 9/30/2015.", "output": "No evidence of acute fracture or malalignment. Moderate degenerative disc disease, most severe at L1-2."}
{"instruction": "Generate impression based on findings.", "input": "Right shoulder pain ROTATOR CUFF: Again seen are complete tears of the supraspinatus and infraspinatus tendons with retraction to the level of the glenohumeral joint. There is mild fatty atrophy of the supraspinatus muscle with marked fatty atrophy of the infraspinatus muscle. The teres minor tendon and muscle are intact. There is high-grade partial-thickness tearing of the insertional fibers of the subscapularis tendon. The subscapularis muscle appears relatively preserved.SUPRASPINATUS OUTLET: Severe osteoarthritis affects the glenohumeral joint. There is a small amount of fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding and there is degenerative cystic change at the insertion of the rotator cuff. There is mild articular cartilage loss of the humeral head and osteoarthritis of the glenohumeral joint. There is degenerative tearing of the anterior labrum both superiorly and inferiorly. There is a small amount of joint fluid present.BICEPS TENDON: Evaluation of the biceps tendon is limited given the internally rotated nature of the patient however the intra-articular portion of the biceps tendon is not well seen likely the result of tearing. There is a small amount of fluid surrounding the biceps tendon which may reflect mild tenosynovitis.ADDITIONAL", "output": "1. Full-thickness tears of the supraspinatus and infraspinatus tendon and high-grade partial-thickness tearing of the subscapularis tendon.2. Severe osteoarthritis of the glenohumeral joint.3. Degenerative tearing of the labrum.4. Probable partial tearing of the long head of the biceps tendon."}
{"instruction": "Generate impression based on findings.", "input": "Sickle cell disease and left P1 segment small aneurysm or infundibulum: surveillance imaging. MRI: There is an area of encephalomalacia and susceptibility effect in the anterior right frontal lobe. There is no evidence of acute infarct. There are unchanged mild scattered foci of non-specific T2 hyperintensity elsewhere in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles 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.MRA: There is an unchanged 2 to 3mm wide conical outpouching involving the P1 segment of the left posterior cerebral artery. The rest of the major cerebral arteries are unremarkable, without evidence of significant steno-occlusive lesions.", "output": "1. Unchanged right frontal lobe encephalomalacia related to a prior hemorrhagic infarct.2. Unchanged 2 to 3mm wide conical outpouching involving the P1 segment of the left posterior cerebral artery. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 57 years old, with von Hippel-Lindau and pre-existing hemangioblastoma of the cerebellum. Evaluate for growth and new lesions. Brain:A punctate focus of enhancement within the left cerebellar tonsil may be slightly more conspicuous than on the prior examination, though it still measures no more than 2 mm in size and does not produce any edema in the surrounding parenchyma. No additional enhancing lesions are seen. No areas of focal signal abnormality or restricted diffusion are detected. There is no edema or mass effect. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits.Spine:The spinal cord, conus and nerve roots of the cauda equina demonstrate normal morphology and signal characteristics. Small foci of enhancement along the cauda equina are nonspecific and may simply represent normal vessels. No definite masslike lesions are seen.Mild reversal of the cervical lordosis is seen. Otherwise, spinal alignment is anatomic. Vertebral body heights are preserved. Spinal numbering reflects the presence of 13 thoracic and 5 lumbar type vertebrae. Evidence of prior posterior element surgery, perhaps reflecting partial laminectomy, is seen at L3-4 and L4-5. No pathologic marrow replacement is noted. Mild degenerative endplate signal changes are seen in the cervical spine at multiple levels and in the lumbar spine at L4-5.Mild posterior disc-osteophyte complex formation is seen at C4-5 through C7-T1 without high-grade spinal stenosis, similar to the prior examination. Mild foraminal narrowing is seen on the left at C5-6 and bilaterally at C6-7. Scattered small disc protrusions are evident in the thoracic spine without significant spinal canal or foraminal compromise. The lumbar intervertebral discs are fairly well preserved with the exception of L4-5 where there is loss of disc height and disc bulging with osteophyte formation. No significant spinal canal stenosis is seen. However, the L4-5 neural foramina are mildly narrowed, similar to prior.", "output": "1.A punctate focus of enhancement within the left cerebellar tonsil is slightly more conspicuous though still only measures 2 mm in size. This perceived difference could potentially be technical in nature. The finding is nonspecific, but given the patient's history, a small hemangioblastoma remains in the differential.2.No definite additional hemangioblastomas are seen in the brain or spine. Scattered tiny foci of enhancement within the cauda equina are nonspecific and could simply represent vascular structures.3.Mild degenerative findings in the spine show no significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "Fetal MRI, evaluate for changes in fetal lymphangioma of pelvis and left thigh PELVIS:UTERUS, ADNEXA: Gravid uterus consistent with 34 week gestation. Posterior thigh T2 hyperintense mass involves the sacrum and left pelvis /retroperitoneum proximally and extends distally to the knee with subtle involvement of the lower leg. Internal heterogeneity may be be due in part to septations or flow voids. The mass measures up to 24 mm in maximal thickness at the buttock. Otherwise, no fetal abnormalities are noted.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": "T2 hyperintense mass involving the sacrum, left retroperitoneum / pelvis / buttock, posterior left thigh, and lower leg suggestive of lymphangioma or hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "Melanoma and right arm weakness, concern for metastases. MRI brain:There is no evidence of intracranial mass or acute infarct. No abnormal intracranial enhancement is evident. There is cystic encephalomalacia in the bilateral frontal lobes in the periventricular region. A 5 mm focus of susceptibility artifact is noted in the anterior paramedian right frontal lobe (series 1701 image 109), which may be related to prior hemorrhage or mineralization. Confluent and scattered foci of T2/FLAIR hyperintensity in the periventricular and cortical white matter are nonspecific, but compatible with chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major intracranial vascular flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI C-spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained. The cervical vertebral bodies and disc spaces are appropriate in height. There is a focus of T1 and T2 hyperintensity in the right side of the T1 vertebral body, compatible with intraosseous hemangioma. No focal worrisome bone marrow signal abnormality is identified. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.There are mild multilevel degenerative changes, most prominent at C5-6. At C5-6, there is right greater than left uncinate hypertrophy contributing to mild right neural foraminal narrowing. There is also mild spinal canal narrowing at this level, predominantly on the developmental basis. No high-grade spinal canal stenosis or neural foraminal narrowing is identified in the cervical spine.", "output": "1. No evidence of intracranial or cervical spine metastatic disease.2. 5 mm focus of susceptibility in the anterior paramedian right frontal lobe which may be related to chronic hemorrhage or mineralization. No associated enhancement.3. Cystic encephalomalacia in the bilateral frontal lobes may be related to remote ischemia or other injury. Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific and may represent chronic small vessel ischemic disease, prior inflammation, or less likely demyelination.4. Degenerative changes in the cervical spine without high-grade spinal canal or neural foraminal stenosis. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Possible myelopathy. Signs and symptoms: Numbness and tingling. Nonenhanced cervical MRI:Examination demonstrates multiple small foci of T2/T2 STIR hyperintensity in the cervical and upper most visualized thoracic cord summed with suggestion of subtle underlying cord volume loss. Distribution of the findings are highly suggestive of demyelinating disease. Findings are best appreciated on sagittal T2 STIR series 4 image 7 as well as axial T2 series 5 and images 16, 19, 20, 23 and 25.There are no prior exams for comparison and this examination is performed without intravenous contrast.There is normal signal intensity of vertebral column. There is straightening of cervical lordosis which may be positional.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate subtle wasting at the level disc level which could indicate attempted congenital partial fusion. No spinal stenosis or neural foraminal compromise.C4-C5 demonstrate mild degenerative disc disease and shallow central disc protrusion without spinal stenosis or neural foraminal compromise.C5-C6 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromiseC6-C7 demonstrate mild degenerative disc and mild bilateral ligamentum flavum hypertrophy however without spinal stenosis or neural foraminal compromise.C7-T1 is unremarkable.", "output": "1.Multiple small foci of T2/T2 STIR hyperintensity in the cervical spine and upper most visualized thoracic cord with morphology and distribution highly suspicious for demyelinating disease.2.Mild degenerative changes of cervical spine however without central spinal stenosis or neural foraminal compromise. Please see above comments."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o medial meniscus History: left knee pain MENISCI: There is mild increased signal within the posterior horn of the medial meniscus which suggests intrasubstance degeneration, but we see no medial meniscal tear. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: Minimal signal heterogeneity of the patellofemoral articular cartilage suggests minimal degeneration but we see no fluid-filled defects. Bone marrow signal intensity is normal. LIGAMENTS: The cruciate and collateral ligaments appear normal. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear normal. There is mild edema of the quadriceps fat pad, which is of questionable clinical significance.ADDITIONAL", "output": "Minimal signal heterogeneity of the cartilage of the patellofemoral articulation. Mild edema of the quadriceps fat pad, which is of questionable clinical significance. We see no meniscal tear or other finding to account for the patient\u2019s pain."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral basal ganglia abnormal signal intensity on MR and CT scans. The route deep venous thrombosis. 3D MRV brain pre and post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.Due to limitation of resolution, localized cortical venous thrombosis or localized deep venous thrombosis cannot be evaluated with MR venogram alone.", "output": "No evidence of venous sinus thrombosis. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for rotator cuff repair, underwent previous single-row rotator cuff repair and AC resection History: Pain with overhead activities Suboptimal evaluation secondary to patient motion artifact.ROTATOR CUFF: Multiple foci of signal void are identified within the superior soft tissues of the shoulder indicating prior surgery. There is a tubular focus of signal void within the greater tuberosity presumably representing a suture anchor. There is increased signal intensity within the distal fibers of the supraspinatus tendon at its insertion on the greater tuberosity at the 12 o'clock position that is nonspecific and could represent insertional tendinosis or granulation tissue from prior tearing/surgery. This measures approximately 1 cm in the AP dimension. The distal fibers of the supraspinatus also appear thinned. There is a more focal fluid signal intensity defect within the bursal surface fibers of the supraspinatus tendon which may represent a small 2 to 3 mm tear, but we see no full-thickness fluid-filled tear. There is perhaps mild tendinosis of the infraspinatus, but otherwise the tendon and muscle appear intact. There is mild insertional tendinosis of the subscapularis. The tendon and muscle appear intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: A small anterior spur seen previously arising from the acromion process is no longer evident which may represent prior surgery. There is a small amount of fluid within the subacromial/subdeltoid bursa which is not necessarily of any clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. No effusion is evident. The superior labrum appears attenuated which may represent a combination of degeneration and prior surgery.BICEPS TENDON: The tendon of the long head of the biceps is noted within the bicipital groove. The intra-articular portion of the tendon of the long head of the biceps appears thinned which may reflect attritional tearing or prior surgery.", "output": "Signal intensity within the distal fibers of the supraspinatus likely reflects a combination of tendinosis and undersurface fraying, but we see no full-thickness rotator cuff tear. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with neck pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild retrolisthesis of C5 on C6 and minimally of C6 on C7. Alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine including prominent facet arthropathy on the left at C3-C4. Individual levels as below: C2-3: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C3-4: Small disc osteophyte complex and ligamentum flavum thickening resulting in effacement of the ventral and dorsal thecal sac and mild to moderate spinal canal stenosis. There is moderate to severe left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. Mild left facet joint distention. No significant right neural foraminal narrowing.C4-5: No significant compromise to the spinal canal or left neural foramen. Mild right neural foraminal narrowing.C5-6: Disc osteophyte complex without significant compromise to the spinal canal. There is moderate to severe right and moderate left neural foraminal stenosis primarily related to uncovertebral hypertrophy.C6-7: Disc osteophyte complex and ligamentum flavum thickening result in mild spinal canal narrowing. There is minimal right and moderate to severe left neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or left neural foramina. Minimal right neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "1. Moderate degenerative changes throughout the cervical spine without evidence of high-grade spinal canal stenosis. Spinal canal narrowing is relatively worse at C3-C4 with mild to moderate stenosis. No cord signal abnormality is definitively appreciated.2. Neural foraminal narrowing at multiple levels as detailed above, particularly on the left at C3-C4, bilaterally at C5-C6, and on the left at C6-C7.3. Left C3-C4 facet arthropathy with mild joint distention which may be contributing to patient's neck pain."}
{"instruction": "Generate impression based on findings.", "input": "58 years, Female, non-small cell lung cancer. Evaluate for restaging. There is no restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. There is increased size and number of intraparenchymal metastases scattered throughout the brain parenchyma. The largest lesion is located within the left cerebellum and measures 0.9 x 0.7 cm, previously 0.6 x 0.6 cm. There are sequela of previously treated metastases identified on MRI June 6, 2014, now visible as punctate T1 iso- to subtly hypointense lesions.There is new gyriform enhancement along left greater than right temporal lobes (series 1101, image 13; series 1101, image 72), and along the temporal horn of the right lateral ventricle (series 9, image 13). Additional foci of enhancement are identified within the right hippocampus (series 1101, image 89). There are a few punctate foci of susceptibility, with no associated lesion, probably microhemorrhages. There is new curvilinear susceptibility along left posterior parietal sulci (series 7, image 43), probably hemosiderin deposition consistent with superficial siderosis.There is no midline shift or herniation. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but probably secondary to chronic small vessel ischemic changes. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.", "output": "1.Increased size and number of multiple brain metastases. However, comparison is limited due to absence of intravenous contrast on the prior study. In comparison to earlier contrast-enhanced study June 6, 2014, there is decreased size of previously identified enhancing metastases, probably secondary to treatment-related change, but multiple new metastases and increased size of dominant cerebellar metastasis.2.New gyriform enhancement along the bilateral temporal lobes and temporal horn of right lateral ventricle, most likely due to metastatic disease.3.New curvilinear area of susceptibility along the left posterior parietal sulci, consistent with interval microhemorrhage possibly from metastases or prior trauma."}
{"instruction": "Generate impression based on findings.", "input": "Shoulder pain with limited activities, evaluate for rotator cuff tear or AC spur ROTATOR CUFF: Mildly increased signal and thickening of the supraspinatus tendon. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "Mild supraspinatus tendinopathy. No evidence of rotator cuff tear or AC spur."}
{"instruction": "Generate impression based on findings.", "input": " There is no suspicious intracranial enhancement, acute infarct, mass effect or midline shift. There are numerous nonspecific periventricular and subcortical punctate white matter T2 signal abnormalities with additional lesions in the right thalamus and questionable ill-defined foci in the central pons (series 501 image 6). There is no suspicious enhancement of the cisternal portions of the trigeminal nerves. Incidental note is made of a small focus of enhancement in the fundus of the left and auditory canal which measures partially 4 x 5 mm in greatest axial dimensions at 1801/47.There is minimal scattered ethmoid sinus mucosal thickening.", "output": "1. No acute intracranial abnormality. 2. Small enhancing nodule in the left internal auditory canal fundus, which could represent a small vestibular schwannoma. Dedicated MRI of the internal auditory canals could be obtained for more detailed evaluation, and clinical correlation is recommended. No definite abnormality involving Meckel's caves, although dedicated trigeminal protocol was not obtained.3. Multiple nonspecific nonenhancing white matter lesions, with differential diagnosis including infectious and inflammatory processes, demyelinating disease, chronic small vessel ischemic changes.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old male with possible elbow MCL tear status post fall. Evaluate for pain and swelling. LIGAMENTS: There is disruption of the proximal fibers of the radial collateral ligament. The ulnar collateral ligament appears intact. The lateral ulnar collateral ligament is poorly visualized and may be disrupted.TENDONS: There is discontinuity of the proximal fibers of the extensor digitorum tendon just distal to its origin off of the lateral epicondyle indicating a tear. There is increased signal abnormality and deformity of the remainder of the common extensor tendon indicating at least partial thickness tearing. Some of the fibers of the common extensor tendon to be traced to their insertion on the lateral epicondyle. The common flexor tendon appears intact. The biceps and brachialis tendons appear intact. The triceps tendon appears intact. ARTICULAR SURFACES AND BONE: There is a minimally displaced fracture of the coronoid process with slight inferior displacement of the volar fracture fragment. There is increased bone marrow signal abnormality on fluid sensitive sequences about the sublime tubercle and in the surrounding area likely representing a minimally depressed (2 mm) impaction fracture. There is increased bone marrow signal abnormality within the lateral aspect of the radial head likely representing a direct bone contusion.SURROUNDING STRUCTURES: There is increased signal abnormality on fluid sensitive sequences within the ulnar nerve within and proximal to the level of the cubital tunnel which likely represents a mild neuritis perhaps related to the patient's history of trauma. There is mild increased signal abnormality within the flexor digitorum profundus and flexor carpi ulnaris which may be related to the patient's history of trauma/inflammation, although subacute denervation cannot be excluded. There is subcutaneous edema in the overlying area.ADDITIONAL", "output": "1. Disruption of the radial collateral ligament, lateral ulnar collateral ligament, and extensor digitorum tendon with additional partial thickness tearing of the remainder of the common extensor tendon as described above.2. Fracture of the coronoid process as well as a minimally depressed impaction fracture about the sublime tubercle of the ulna.3. Bone contusion of the radial head.4. Moderate size elbow joint hemarthrosis. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "H/o brain tumor. S/p biopsy. Examination demonstrates postsurgical change including a Burr hole in the right frontal bone. Again, a hypoattenuating mass is seen in the right frontal lobe with extension into the genu of corpus callosum and left anterior frontal lobe and mass effect on the right frontal horn. Please refer to the previous MRI for the measurements. No evidence of intracranial hemorrhage is identified. The ventricular size has been stable.", "output": "Frontal tumor. Interval postsurgical change with no intracranial hemorrhage. "}
{"instruction": "Generate impression based on findings.", "input": "DLBCL status post R-CHOP and neuropathy. There are postoperative findings related to left lateral neck dissection. There is no significant lymphadenopathy by size criteria. Indeed, the largest lymph nodes in the neck measure up to 8 mm in short axis in the right level 2 region. The Waldeyer ring structures are not significantly enlarged. No mass lesions are identified. The thyroid gland and major salivary glands are unremarkable. The major cervical flow voids are grossly intact. There is mild degenerative cervical spondylosis. The imaged portions of the orbits and intracranial structures are grossly unremarkable.", "output": "No evidence of neuromas or significant cervical lymphadenopathy in the neck."}
{"instruction": "Generate impression based on findings.", "input": "Male 16 years old with sacral decubitus ulcer and concern for sacral osteomyelitis. PROSTATE, SEMINAL VESICLES: No significant abnormality.BLADDER: Distended and normal.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction. A small amount of free fluid in the pelvis is nonspecific but most likely related to the patient's ventriculoperitoneal shunt.BONES, SOFT TISSUES: There is a decubitus ulcer just to the left of midline overlying the coccyx. It measures 2.7 cm transverse and 5.3 cm in craniocaudal dimension. There is mild surrounding inflammatory change and moderate contrast enhancement but no discrete fluid collection. The bone marrow signal in the sacrum and coccyx is unremarkable.OTHER: No significant abnormality.", "output": "2.7 x 5.3 cm decubitus ulcer without associated abscess or underlying osteomyelitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old male with left-sided weakness and numbness; evaluate for stroke There is no evidence of acute intracranial hemorrhage, significant mass effect/midline shift, hydrocephalus or edema. Gray-white matter differentiation is preserved.The ventricles and basal cisterns are normal in size and configuration. There is mild ectopia of the cerebellar tonsils. Recommend MRI with CSF flow study for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses, middle ear cavities and mastoid air cells are normally pneumatized.", "output": "1. No acute intracranial hemorrhage, cortical infarct, mass-effect or edema. 2. Mild ectopia of the cerebellar tonsils. Recommend MRI with CSF flow study for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": " There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged small patchy foci of T2 hyperintensity within the subcortical, deep, and periatrial white matter compatible with chronic small vessel ischemic disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is an unchnaged deformity of the left medial orbital wall. The skull, paranasal sinuses, and scalp soft tissues are otherwise unremarkable.", "output": "Unremarkable MRI with the exception of mild chronic small vessel ischemic disease. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Seizure-like activity. Signs and symptoms: As above. Nonenhanced brain MRI:Examination demonstrate normal anatomical development of brain and a normal pattern of myelination for age.There is no detectable cortical abnormality. The cortical sulci remain within normal. The ventricular system remain within normal size and morphology for age and with maintained midline.Signal void of all major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses appear normal. Unremarkable images through the orbits.The signal intensity calvarium demonstrate no abnormalities.Images through the paranasal sinuses and bilateral mastoid air cells demonstrate diffuse increased T2 signal intensity.", "output": "1.Unremarkable nonenhanced brain MRI for age.2.Diffuse patchy opacification of mastoid air cells and paranasal sinuses."}
{"instruction": "Generate impression based on findings.", "input": "4-year-old status post Chiari decompression. Evaluate Chiari and syrinx. There has been evolution of postoperative changes of Chiari decompression which included suboccipital craniectomy, C1 laminectomy, and reduction of cerebellar tonsillar tissue. There has also been evolution of the previously seen diffusion abnormality involving the inferior cerebellum. The cerebellar tonsils and cervicomedullary junction remain caudally displaced with persistent crowding at the foramen magnum at the C1-C2 level; retroflexed dens also contributes to the crowding. Cerebellar tonsils extend to the mid to lower C2 level on the right, previously at the C2-C3 level on preoperative study. There is interval decrease in T2/FLAIR signal abnormality involving the inferior cerebellum. No new parenchymal signal abnormality is seen. No suspicious intracranial mass, midline shift, or herniation. Ventricles remain normal in size. Subcentimeter pineal cyst is unchanged. Cystic arachnoid space extension superiorly along the anterior superior surface of the tentorium cerebell is also unchanged. Extradural suboccipital fluid collection is again seen and compatible with a pseudomeningocele. There is mild to moderate mucosal thickening in the right maxillary sinus which is increased in the interval. There is also mild additional scattered paranasal sinus opacification.CSF flow imaging again demonstrates focally attenuated biphasic flow through the anterior aspect of the foramen magnum, similar to prior. Flow through the posterior aspect of the foramen magnum is similar to recent prior but improved since preoperative MRI from 5/25/2016. There appears to be preserved flow into the fourth ventricle.MRI CERVICAL SPINE", "output": "1. Postoperative changes of Chiari decompression have evolved in the interval. The residual cerebellar tonsils and cervicomedullary junction remain caudally displaced with persistent crowding at the foramen magnum at the C1-C2 level, although improved compared to preoperative study. 2. There has been interval progression of cervical and partially imaged thoracic syringohydromyelia."}
{"instruction": "Generate impression based on findings.", "input": "Male, 67 years old, with mesothelioma, being treated with PD1 antibody, presenting with an episode of encephalopathy. Confluent T2 hyperintensity seen within the periventricular white matter with scattered additional foci in the subcortical white matter and brainstem. None of these lesions is associated with restricted diffusion. There is no pathologic intracranial enhancement. No evidence of parenchymal edema or mass effect is seen. The ventricles and sulci are proportionately prominent compatible with underlying volume loss. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Scattered small foci of susceptibility in the bilateral cerebral hemispheres may reflect tiny chronic microhemorrhages.", "output": "1.No evidence of any active inflammatory or neoplastic process is seen intracranially.2.Findings are noted which may reflect chronic microvascular ischemia."}
{"instruction": "Generate impression based on findings.", "input": "Knee pain. Question of ACL injury or meniscus tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. There is minimal fraying of the posterior medial femoral condyle articular cartilage. There is generalized thinning of the patellar articular cartilage. No full-thickness chondral defect is identified. The lateral compartment articular cartilage is intact.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Intact menisci and ligaments. 2. Mild thinning/fraying of the patellar and medial femoral condyle articular cartilage. "}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with history of right upper quadrant abdominal pain. Exam somewhat limited without intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Scattered, probably benign cysts. No intrahepatic biliary ductal dilatation. The common bile duct measures up to 6 mm.SPLEEN: No significant abnormality noted.PANCREAS: Normal appearing pancreatic duct. Normal pancreatic parenchyma. No evidence of divisum or annular pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No findings to account for the patient's right upper quadrant pain."}
{"instruction": "Generate impression based on findings.", "input": "Reason: intracranial stenosis History: right face and left arm weakness MRI of the brainThere are five to eight 2-8 mm size foci of diffusion restriction are present along the right precentral and postcentral gyri. There are a couple 2mm sized foci of diffusion restriction along the right precuneus and cuneus.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional similar appearing lesions present in the brainstem.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is approximately 40% narrowing of the mid basilar artery.There is mild narrowing at the origins of the superior and inferior divisions of the right middle cerebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is small The posterior communicating arteries are not readily visualized. The left vertebral artery is very small.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is high-grade stenosis present the origin of the left vertebral artery. Left vertebral artery is small compared to the right vertebral artery throughout its cervical course.", "output": "1.Small foci of acute infarction are present in the right parietal lobe, right pre-and postcentral gyri and right occipital lobe. The vascular distributions include right posterior cerebral artery territory and the right middle cerebral and territory. The posterior communicating arteries are tiny.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Punctate lesions in the pons and midbrain are most likely vascular related.4.There is mild narrowing at the origins of the superior and inferior divisions of the right middle cerebral artery."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with acute shortness of breath and hemoptysis. Rule out PE. PULMONARY ARTERIES: No evidence of pulmonary embolus.LUNGS AND PLEURA: Severe emphysema. Right hilar and peribronchial thickening with adjacent interstitial and air space disease concerning for with lymphangitic spread of diseaseMEDIASTINUM AND HILA: Bulky AP window lymph nodes, the largest of which measures 2 x 2.6-cm, (image 37, series 6). and moderate pericardial effusion. Right hilar mass has ill-defined borders but grossly measures 4.7 x 4.1cm (image 86, series 8) which sounds and narrows the right upper lobe bronchus and right upper pulmonary artery. The distal aspect of the right upper lobe bronchus is narrowed measuring approximately 4 mm (image 36, coronal series).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Right adrenal gland is incompletely imaged but has a bulky appearance which is nonspecific and may be further evaluated with dedicated adrenal CT or MRI if clinically indicated.", "output": "1. Bulky mediastinal lymphadenopathy and right hilar mass with adjacent interstitial and airspace disease concerning for primary neoplasm with local extension and lymphangitic spread.2. Bulky right adrenal gland as described above."}
{"instruction": "Generate impression based on findings.", "input": "Posttraumatic headache, unspecified, intractable. 17 years, Male, headache and dizziness. No intracranial mass or mass-effect. There are areas of cortical volume loss with adjacent T2/FLAIR hyperintensity involving the lateral cortex of the right lateral temporal as well as the inferior frontal lobes. There is susceptibility artifact related to patient's braces which limits evaluation of the bilateral frontal lobes on the susceptibility weighted and diffusion-weighted sequences. There is a punctate focus of susceptibility involving the left occipital deep white matter. Subtle focus of susceptibility is also questioned in the left cerebellar hemisphere. No surrounding edema. No evidence of acute ischemia or hemorrhage. No extra-axial collections. Major flow-voids are preserved. Mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are grossly unremarkable within the limits of the susceptibility artifact from patient's braces.", "output": "1. Small areas of encephalomalacia involving the cortex of the right inferior and right lateral temporal lobes may be related to prior trauma. There are also punctate foci of susceptibility in the left occipital white matter and left cerebellar hemisphere which are compatible with chronic microhemorrhages. These are nonspecific but may be also be related to remote trauma.2. Brain parenchyma appears otherwise unremarkable without intracranial mass or mass effect."}
{"instruction": "Generate impression based on findings.", "input": "Multiple sclerosis Brain: There are least 6 T2/flair hyperintense lesions involving the bilateral periventricular and subcortical white matter including pericallosal/periventricular lesions with an ovoid morphology. Lesions include the bilateral pericallosal white matter, splenium of the left corpus callosum, left anterior temporal subcortical white matter and adjacent to the left occipital horn. Possible tiny juxtacortical lesions involving the superior frontal gyri. Few lesions with T1 hypointensity are noted. No lesions with enhancement are seen. There is a small lesion involving the right middle cerebellar peduncle. No other infratentorial lesion is appreciated. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchymal volume is within normal limits. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Possible tiny cyst in the posterior aspect of the pituitary, not well evaluated. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: There are T2 hyperintense lesions in the cervical cord, most prominent of which are seen at the left ventral C3 level and the left aspect of the cord at the C6-C7 level. There may be additional tiny lesions such as at the left dorsal C4 level. Small lesion involving the left T1 level is also noted. There is some intrinsic T1 hyperintensity associated with the left C6-C7 lesion. No significant enhancement is appreciated.Vertebral body heights in the cervical spine are normal. Alignment is normal. Mild degenerative changes are seen with disk osteophyte complexes at C4-C5 and C5-C6 including disk extrusion at the C5-C6 level with effacement of the left ventral thecal sac. There is mild left neural foraminal stenosis at the C5-C6 level. Otherwise, no significant spinal canal or neural foramina stenosis is appreciated. Bone marrow signal is benign.", "output": "1. At least 6 T2/FLAIR hyperintense lesions involving the supratentorial and one in the infratentorial white matter, several of which demonstrate a morphology and distribution consistent with demyelinating disease. No lesions with enhancement to suggest active demyelination. Brain parenchymal volume is maintained. Several T1 hypointense lesions are also noted. No prior study is available for comparison.2. Multiple T2 hyperintense lesions in the cervical cord such as the left ventral C3 and left C6-C7 levels compatible with chronic demyelinating plaques. Small upper thoracic lesion at left T1 level also noted. No lesions with enhancement to suggest active demyelination.3. Small disk extrusion at the left C5-C6 level with mild left neural foraminal stenosis. Otherwise no significant spinal canal or neural foramina stenosis in the cervical spine."}
{"instruction": "Generate impression based on findings.", "input": "FIGO IIB cervical cancer status post chemoradiation, MRI for brachial planning PELVIS:UTERUS, ADNEXA: Persistent tethering and linear soft tissue signal seen at level of posterior cervix reflecting parametrial involvement (see images 35 through 37 series 501), evaluation suboptimal due susceptibility artifact related to interval placement of tandem and ovoids. Persistent mild focal T2 hyperintensity seen involving posterior cervix (similar to earlier exam) and small nabothian cyst formation seen. Site is located within 1 cm of superior aspects of ovoids and located posterior to and approximately 2 to 2.5 cm from end of tandem. Accounting for these differences and differences in technique overall appearance without significant change, no corresponding postcontrast enhancement identified. Instilled vaginal gel and vaginal tube noted.BLADDER: Foley catheter in underdistended bladder, small gaseous foci also seen.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Rectal tube in place. Increased perirectal fat.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "Interval placement of tandem and ovoids related for radiation therapy. Associated susceptibility artifact makes evaluation suboptimal but accounting for differences in technique no significant change in posterior cervical lesion. Persistent tethering and linear soft tissue signal seen at level of posterior cervix related to parametrial involvement and/or scarring. Please refer to discussion above."}
{"instruction": "Generate impression based on findings.", "input": "11-year-old female with right thigh pain who presents for evaluation of the menisci. MENISCI: The medial and lateral menisci are normal in signal and morphology.ARTICULAR CARTILAGE AND BONE: No evidence of a fracture, osteochondral defect, or articular cartilage defects.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament are intact.EXTENSOR MECHANISM: Quadriceps and patellar tendons are intact.ADDITIONAL", "output": "No evidence of a meniscal tear as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "Small cell neuroendocrine carcinoma of nasopharynx/sinus with extension to the skull base, s/p cisplatin/etoposide + concurrent RT completed in November 2014, now with leptomeningeal only disease recurrence. The patient is status post resection of the bilateral superior and middle turbinates, and nasal septum. There is prominent mucosal thickening in the bilateral maxillary sinuses, which has decreased slightly on the left. Trace fluid is identified within the mastoid air cells, left greater than right. There is diffuse hyperenhancement of the nasopharyngeal mucosal space, but no evidence of discrete mass lesion or upper cervical lymphadenopathy. There is a T2 hyperintense, enhancing lesion within the left inferior colliculus which restricts diffusion, compatible with increased cellularity. This measures 0.9 x 0.9 cm, previously 0.7 x 0.5 cm. There is an enhancing lesion within the mid to inferior right frontal lobe measuring 0.8 x 0.7 cm, previously 0.5 x 0.4 cm. There is unchanged enhancement and thickening of the pituitary infundibulum, measuring up to 5 mm in diameter. There is increased leptomeningeal disease, which now appears more confluent and extends along the cerebellum, midbrain, bilateral sylvian fissures, olfactory bulbs, trigeminal nerves (right greater than left), and cranial nerves VII and VIII. November median sulci also demonstrate diffusion restriction consistent with hypercellular leptomeningeal tumor.", "output": "1.Post treatment findings in the nasopharyngeal and sinonasal regions, with no measurable mass lesion within the sinuses.2.Progression of leptomeningeal disease involving the cerebellum, bilateral sylvian fissures, multiple cranial nerves and midbrain, with diffusion restriction noted along the cerebellar vermin sulci.3.Increased size of enhancing lesions within the inferior colliculus and right frontal lobe, consistent with metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Multiple myeloma. Evaluate for lesion in the lumbar spine. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is dextroscoliosis of the lumbar spine with apex at the L2-L3 level. There is severe loss of disc height at the left L2-L3 level. There is increased edema involving the L2-L3 endplates and enlargement of a Schmorl's node involving the superior L3 endplate. Schmorl's node involving the inferior endplate of L2 is similar to prior. No definite myelomatous lesion in the lumbar spine is appreciated. There is nonspecific heterogeneous bone marrow particularly in the pelvis with areas of T1 hyper and hypointensity similar to prior. The conus medullaris is normal in position.There is mild to moderate facet arthropathy throughout the lumbar spine. Additional details regarding degenerative changes as below: L1-L2: Mild disc bulge. No spinal canal or neural foraminal stenosis. L2-L3: Diffuse disc bulge, eccentric to the left with effacement of the left lateral recess and moderate left neural foraminal stenosis. No significant central spinal canal or right neural foraminal stenosis. L3-L4: Disc bulge, ligamentum flavum thickening, and facet arthropathy. There is mild spinal canal and mild left greater than right neural foraminal narrowing.L4-L5: Mild disc bulge and facet arthropathy without significant spinal canal or neural foraminal stenosis. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are grossly unremarkable.", "output": "1. There is nonspecific heterogeneity of the bone marrow as before without definite evidence of myelomatous lesion in the lumbar spine.2. Severe loss of height involving the left aspect of the L2-L3 disc space with associated dextroscoliosis and interval increase in bone marrow edema and endplate irregularity at this level. 3. There is moderate left L2-L3 neural foraminal as well as lateral recess stenosis as before. There is also mild L3-L4 central spinal canal stenosis as before."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Malignant neoplasm of frontal lobeClinical question: preop planning for tumor removalSigns and Symptoms: seizures: preop planning The patient is status post left frontal lobe surgery for removal of a left frontal lobe mass. Since the prior exam from 6/17/2015 a new 18mm focus of T2 signal change has developed along the left fontal lobe at the anterior aspect of the left superior frontal gyrus at the inferior and anterior aspect of the surgical site. This now enhances heterogenously following contrast administration. It has not changed substantially in size since 10/21/2015.T2 signal change adjacent to and inferior and posterior to the surgical site remains stable when compared to the previous exams.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "Since the prior exam in June, a new focal lesion has developed at the anterior aspect of the left frontal lobe adjacent to the anterior and inferior margin of the surgical site which is suspicious for local recurrence. This has not changed substantially since the 10/21/2015 exam."}
{"instruction": "Generate impression based on findings.", "input": "6-year-old male with history of epilepsy, ADHD, behavioral issues with intense headache in afternoon and waking the patient in the middle of the night. Evaluate for abnormalities. There is no evidence of intracranial hemorrhage, mass or edema. No abnormal enhancement in the brain or leptomeninges.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Normal brain CT."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Compression of brain. Variants of migraine, not elsewhere classified, without mention of intractable migraine without mention of status migrainosusClinical question: Please evaluate for meningeal enhancement. Known Chiari.Signs and Symptoms: Right arm numbness and positional headaches. MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils are low lying. No abnormal enhancing lesions are appreciated intracraniallyNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.", "output": "1.No intracranial mass lesions are appreciated.2.There are only minor degenerative changes present in the cervical spine."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out intracranial pathology. Signs and symptoms: Syncope without head trauma. Non-infused CT of brain:There is diffuse prominence of cortical sulci, CSF cisterns and ventricular system. Patchy areas of periventricular low attenuation region represent small vessel disease of indeterminate age. In comparison with the prior MRI examination no gross interval change is appreciated.There is no evidence of hemorrhage, acute cortical stroke, mass effect or midline shift.", "output": "1.Findings consistent with small vessel disease of indeterminate age.2.Prominence of cortical sulci and ventricular system is stable since prior MRI examination.3.No evidence of acute hemorrhage or cortical stroke."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral ACA and left MCA territorial ischemic infarctions. CTA evidence of left carotid bulb plaque irregularity. The 3D T1 weighted WATS sequence was applied.However, the images are blurred especially on posterior lateral aspect of the left carotid bulb prevents detailed analysis.Subtle linear low signal intensity (arrows on series 801, image 29/50) delineating carotid luminal high signal intensity might represent fibrous cap of carotid plaque and irregularity with interruption of the linear low signal intensity could represent ruptured portion of carotid plaque.However, there is no evidence of definitive evidence of fibrous cap interruption or intra-plaque hemorrhage (usually showing high signal intensity on T1 weighted image) on this scan.Black blood imaging attempt was not successful to show carotid bulb wall.Therefore, this MR exam is non-diagnostic.", "output": "Non diagnostic MR imaging. "}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Injury, unspecifiedClinical question: hemorrhage, vestibular injurySigns and Symptoms: blunt trauma, nausea, headache Images of both right and left internal auditory canals images demonstrate normal neural bundles. There is normal appearance of the membranous labyrinth with no evidence of enlargement of the endolymphatic ducts at the level of the vestibular aqueduct bilaterally.The right vertebral artery flow-void appears very small and hypoplastic.", "output": "Normal non-contrast MRI examination of the internal auditory canals."}
{"instruction": "Generate impression based on findings.", "input": "Shoulder pain for months. Evaluate for calcific tendinitis. There is a slight lateral downsloping of the acromion process, but otherwise the shoulder appears normal without periarticular calcifications or other findings to account for the patient's pain.", "output": "No calcific tendinopathy or other specific findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Right locked jaw, muscle spasms of right jaw muscles. Abnormality of right TMJ, hypertrophy of right facial/mastication muscles? The right mandibular condyle is appropriately situated within the mandibular fossa on the closed mouth sequences. There is appropriate anterior translation of the mandibular condyle on the open mouth sequences. The articular disc is unremarkable, situated between the mandibular condyle and articular eminence on all sequences. I see no frank arthritic changes such as synovitis or erosion.The left mandibular condyle is appropriately situated within the mandibular fossa on the closed mouth sequences. There is appropriate anterior translation of the mandibular condyle on the open mouth sequences. The articular disc is unremarkable, situated between the mandibular condyle and articular eminence on all sequences. I see no frank arthritic changes such as synovitis or erosion.The musculature in the vicinity of the temporomandibular joints appears symmetric.", "output": "Normal-appearing temporomandibular joints bilaterally, without findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for headaches. Rule out PRES syndrome: History of kidney transplant and chronic headaches. Recent worsening of headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered cerebral white matter T2 hyperintense foci. The ventricles and basal cisterns are normal in size and configuration. The cerebellar tonsils are minimally low-lying. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. Mild scattered cerebral white matter T2 hyperintense foci are nonspecific, but not suggestive of posterior reversible encephalopathy syndrome.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct."}
{"instruction": "Generate impression based on findings.", "input": "History of recurrent fistulas. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Best seen on the post contrast imaging is a fistula tract extending from approximately4:00 position extending into the ischioanal fossa inferiorly to the medial gluteal cleft with a Seton in place. There is also a small fistula extending from approximately the 6:00 position of the anal canal extending anteriorly and towards the left and likely communicates with the above-described fistulous tract best seen on the DWI images (series 9/115).No drainable fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Transsphincteric fistula extending from the 4:00 position of the anal canal and inferiorly to the medial gluteal cleft with a Seton in place. This likely communicates with a 6:00 position short fistulous tract as well."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Radiographic findings consistent with osteomyelitis of the fifth metatarsal on XR, right heel with eschar/wound, OM of right heel? OM seen on XR? There is bony destruction of the head of the fifth metatarsal and base of the fifth proximal phalanx with underlying abnormal signal intensity in the adjacent bone, indicating osteomyelitis. Adjacent to the fifth MTP joint is a collection of fluid signal intensity, measuring 2 cm in cross-section and 2 cm in longitudinal dimension, likely representing an abscess that perhaps communicates with the fifth MTP joint. The middle and distal phalanges of the fifth toe and remaining phalanges appear normal. There is mild signal abnormality in the head, neck, and distal diaphysis of the first metatarsal that may be degenerative in etiology or perhaps represent bone infarction but we see no adjacent soft tissue defect to suggest osteomyelitis. The bones of the midfoot appear normal. There is ulceration with reticulation of underlying subcutaneous fat of the posterior soft tissues of the heel with minimal edema of the inferomedial aspect of the posterior calcaneal tuberosity that we suspect reflects reactive osteitis rather than osteomyelitis. There is edema of the subcutaneous fat along the dorsum of the foot and ankle and fatty atrophy of the ankle and foot musculature.", "output": "1. Osteomyelitis of the fifth metatarsal head and base of the proximal phalanx with adjacent abscess perhaps arising from the fifth MTP joint.2. Heel ulceration with mild signal abnormality in the calcaneus which we suspect represents reactive osteitis rather than osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are digital mammographic images (6/3/15, 6/10/15), ultrasound images of both breasts (6/10/15), images from ultrasound guided biopsy of right breast and postprocedural mammographic images (6/11/2015), breast MRI (6/17/2015) performed at Silver Cross Hospital. DIGITAL MAMMOGRAPHIC IMAGES (6/3/15, 6/10/15):The breast parenchyma is composed of scattered fibroglandular elements. An irregularly shaped asymmetry is seen at 12:00 position in the right breast measuring approximately 35 mm.In the left breast at the medial aspect, there is a subcentimeter circumscribed oval mass, likely benign.No suspicious microcalcifications are seen in either breast.ULTRASOUND IMAGES OF BOTH BREASTS (6/10/15):In the right breast at 12:00 position, there is a irregularly shaped hypoechoic/isoechoic lesion, corresponding to the asymmetry on the mammogram. The lesion measures at least 12 mm.In the left breast there is a small cyst measuring 5 mm, corresponding to the circumscribed benign-appearing mass seen on the mammogram.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL MAMMOGRAPHIC IMAGES (6/11/2015):Ultrasound guided biopsy for the evaluation shaped hypoechoic lesion in the right breast at 12:00 position is performed. A biopsy needle is placed at the anterior aspect of the lesion. Postprocedural right mammographic images show a marker clip placed anterior aspect of the abnormal asymmetry. Per outside radiology report, the pathology result was benign breast tissue, which is discordant.BREAST MRI (6/17/2015):Imaging protocol is described in the outside radiology report.There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.In the right breast, an irregularly shaped enhancing mass measuring 36 x 21 x 18 mm at 12:00 position, corresponding to the area of abnormalities on mammogram and ultrasound. Enhancing intramammary lymph node is seen at lower outer quadrant in the left breast. No suspicious enhancement is seen in the left breast. No abnormal lymph nodes are seen in either axilla.", "output": "1. Suspicious MR enhancing lesion at 12:00 position in the right breast, corresponding to mammographic and sonographic abnormalities. Benign pathology result of this lesion is discordant with imaging findings. Repeat ultrasound guided biopsy of the right breast lesion is recommended. 2. No imaging evidence of malignancy in the left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Giacalone is a 43-year-old woman with personal history of left breast lumpectomy in 01/2013 for IDC treated with neoadjuvant chemotherapy and radiation. She presents for routine MRI imaging surveillance. There is scattered fibroglandular tissuein both breasts. Mild parenchymal enhancement is noted bilaterally.There are stable post-lumpectomy changes present in the left breast, including architectural distortion and skin retraction. There is no abnormal enhancement within the lumpectomy bed or elsewhere in the left breast.No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.", "output": "Stable postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with simple partial seizures. No restricted diffusion to suggest acute ischemia. In the limited context of this examination, no intracranial hemorrhage is identified. There is left greater than right T2/FLAIR hyperintensity seen within the subcortical and periventricular frontal white matter that is consistent with encephalomalacia. There is ex vacuo dilation of the left lateral ventricle and expanded perivascular spaces secondary to this confluent encephalomalacia in the left frontal lobe. The T2/FLAIR hyperintensity is also visualized within the left internal capsule, left external capsule, and left thalamus. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.", "output": "1.Findings are compatible with encephalomalacia and gliosis in the left greater than right subcortical and periventricular white matter associated with extension into the left external capsule, left internal capsule and left thalamus. Etiology is nonspecific. Although it could be vascular related or could be related to other process resulting in encephalomalacia."}
{"instruction": "Generate impression based on findings.", "input": "Reason: concern for quad rupture History: pain Evaluation is limited due to the large field of view utilized to evaluate the quadriceps tendon as well as extensive susceptibility artifact within the quadriceps tendon from prior repair.MENISCI: There is truncation of the inner fibers of the posterior horn of the medial meniscus, which may reflect prior meniscectomy or repeat tearing. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is marked thinning of the articular cartilage of the patellofemoral compartment. The bone marrow signal is within normal limits.LIGAMENTS: The posterior collateral and anterior collateral ligaments are intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: Extensive susceptibility artifact within the quadriceps tendon limits evaluation. The tendon appears irregular and thickened with associated intermediate signal intensity which may reflect scarring or tendinosis, and is likely at least partially intact.ADDITIONAL", "output": "1.Evaluation of the quadriceps tendon is limited by extensive susceptibility artifact from prior repair; however, the tendon is thickened and irregular, but appears to be at least partially intact.2.Defect in the posterior horn of the medial meniscus may reflect prior meniscectomy or re-tearing.3.Moderate joint effusion.4.Marked thinning of the articular cartilage of the patellofemoral compartment."}
{"instruction": "Generate impression based on findings.", "input": "Headache. MS. Street renal transplant. No intracranial bleed. Mildly prominent extra-axial space and sulci. Moderate patchy periventricular and subcortical white matter low-attenuation are again seen. Gray-white differentiation is preserved. Basal cisterns are patent. Ventricles are symmetric and normal in size. Visualized paranasal sinuses and mastoid air cells are clear.", "output": "No acute intracranial abnormality. No significant interval changes in the appearance of the brain since prior exam, allowing for comparison with the previous study a different modality, brain MRI October 28, 2009."}
{"instruction": "Generate impression based on findings.", "input": "82 years Male (DOB:2/21/1934)Reason: syncope workup History: near syncopePROVIDER/ATTENDING NAME: NIR Y URIEL NIR Y URIEL MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR hyperintense focus is present in the brainstem, along the posterior aspect of the pons measures approximately 17 x 15 mm. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is 55% stenosis at the origin of the right internal carotid artery and 70% stenosis at the origin of the left internal carotid artery both of which are associated with intraluminal filling defects. The filling defect on the left is larger than the one on the right.The left A1 segment appears hypoplastic . The left internal carotid artery is smaller than the right internal carotid artery. There is no significant stenosis along the course of the vertebral arteries.", "output": "1.55% stenosis at the origin of the right internal carotid artery and 65% stenosis at the origin of the left internal carotid artery both of which are associated with intraluminal filling defects. The filling defect on the left is larger than the one on the right. It is conceivable that this could represent intraluminal thrombus. Please correlate with the ultrasound findings.2.Periventricular and subcortical white matter lesions of a moderate degree as well as a lesion in the pons are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "New lung cancer diagnosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are subcentimeter areas of enhancement superficially along the cortex of the right precentral and postcentral gyri, with associated high T2 signal in the cortex. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is a subcentimeter enhancing lesion in the right frontal bone and a partially imaged lesion in the left C3 vertebra.", "output": "1. Subcentimeter areas of enhancement superficially along the cortex of the right precentral and postcentral gyri are compatible with metastases, perhaps leptomeningeal in nature.2. A right frontal bone lesion and a partially imaged lesion in the left C3 vertebra is also compatible with metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": " The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural \u201ctime-out\u201d form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient\u2019s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 17 seconds.", "output": "Successful fluoroscopic guided injection of dilute gadolinium for subsequent MRI arthrogram of the left hip. "}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with Parkinsonism, gait and balance issues with falls backwards, evaluate midbrain and cerebellum and ventricles. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is moderate to severe periventricular and to a lesser degree subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. No significant change since prior study from 12/27/2013. There is also a small focus of T2 hyperintensity in the right paramedian upper aspect of the pons likely reflecting chronic infarct and present on 5/13/2015 CT but not definitively seen on prior MRI from 2013. There is is moderate degree of global parenchymal volume loss. No disproportional volume loss involving the brainstem or cerebellum is appreciated.There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. Moderate to severe periventricular, and to a lesser degree subcortical, white matter T2/FLAIR hyperintensity is nonspecific but likely related to chronic small vessel ischemic disease. Prior inflammation or demyelination are additional considerations. There is also a chronic right pontine lacunar infarct. 2. No disproportional volume loss involving the brainstem or cerebellum. No evidence of hydrocephalus. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "22 years old Male. History of repeated shoulder dislocation (4 dislocations in the last 4 months). Evaluate for glenoid bony loss. IMAGE ACQUISITIONS: CT of the right shoulder without contrast The osseous structures of the glenoid are intact with no evidence of osseous Bankart's fracture.Depression at the superior lateral aspect of the humeral heads is consistent with Hill-Sachs deformity which was noted on prior MRI dated 7/15/2010", "output": "1.No abnormalities in the osseous components of the glenoid.2.Hill-Sachs deformity of the humeral head is noted."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female with right shoulder pain. Evaluate for rotator cuff tear ROTATOR CUFF: The tendons and muscle fibers of the supraspinatus, infraspinatus, subscapularis and teres minor appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly normal. There is small amount of fluid within the glenohumeral joint and subscapular recess which is not pathologic.BICEPS TENDON: The biceps tendon is normal throughout its course. ADDITIONAL", "output": "1. No evidence of rotator cuff tear as clinically questioned.2. The labrum is grossly normal. However if there is a question of labral pathology clinically, an MR arthrogram of the shoulder would be helpful for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Neck pain with right arm paresthesias Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. Minimal degenerative changes are seen in the cervical spine with mild multilevel disk desiccation and mild facet arthrosis.The cervical spinal cord has normal signal characteristics and overall morphology.Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "Minimal degenerative changes in the cervical spine. No significant spinal canal stenosis or neural foraminal stenosis at any level in the cervical spine."}
{"instruction": "Generate impression based on findings.", "input": "80-year-old female with history of thoracic spine decompression, annual surveillance Redemonstrated is vertebral body height loss involving T8, T9, and T10 with significant wedge deformity of T9. There is also significant effacement of intervertebral disk spaces at these levels with increased fusion across the disc level at T8/9. Minimal edema within T9 and T10 have resolved. As before, there is exaggerated kyphosis of thoracic spine centered at T8/9, not significant changed. The alignment of vertebral column otherwise remains anatomical similar to prior exam.T2 hyperintensity within the thoracic cord at T7/8, T8/9, and T9/10, as well as 2 subtle punctate foci of T2 hyperintensity at the T8 and T10 levels are similar to prior exam. Postoperative changes of multilevel laminectomy at this level is stable. Post procedural T2 hyperintensity within the soft tissues has nearly resolved. Multilevel mild degenerative changes without significant associated stenosis is again noted. Redemonstrated is a partially visualized heterogeneously T2 hyperintense lesion within the right lobe of the thyroid gland measuring 22x18 mm in axial dimension which is unchanged.", "output": "1.Minimal edema within T9 and T10 have resolved. There is increased fusion across the disc level at T8/9. The remaining changes of T8, T9 and T10 are stable. 2.Stable foci of thoracic cord T2 hyperintensity of the T8 through T10 levels is stable.3.Post procedural T2 hyperintensity within the soft tissues has nearly resolved."}
{"instruction": "Generate impression based on findings.", "input": "Benign neoplasm of cerebral meninges [D32.0], Reason for Study: ^Reason: yearly f/u for meningioma History: surveillance Again seen is an avidly enhancing dural-based enhancing extra-axial mass along the dorsal aspect of the clivus extending through the ventral foramen magnum to the upper C2 level. Inclusive of the dural tail, the lesion measures 3.9 x 1.8 cm in maximal transverse dimension in the sagittal plane and 2.7 x 2.4 cm in the axial plane, which represents no significant change from the prior study. This lesion impinges upon and significantly flattens the medulla, similar to the prior exam. There is susceptibility effect in the right aspect of the lesion which may represent calcification or chronic blood products.No additional intracranial masses or enhancing abnormalities are detected. Brain parenchyma is otherwise significant only for mild scattered T2 hyperintensities within the white matter which are unchanged and likely reflect chronic small vessel ischemic disease. Diffusion-weighted images are negative for evidence of acute ischemia. No intracranial hemorrhage or abnormal extra-axial fluid collections are detected. A left parietal approach ventricular shunt catheter is in stable position with distal tip along the septum pellucidum. The ventricles are stable in size with left lateral ventricle smaller than right. No hydrocephalus.There is redemonstration of a 7 mm enhancing T2 hyperintense lesion in the posterior right pituitary. Lesion demonstrates a more solid pattern of enhancement relative to prior. The lesion has not clearly grown, however, and the pituitary gland itself appears slightly decreased in size.Bone marrow signal characteristics are unremarkable. A mucous retention cyst is redemonstrated in the right maxillary sinus.", "output": "1. There is a stable meningioma extending along the dorsal clivus through the foramen magnum with unchanged mass effect on the medulla.2. A subcentimeter posterior right pituitary lesion appears more solidly enhancing but no larger than on prior examination."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old man with history of colon cancer and metastasis to the liver. ABDOMEN:LIVER, BILIARY TRACT: A T2 hyperintense lesion in segment 8 of the liver (series 5, image 7) measures 20 x 18 mm and abuts the right hepatic vein. This lesion corresponds to the FDG avid lesion seen on the outside PET. This lesion demonstrates mild, peripheral enhancement. Additional, smaller highly T2 hyperintense lesions are noted in segments 4 (series 5, image 9) and segment 2 of the liver (series 5, image 10).SPLEEN: The spleen appears normal.PANCREAS: The pancreas is atrophic, but otherwise appears normal. The previously seen peripancreatic lymph node is not visualized on this study.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance normally.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The patient is status post total colectomy. The visualized small bowel is normal.BONES, SOFT TISSUES: Bilateral hip prostheses are noted.OTHER: Small bilateral pleural effusions noted.", "output": "1.Solitary segment 8 liver lesion suspicious for metastasis.2.Previously seen FDG avid peripancreatic lymph node not visualized on today's study.3.Left lobe hepatic cysts."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Structural brain lesion signs and symptoms: Weakness. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted images.There is normal anatomical morphology of the brain parenchyma and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal parenchymal, meningeal or calvarial enhancement.Normal visualization of nature intracranial arterial branches.Normal signal intensity and pattern of enhancement of intracranial venous sinuses.Slight prominence of the pituitary gland with normal pattern of enhancement is appropriate for patient's stated age of 33.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal signal intensity of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.", "output": "Unremarkable 3 and post enhanced brain MRI."}
{"instruction": "Generate impression based on findings.", "input": "64 year old with strong family history of breast cancer in mother and sister. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Tongue pain and burning. The tongue and other oral cavity structures appear unremarkable. There is no evidence of mass lesions. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures and orbits are unremarkable. There is a small retention cyst in the left maxillary sinus.", "output": "No evidence of mass lesions in the tongue."}
{"instruction": "Generate impression based on findings.", "input": "76 year-old woman with history of adenocarcinoma of the lung, status post right lower lobectomy CHEST:LUNGS AND PLEURA: Areas of consolidation and ground glass opacities are identified in the lingular segment of the left upper lobe as well as in multiple locations in the residual right right lung. These demonstrate significant interval increase compared to the prior outside exam and may represent multiple sites of bronchiolo - alveolar carcinoma. Multifocal infection is considered less likely.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy is identified.Cardiac size is normal without evidence of pericardial effusion. Pacemaker lead wires are noted.CHEST WALL: Right-sided pacer.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodensities, which may represent hepatic metastases. Dedicated imaging of the liver with CT and/or MRI is recommended.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes within the thoracic and lumbar spine.OTHER: No significant abnormality noted", "output": "1.Multifocal areas of mixed solid and ground glass opacities bilaterally, compatible with multiple sites of bronchiolo - alveolar carcinoma.2.Multiple hepatic hypodensities, which may represent hepatic metastases. Dedicated CT and/or MRI imaging of the liver is recommended. In addition, PET scanning may be of value."}
{"instruction": "Generate impression based on findings.", "input": "68 year old with altered mental status. Patchy areas of periventricular and subcortical lucencies are consistent with small vessel disease of undetermined age. No evidence of hemorrhage, mass effect, midline shift or hydrocephalus is detected. Additional clinical history of metastatic colon cancer was relayed to the radiology resident on call. If concern for metastatic process or acute stroke is suspected an MRI is recommended.", "output": "Small vessel disease of undetermined age. Please see above comments."}
{"instruction": "Generate impression based on findings.", "input": " Brain: Exam is limited by metallic artifact from braces, especially of the orbits and paranasal sinuses. Within these limitations, there is no restricted diffusion to indicate an acute ischemic infarct. No susceptibility weighted abnormalities to indicate hemorrhage within the limitations caused by extensive artifact. There are no masses, mass effect or midline shift. Several subcortical punctate white matter signal hyperintensities on flair and T2 imaging, including within the left superior frontal gyrus, are stable. The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. There is no abnormal enhancement within the brain. Cervical Spine: There is slight reversal of lordosis of the cervical spine. There is a small left paracentral disc protrusion with resultant mild to moderate spinal canal narrowing at the C3/4 level. No neuroforaminal stenosis is noted in the cervical spine. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The visualized paraspinal contents are unremarkable.", "output": "1.Evaluation of the brain is limited secondary to extensive artifact from braces. Within these limitations, there are no acute brain abnormalities.2.No discrete evidence of demyelination in the brain or cervical spine.3.There is a small left paracentral disc protrusion with resultant mild to moderate spinal canal narrowing at the C3/4 level."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male experiencing right upper extremity weakness, history of invasive squamous cell carcinoma of the supraciliary ridge with chemoradiation treatment Motion is present on several series due to patient pain and sleeping. Repeat sequences were performed when possible. Given this caveat:Brain MRI:Redemonstrated are post-treatment findings in the left supraciliary region with a persistent infiltrative enhancing lesion in the left supra-orbital subcutaneous tissues with extension into the left orbital roof, traversing the frontal bone along the lateral aspect of the left frontal sinus with slight epidural extension and extraconal left orbital extension. Overall, the lesion appears unchanged in appearance given differences in technique.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no brain parenchymal masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. A left maxillary retention cyst is unchanged. The remaining paranasal sinuses and mastoid air cells are clear.Cervical spine MRI:Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Posterior osteophyte disc complex and bilateral facet hypertrophy. There is moderate left neural foraminal and severe right neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is moderate central and severe bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex eccentric to the left, bilateral uncinate hypertrophy, ligamentum flavum thickening and left facet hypertrophy. There is mild to moderate central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum flavum thickening. There is mild central, moderate left neural foraminal, and severe right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is severe left neural foraminal and moderate right neural foraminal stenosis.C7/T1: Endplate spurring eccentric to the right causes moderate right neural foraminal stenosis.", "output": "1.Redemonstrated are post-treatment findings in the left supraciliary region with a persistent infiltrative enhancing lesion in the left supra-orbital subcutaneous tissues with extension into the left orbital roof, traversing the frontal bone along the lateral aspect of the left frontal sinus with slight epidural extension and extraconal left orbital extension. Overall, the lesion appears unchanged in appearance given differences in technique. Otherwise negative MRI of the brain.2.C2/3: Moderate left neural foraminal and severe right neural foraminal stenosis.3.C3/4: Moderate central and severe bilateral neural foraminal stenosis.4.C4/5: Mild to moderate central and severe bilateral neural foraminal stenosis.5.C5/6: Mild central, moderate left neural foraminal, and severe right neural foraminal stenosis.6.C6/7:Severe left neural foraminal and moderate right neural foraminal stenosis.7.C7/T1: Moderate right neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 51 years old. Reason: re-evaluate osseous lesions seen on prior study, hx osseous sarcoid History: re-evaluate osseous lesions seen on prior study, hx osseous sarcoid Again seen are multiple round lesions within the sacrum, innominate bones, and proximal femora, many of which appear slightly smaller and less confluent on the current study than on the prior study. For example, a right intertrochanteric lesion measured 2.3 cm in craniocaudal dimension on the prior study, and now measures 2 cm. These lesions are of similar intensity to skeletal muscle on T1WI, hyperintense on T2WI, and enhance following contrast administration.Osteonecrosis of the femoral heads appears similar to the prior study, with osteoarthritis affecting both hips, left greater than right. Degenerative disc disease at L4-5 appears similar to the prior study.Lymphadenopathy seen on the prior study is again noted, although many of the lymph nodes appear slightly smaller in size. A uterine fibroid and nabothian cysts appear similar to the prior study accounting for slight positional differences.", "output": "1.Findings compatible with sarcoidosis as described above with lesions appearing smaller and less confluent on the current study than on the prior study.2.Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate hygroma. Signs and symptoms: Status post Chiari decompression with hygroma now on head CT. Continuous dizziness. Nonenhanced brain MRI:Unremarkable diffusion-weighted series. Examination demonstrate postoperative changes of Chiari decompression. There is postoperative epidural fluid collection/seroma at the surgical site with subtle mass effect and without significant expansion of subarachnoid space. There is mild remaining flattening deformity of the cerebellar tonsils without detectable signal abnormality. On sagittal images this collection measures approximately 40 mm in cranial cephalad axis and 12 mm in AP axis.There is a CSF signal intensity hygroma along the left hemispheric convexity. Hygroma in the posterior fossa is also detected surrounding the cerebellar hemispheres (left greater than right). This finding demonstrate no significant change since prior head CT examination from 10-12-15. The left hemispheric convexity hygroma measures approximately 7 to 8 mm in thickness. There is resultant subtle flattening deformity of the adjacent parenchyma and subtle mass effect on the left lateral ventricle and trace rightward deviation of midline of approximately 4 mm. Hypoechoic posterior fossa measures maximum of approximately 1.5 mm thickness.There is no evidence of ventriculomegaly. There is no signal abnormality of the brain parenchyma.Nonenhanced cervical MRI:Revisualization of the above detailed postoperative changes of suboccipital craniectomy.Normal signal intensity and alignment of vertebral column.Normal signal intensity and caliber of cervical and upper most visualized thoracic cord without evidence of syrinx.No spinal stenosis or neural foraminal compromise.CSF flow study demonstrates presence of biphasic flow through the foramen magnum anterior and without detectable flow posteriorly. There is also no detectable flow through the fourth ventricle or the aqueduct.", "output": "1.Nonenhanced brain MRI demonstrate postoperative changes of suboccipital craniectomy, epidural seroma immediately posterior to the surgical site with subtle mass effect as detailed-measured about. Right hemispheric convexity hygroma measuring approximately 7 to 8 mm without significant change since prior head CT examination and with resultant 4 mm midline shift. Thin approximately 1.5 mm maximum thickness of diffuse hygroma in the posterior fossa (left greater than right) without significant mass effect.2.Unenhanced cervical MRI demonstrate Chiari decompression postop changes. Normal signal intensity and caliber of the cord. Normal appearing biphasic flow through the foramen magnum anteriorly and absence of flow posteriorly. No detectable flow through the fourth ventricle or the aqueduct."}
{"instruction": "Generate impression based on findings.", "input": "Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: Pt with history of previous coiling, partially recanalized right cavernous carotid. Follow up MRI. History: See above. Brain MRINo evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. Minimal non specific small vessel ischemic disease.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 3mm sized partial recanalization of previously coiled right proximal cavernous sinus segment aneurysm, unchanged. No other aneurysm is seen.No evidence of intracranial arterial luminal stenosis.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. Minimal non specific small vessel ischemic disease.3. Stable partial recanalization of the right proximal cavernous sinus segment ICA aneurysm since prior scan. "}
{"instruction": "Generate impression based on findings.", "input": "Low back pain, history of lumbar fusion, radicular pain. Left lower extremity atrophy. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of normal lumbar lordosis.. Bone marrow signal is benign including T1 hyperintense lesions at the T11 and L2 vertebral bodies compatible with hemangiomas. The conus medullaris is normal in position. There are postsurgical changes of prior laminectomy at the L4-L5 and L5-S1 levels.Multilevel degenerative changes are seen, as described below:L1-L2: Mild disk bulge. No spinal canal or neural foraminal stenosis.L2-L3: Mild disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: Mild disk bulge. No spinal canal or neural foraminal stenosis.L4-L5: There is some loss of disk height and left paracentral disk protrusion with partial effacement of the left lateral recess which may be effecting the traversing L5 nerve root. There are prominent degenerative endplate marrow signal changes. There is mild right and moderate left neural foraminal stenosis. Central spinal canal is patent with laminectomy at this level noted. Mild facet arthropathy.L5-S1: There is severe loss of disk height and prominent degenerative endplate marrow signal changes. There is diffuse disk bulge which involves the bilateral lateral recesses and foramina. There is an osteophyte component. There is severe left and moderate to severe right foraminal stenosis. Central spinal canal is patent with laminectomy at this level noted. Mild facet arthropathy.Paraspinous soft tissues are postsurgical changes but are within normal limits. Bilateral renal cysts incidentally noted.", "output": "1. Advanced degenerative changes at the L4-L5 and L5-S1 levels with evidence of prior laminectomies at these levels. There is no significant spinal canal stenosis at any level. 2. There is moderate left L4-L5 and severe left L5-S1 neural foraminal stenosis which may be impinging on the left L4 and L5 nerve roots. There is also effacement of the lateral recesses at these levels, left greater than right, where there may be impingement of the traversing L5 and S1 nerve roots."}
{"instruction": "Generate impression based on findings.", "input": "45 year old with biopsy proven left breast cancer. BRCA 1 positive. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a rapidly enhancing mass, measuring 11 x 11 x 18 mm (AP x LR x CC), at posterior 11 o'clock position in the left breast, consistent with the known cancer. Metallic artifact presumably from a marker clip is present immediately anterolateral to the mass.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.", "output": "1. Unifocal cancer in the left breast.2. No MRI evidence of malignancy in the right breast.3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": " Cervical spine:The anterior arch of C1 appears larger than typical, although the remainder of C1 appears intact without dysplasia. The immediately adjacent odontoid tip also appears atypical in appearance, yet without gross dysplastic change.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no stenoses.Thoracic and Lumbar spine:There is complex osseous dysplasia which begins at the T12/L1 level and includes only a partial L1 lumbar level, absent lumbar segments more inferiorly, with sacral agenesis. The paraspinal musculature also appears absent below the L1 level.The cord terminates just above the T10/11 level and demonstrates a blunt ended appearance. Nerve roots along the posterior central canal inferiorly demonstrate a thickened and clumped appearance. Neural foramina appear patent to the T12/L1 level, with nonvisualized neural foramina at the dysplastic L1/2 level, and none inferiorly.There appears to be a tract within the soft tissues that extends from the level of the dysplastic inferior aspect of L1 extending to the skin surface. There is a tiny, 6 mm, fluid appearing cystic portion along its mid aspect.", "output": "MRI evidence for caudal regression syndrome including lumbosacral agenesis."}
{"instruction": "Generate impression based on findings.", "input": "Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: Pt w/ breast CA and brain mets. History: brain mets s/p SRS. 28 years Female (DOB:3/26/1988)Reason: Pt w/ breast CA and brain mets. History: brain mets s/p SRS.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS Comparing to prior scan, there are nodular and somewhat linear enhancing lesions especially on the right cerebellar hemisphere, one at the inferior aspect and another at the superior aspect. Both are measured about 1 to 2 mm in diameter. There are not associated with surrounding edema. Comparing to prior scan, the mass size has been significantly decreased.Supratentorially, there is no identifiable enhancing lesion on today's scan.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids of major intracranial vasculature are present.The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Opacification of the left maxillary sinus with mucosal thickening on the right maxillary sinus are seen.", "output": "1. Significant interval decrease of the size of the posterior fossa, especially on the right cerebellar hemispheric metastatic lesion since prior scan.2. Nonvisualization of previously seen enhancing metastatic lesion supratentorially.3. No evidence of acute ischemic or hemorrhagic lesion. No other abnormal enhancing lesion is seen."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old female with recurrent paraganglioma post MIBGEXAMINATION: MR abdomen and pelvis without and with IV contrast 2/25/2015 ABDOMEN:LIVER, BILIARY TRACT: Normal with no evidence of intra or extrahepatic biliary ductal dilatation. Gallbladder is normal.SPLEEN: Normal.PANCREAS: Normal. No evidence of pancreatic ductal dilatation.ADRENAL GLANDS: Redemonstration of a low T1, high T2 enhancing left suprarenal lesion measuring 2.5 cm x 2.4 cm (Series 501, image 19) previously measured 2.3 cm x 2.3 cm. The left adrenal gland is not identified separate from this lesion. The right adrenal gland is normal. KIDNEYS, URETERS: Normal bilaterally with no evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: There is a similar appearing aortocaval mass with prominent mass effect on the adjacent IVC measuring 3.0 cm x 2.8 cm (series 501, image 6) previously measured 3.1 cm x 2.7 cm. BOWEL, MESENTERY: Normal in caliber with no evidence of obstruction.BONES, SOFT TISSUES: Numerous enhancing lesions throughout the pelvis, proximal left femur and visualized spine which appear similar to prior. A lesion within the L5 vertebral body is again seen not significantly changed with epidural extension and partial effacement of the thecal sac as well as possible impingement on the exiting left S1 nerve root.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: NormalBLADDER: NormalLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal in caliber with no evidence of obstruction.BONES, SOFT TISSUES: Numerous enhancing lesions throughout the skeleton as described above.OTHER: No significant abnormality noted", "output": "No significant interval change in left suprarenal mass as well as widespread osseous and retroperitoneal metastatic disease. Epidural extension of the L5 lesion with impingement on the exiting left S1 nerve root is not significantly changed. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 29 years old. Knee pain. Eval for quad strain; meniscal tear. MENISCI: There is vertically oriented intermediate signal within the peripheral fibers of the posterior horn of the lateral meniscus, likely representing a chronic, possibly healed tear that is continuous with the interface of the ligament of Wrisberg. This appears similar to that seen on the prior study. We see no fluid signal intensity within this tear to indicate instability. The remainder of the lateral meniscus and the medial meniscus appear normal.ARTICULAR CARTILAGE AND BONE: The articular cartilage and bone are normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps tendon and distal quadriceps musculature appear normal. The patellar tendon appears normal.ADDITIONAL", "output": "Possible chronic, healed tear of the vascularized periphery of the posterior horn of the lateral meniscus. The knee otherwise appears normal."}
{"instruction": "Generate impression based on findings.", "input": "Low back pain, leg pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is straightening of the lumbar curvature and minimal retrolisthesis of L3 on L4 and L4 and L5. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is disc desiccation and mild disc bulge. There is no significant spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis. Mild facet arthropathy.L4-L5: There is disc desiccation and mild bulge without significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis. There is a Schmorl's node and mild edema involving the inferior L4 endplate on the left which is on a degenerative basis. Mild facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits. Left kidney is absent.", "output": "1. Disc bulges at L3-4 L4 and L4-L5 with mild-to-moderate neural foraminal stenosis as described above.2. No significant spinal canal stenosis at any level."}
{"instruction": "Generate impression based on findings.", "input": "Mycosis fungoides and leptomeningeal disease: vision loss and loss of vision acuity with 3rd nerve palsy and ptosis. Orbits MRI: There is high T2 signal and mild hyperenhancement of the left inferior, medial, and superior oblique muscles. There may also be mild high T2 signal in the right inferior recuts muscle. The bilateral globes, lacrimal glands, and optic nerves are otherwise unremarkable. Brain MRI: There is diffuse enhancement of the bilateral oculomotor nerves, left more than right. There also appears to be enhancement of the cisternal segments of the bilateral trigeminal nerves, left more than right. Furthermore, there appears to be a greater degree of diffuse enhancement involving the bilateral facial nerves than usual. There is no evidence of abnormal enhancement in the cerebral sulci. There is nonspecific high T2 signal in the left peritrigonal white matter. The rest of the brain parenchyma appears to be unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.", "output": "Abnormality involving the bilateral oculomotor and trigeminal nerves, left more than right, as well as possibly the facial nerves, with denervation effects in the extraocular muscles, particularly on the left side may be related to neoplastic involvement."}
{"instruction": "Generate impression based on findings.", "input": "History of small cell lung cancer with brain metastases treated with WBRT. There is a heterogeneously enhancing mass present along the medial aspect of the left temporal lobe currently measuring 19 x 13 mm axial dimensions and previously 27 x 13 mm axial dimensions. It is associated with T2 signal hyperintensity and some punctate foci of signal loss on susceptibility imaging. FLAIR signal abnormality associated with this particular lesion appears to have mildly regressed.A lesion located in the right medial temporal lobe patient's of the right lateral ventricle currently measures 15 x 15 mm axial dimensions and previously measured 8 mm axial dimensions. A lesion adjacent to the trigone of the left lateral ventricle at its junction with the temporal horn is not clearly visible on the prior exam but currently measures approximately 5 mm. Lesion located within the left hippocampus now measures 5 mm and previously measured 3 mm. FLAIR signal abnormality associated with these lesions appears to have increased.There is a cystic lesion present at the occipital horn of the left lateral ventricle which measures 10 x 19 mm axial dimensions. It has different signal intensity relative to CSF. On the prior exam it is not clearly distinguished. This particular lesion is associated with surrounding FLAIR signal hyperintensity.There several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These were also present on the prior exam.A lesion along the left occipital lobe lingual gyrus currently measures 20 x 11 mm and previously measured 6 x 7 mm.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small opacity in the left maxillary sinus. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.", "output": "1.There are multiple lesions scattered within the brain parenchyma the majority of which have increased in size relative the prior exam. The exception is a lesion in the left temporal lobe which has mildly decreased in axial dimensions. These are compatible patient's diagnosis of metastatic disease2.A cystic lesion is present in the occipital horn of the left lateral ventricle which appears to potentially represent entrapment of the occipital horn."}
{"instruction": "Generate impression based on findings.", "input": "Headache and dizziness. Syncope and collapse. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter. There is no pathological enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.", "output": "1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Scattered punctate foci of abnormal T2 signal within the periventricular and subcortical white matter, which are nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female with a history of migraine headaches presents with increased frequency and severity of headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "No evidence of intracranial hemorrhage, mass, or acute infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "77 year old male with history of biliary stricture and evidence of chronic pancreatitis on EUS. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in contour. There is mild extrahepatic biliary duct dilatation with the common bile duct measuring 12 mm in diameter, appearing similar to the prior study. There is associated narrowing at the level of the head of the pancreas. No significant intrahepatic biliary ductal dilatation. No focal parenchymal lesions. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: There is marked atrophy of the pancreas. A small volume of residual tissue demonstrating signal characteristics of normal pancreas remains in the pancreatic head, unchanged. The main pancreatic duct is markedly dilated measuring 12 mm in diameter, previously 10 mm. The main pancreatic duct is again noted to smoothly taper just proximal to its junction with the common bile duct. No mass lesion is evident. In response to secretin administration, there is normal opacification of the entire duodenum up to the ligament of Treitz, however, there appears to an overall blunted response to secretin augmentation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Hemangioma in the L2 vertebral body.OTHER: No significant abnormality noted.", "output": "Persistent findings consistent with chronic pancreatitis. There is main pancreatic duct and common bile duct dilation with associated narrowing at the level of the pancreatic head, most consistent with benign stricturing which may be a sequela of chronic pancreatitis. There are no focal pancreatic mass lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "2-year-old previously healthy male with a recent history of abdominal lymphovascular resection 4 weeks ago, who presents with new onset focal seizures (left arm stiffening, staring, drooling). Please evaluate for brain malformation or abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears within normal limits, including bilateral terminal zones of myelination in the posterior cerebral hemispheres. No findings to suggest seizure focus are appreciated. Specifically, there is no evidence of gray matter heterotopia or cortical dysplasia. The bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal mucosal thickening.", "output": "No findings to suggest seizure focus are appreciated."}
{"instruction": "Generate impression based on findings.", "input": "Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus [G43.509], Reason for Study: ^Reason: vision changes with headache History: vision changes There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Polypoid soft tissue lesion on the posterior aspect of nasal cavity which appears to be connected to the left inferior turbinate posterior aspect with homogenous enhancement. This lesion suggest possible nasal polyposis, thus clinical correlation/inspection is recommended. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or intracranial abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement intracranially.3. Possible nasal polyposis especially left inferior posterior turbinate, clinical correlation is recommended."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with history of EBV lymphoma proliferation in HIV. Follow-up. BRAIN: Limited intracranial images demonstrate no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.NECK SOFT TISSUES:The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The lingual tonsils appear slightly prominent. No frontal masses are noted. There are many cervical lymph nodes at multiple levels.Small intraparotid lymph node is borderline in size measuring 12 x 8 mm (series 4, image 36). Small level 2 lymph node posterior and inferior to the right parotid gland is 11 x 8 mm (series 4, image 41). Small level 2 lymph node anterior to the sternocleidomastoid muscle anterior to the carotid artery measures 17 x 6 mm, (series 4, image 44). Additional multiple small lymph nodes are present throughout the visualized soft tissues not enlarged by CT criteria.Minimal multilevel degenerative change affects the visualized cervical spine without evidence of central canal or neuroforaminal stenosis. Vertebral body hypertrophy with posterior bridging osteophyte present at T1-T2 which is causing posterior indentation into the visualized cervical central canal. Due to CT technique and artifact in the spinal cord cannot be evaluated. There is clinical concern for cord compromise an MRI may be considered. The osseous structures are otherwise unremarkable.LUNG APICES:Lung apices are clear bilaterally.", "output": "1. Multiple lymph nodes some of which are borderline many of which are not pathologically enlarged by CT criteria, none of which demonstrate pathologic enhancement. No additional masses identified.2. Slight prominence of the lingual tonsils of uncertain etiology.3. Vertebral body hypertrophy with posterior bridging osteophyte present at T1-T2 which is causing posterior indentation into the visualized cervical central canal. Due to CT technique and artifact in the spinal cord cannot be evaluated. There is clinical concern for cord compromise an MRI may be considered. "}
{"instruction": "Generate impression based on findings.", "input": "CSF leak, plan for OR. Additional history includes prior right hemispherectomy for epilepsy. Status post right hemispherectomy. A left transoccipital catheter terminates in the right cerebral hemisphere cavity, unchanged. Dysmorphic and collapsed third and left lateral ventricles are unchanged. Periventricular white matter T2 hyperintensity is again seen, and grossly unchanged. A complex cystic collection in the posterior left cerebral hemisphere is unchanged. No evidence of restricted diffusion to suggest acute infarct. Carotid, basilar, and left sided major intracranial flow voids are present indicating patency. The right lenticular shaped extradural collection has decreased in maximal diameter currently measuring 12 mm, previously up to 19 mm, and is now predominantly air-filled. The paranasal sinuses and mastoid air cells are clear.", "output": "Postoperative changes of right hemispherectomy with decreasing right extradural fluid collection. "}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female with a history of glioblastoma multiforme presents with generalized weakness. There is redemonstration of a large right frontotemporal lobe mass involving the insula consistent with patient's biopsy proven glioblastoma multiforme. There is hypodensity surrounding this mass consistent with a combination of tumor infiltration and vasogenic edema. Periventricular white matter hypoattenuation also noted. These findings appear similar to the prior studies though MRI would be more accurate for evaluation of tumor progression.There is no evidence of a new intracranial mass or focal lesion. There is no evidence of acute territorial ischemia. There is no acute intracranial hemorrhage or extra-axial fluid collection. While there remains 4mm of right to left midline shift, the sulci and ventricles appear slightly more prominent than in November 2011, probably on the basis of treatment related change (e.g. steroids). There is no basal cistern effacement or herniation.Right frontal bone burr hole. The remainder of the calvaria and skull base are radiographically normal. The visualized mastoid air cells are clear. Partial opacification of the ethmoid sinuses bilaterally. Bilateral lens prosthesis.", "output": "1. No acute intracranial abnormality.2. Right frontotemporal mass with surrounding edema, similar to the previous examination when allowing for differences in modalities. No significant interval change in associated leftward midline shift. MRI examination would be more sensitive for evaluation of tumor progression."}
{"instruction": "Generate impression based on findings.", "input": "Gait imbalance with veering left greater than right. No restricted diffusion abnormality to suggest acute ischemia. The brain parenchymal signal intensity is within normal limits for age. There is a juxtacortical punctate focus of T2 hyperintensity in the left superior frontal gyrus, which is nonspecific. The ventricles, sulci, and basal cisterns are normal in size and configuration. There is no evidence of regional mass effect or midline shift. The cerebellum is normal in appearance without evidence of atrophy. The cerebellar tonsils are normal in position. No abnormal foci of enhancement are noted. Incidentally noted is a developmental venous anomaly in the right middle frontal gyrus. A focus of susceptibility in the right occipital lobe likely represents old microhemorrhage or mineralization. There is no associated edema. There is patchy paranasal sinus mucosal thickening/opacification involving the ethmoid air cells and maxillary sinuses. The orbits are within normal limits.", "output": "No evidence of cerebellar atrophy or other specific findings which would account for the patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "visual field loss left side history of pituitary cyst \"collapsed\" There is no evidence of intracranial hemorrhage, mass, or acute infarct. Punctate T2 hyperintense foci in the left periventricular white matter and right corpus callosum are not significantly changed. There is no abnormal intracranial enhancement. Ventricles and sulci are prominent for age suggesting volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.A 2 mm lesion which is hypoenhancing and hypointense on T2 is more evident on this exam but was likely present on prior exams accounting for differences in technique. There is an additional 3 mm T2 hyperintense focus more posteriorly and superiorly which is unchanged from the prior exams. Please note that this lesion is not seen on current dynamic images as it is not included within the slices sampled. Pituitary size and shape otherwise appears normal. Pituitary stalk appears normal. No significant mass effect on the chiasm.", "output": "1.No findings to explain visual field deficit.2.A 2 mm lesion which is hypointense on T2 and hypoenhancing is unchanged from prior exams accounting for differences in technique and may represent a remnant pars intermedia cyst or other incidental pituitary cyst.3.A 3 mm T2 hyperintense focus within the pituitary is unchanged from prior exams and may represent a cystic microadenoma or another incidental pituitary cyst.4.Stable minimal white matter changes within the brain."}
{"instruction": "Generate impression based on findings.", "input": "New onset panhypopituitarism on anti-cancer immune modulator with hypophysitis as side effect; rule out mets or other causes of pituitary failure There is heterogenous enhancement of the pituitary gland without significant enlargement of the gland or the pituitary infundibulum. The posterior pituitary bright spot is intact. There is no evidence of mass lesions. The optic apparatus and cavernous sinuses are intact. The imaged intracranial structures are unremarkable.", "output": "Heterogenous enhancement of the pituitary gland may represent treatment-related necrotizing hypophysitis."}
{"instruction": "Generate impression based on findings.", "input": "Sensory neuropathy legs to nipple and dysmetria. Assess for myelitis. Cervical:Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning areas of marrow replacement or marrow edema are seen. The pattern of marrow enhancement is within normal limits.The visualized spinal cord shows normal signal intensity and caliber. There is no abnormal enhancement involving the cervical cord. There is minimally increased epidural enhancement C6-C7 level similar to prior and on a degenerative basis. Mild degenerative changes in the cervical spine are again seen and are unchanged. Individual levels as below.C2-3: Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis. Facet hypertrophy.C3-4: Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis. Mild facet arthropathy.C4-5: No significant disk degeneration, spinal canal stenosis or neuroforaminal narrowing. Mild facet arthropathy.C5-6: Mild disk height loss and osteophyte formation. No significant spinal canal or neuroforaminal stenosis. Mild facet arthropathy.C6-7: There is loss of disk height, disk osteophyte complex and uncovertebral hypertrophy on the left with mild to moderate narrowing of the left neural foramen. There is partial effacement of the ventral thecal sac and minimal spinal canal stenosis. No significant right neural foraminal narrowing. There is mild facet arthropathy.C7-T1: No significant disk degeneration, spinal canal or neuroforaminal stenosis. Mild facet arthropathy. Thoracic:The thoracic spine is in normal alignment with a normal thoracic kyphosis. There are minimal degenerative changes; the vertebral body and disk heights are otherwise well maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.Mild apparent patchy T2 signal in the mid to lower thoracic cord is most likely artifactual. No abnormal cord signal or abnormal enhancement is seen. Paraspinous soft tissue structures in the thoracic spine are unremarkable.", "output": "1. No abnormal signal in the cervical cord or abnormal enhancement. 2.No high-grade spinal canal or neural foramina stenosis in the cervical spine. There are mild degenerative changes with minimal spinal canal narrowing and mild to moderate left neural foraminal narrowing at the C6-C7 level.3.No abnormal signal within the thoracic cord or abnormal enhancement. No significant spinal canal or neural foraminal stenosis in the thoracic spine."}
{"instruction": "Generate impression based on findings.", "input": "Male, 55 years old, with transverse myelitis. Assess for MS. Brain:A few nonspecific T2 hyperintensities are seen in the periventricular white matter, most prominently adjacent to the left ventricular atrium. A nonspecific focus of T2 hyperintensity is also seen within the right pons.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.Bone marrow signal characteristics are unremarkable. Incidental note is made of two subcentimeter cutaneous nodules along the left face.C-spine:A mild reversal of the normal cervical lordosis is seen. Alignment is otherwise unremarkable. Vertebral body height and morphology are preserved. No evidence of concerning marrow replacement or marrow edema is detected.The spinal canal is slender, most notably between C3 and C5, which is at least partially congenital but with some contribution from disk osteophyte formation and PLL thickening.The cervical spinal cord is also slender and demonstrates patchy parenchymal T2 hyperintensity beginning approximately at the C2-3 level and continuing down to at least C5-6.C2-3: Facet hypertrophy, right side more than left. Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Mild right foraminal narrowing.C3-4: Facet hypertrophy. Mild posterior disk osteophyte formation. Mild spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. C4-5: Posterior disk osteophyte formation, asymmetric to the right. Mild to moderate spinal canal stenosis with particular effacement of the right lateral recess. Moderate to severe bilateral foraminal narrowing. C5-6: Thickening of the PLL between C4-5 and C5-6. Posterior disk osteophyte formation, asymmetric to the left. Moderate spinal canal stenosis with particular effacement of the left lateral recess. Severe bilateral foraminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. T-spine:Spinal alignment is anatomic. Vertebral body height and morphology are unremarkable. No concerning marrow replacement or marrow edema is detected.Again, the spinal canal is diffusely congenitally narrowed.The visualized spinal cord shows no evidence of any definite or convincing signal alteration.At T5-6, there is a small left paracentral/foraminal disk protrusion, in conjunction with left costovertebral joint hypertrophy.At T8-9 and T9-10, there are small central disk protrusions.At T10-11, there is a mildly bulging disk.At none of the above levels is there any evidence of cord impingement or significant spinal canal stenosis. Foraminal narrowing is suspected bilaterally at T10-11 and T11-12.At L1-2, a bulging disk and right paracentral disk protrusion, along with posterior element hypertrophy, contribute to produce a moderate generalized spinal canal stenosis with some crowding of the cauda equina. The neural foramina are mildly narrowed.", "output": "1. A few scattered small T2 hyperintense lesions are detected within the brain. These lesions are nonspecific, and while demyelinating disease may be considered, numerous additional etiologies could also produce this appearance.2. Patchy T2 signal abnormality is evident within the parenchyma of the cervical spinal cord involving the region from C2-3 down to C5-6. The cord does not appear edematous, and if anything, there seems to be some volume loss. Sequela of chronic demyelination could certainly be considered, and with the relative lack of specific findings in the brain, both MS and NMO would be in the differential. However, additional etiologies might include myelomalacia from chronic spinal canal stenosis, as well as sequelae of prior infectious or inflammatory conditions.3. Spinal canal stenosis is seen at several levels in the cervical spine, which reflects a congenitally slender spinal canal with superimposed disk osteophyte complexes and perhaps some PLL thickening.4. Aside from relatively mild degenerative disk findings, no significant abnormalities are detected in the thoracic spine.5. Disk degeneration at L1-2, just barely visualized on this examination, results in at least moderate spinal canal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male with left shoulder pain. ROTATOR CUFF: There is a full thickness tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring approximately 11 mm in AP dimension. There is approximately 13 mm of retraction. There is increased signal abnormality within the supraspinatus tendon at the level of the myotendinous junction consistent with interstitial tearing. There may be mild atrophy of the supraspinatus muscle. The infraspinatus muscle and tendon appear intact. Note is made of a focus of low signal intensity within the infraspinatus tendon at the level of its insertion on the greater tuberosity which appears to correspond to the previously described findings consistent with calcific tendinopathy. There is thickening and increased signal abnormality within the subscapularis tendon consistent with tendinosis. There is increased signal abnormality consistent with interstitial and undersurface tearing of the subscapularis tendon. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Moderate degenerative changes affect the acromioclavicular joint. There is fluid within the acromioclavicular joint with foci of low signal intensity internally, which may represent the previously described chondrocalcinosis. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: There is subluxation of the long head of the biceps tendon which is perched upon the lesser tuberosity suggestive of disruption of the transverse humeral ligament. ADDITIONAL", "output": "1. Full-thickness rotator cuff tear as described above.2. Subluxation of the long head of the biceps tendon.3. Findings suggestive of calcific tendinopathy and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evalute for pancreatitis etiology History: Pancreatitis, abdominal painEXAMINATION: MRI MRCP with and without intravenous contrast. The liver, gallbladder, pancreas, spleen, adrenal glands and kidneys demonstrate a normal MRI appearance. The pancreatic duct is also normal in appearance without evidence of dilatation.", "output": "Normal examination."}
{"instruction": "Generate impression based on findings.", "input": "History of a type I aortic dissection status post repair. CHEST:LUNGS AND PLEURA: Basilar pulmonary opacities which are nonspecific but may reflect atelectasis.MEDIASTINUM AND HILA: Postsurgical changes from a type A aortic dissection repair. The dissection flap extends into the left subclavian, proximal left common carotid and right brachiocephalic arteries, appearing grossly similar to the prior study, although the great vessels are not well visualized due to technical factors.The aortic root measures 4.8 cm in AP dimension (series 1101, image 134), not significantly changed.The ascending aorta measures approximately 3.1 cm in AP dimension (series 1101, image 145), not significantly changed.The descending aorta measures 4.4 cm in AP dimension (series 1101, image 145), not significantly changed.The abdominal aorta measures 3.5 cm in AP dimension (series 1101, image 65), not significantly changed.Focal ulcerations within mural plaque within the false lumen appears similar to prior examinations.The celiac, superior mesenteric and right renal arteries appear to arise from the true lumen. The left renal and inferior mesenteric arteries appear to arise from the false lumen. The dissection flap extends to the iliac bifurcation beyond the inferior margin of the images.CHEST WALL: Sternotomy changes.ABDOMEN:LIVER, BILIARY TRACT: Probable subcentimeter hepatic cysts. No focal suspicious liver lesions. No biliary ductal dilatation. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are unchanged and are without evidence of enhancement.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. See above for discussion of the aorta.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "No significant change in type A aortic dissection status post repair. However, the components of the dissection within the great vessels are not well evaluated on this examination, and dedicated imaging of the neck (such as with a CTA) can be considered if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "History of uterine fibroids status post uterine artery embolization. PELVIS:UTERUS, ADNEXA: The uterus measures 10.7 x 7.6 x 8.1 cm, previously 11.7 x 8.7 x 11.2 cm.There are numerous foci of mildly increased T1 and low T2 signal compatible with uterine fibroids. These are predominantly intramural in location with a single moderate size subserosal fibroid arising from the dorsal fundus. The majority of these are slightly decreased in size compared to prior. The largest fibroid is in the right mid uterine body and measures 5.1 x 3.9 x 4.1 cm, previously 5.9 x 4.9 x 5.2 cm. Compared to prior, the majority of the fibroids do not demonstrate postcontrast enhancement. There is mild residual enhancement of 2 smaller fibroids in the lower uterine segment measuring up to 2.3 cm in maximum dimension.The uterine cavity is distorted by the adjacent intramural fibroids, but is otherwise unremarkable. The junctional zone is normal in thickness.Resolution of previous right ovarian cyst, likely follicle. The left ovary is unremarkable.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": "1.Enlarged lobular uterus containing numerous moderate to large fibroids a predominantly intramural distribution. Compared to prior, individual fibroids in the uterus overall are slightly decreased in size. There is mild residual enhancement of 2 smaller fibroids in the lower uterine segment, otherwise the most of the fibroids do not enhance on the postcontrast images indicating interval necrosis."}
{"instruction": "Generate impression based on findings.", "input": "72 year old with history of hypertension, frequent premature ventricular contractions, and mildly reduced systolic function Left VentricleThe left ventricle is mild to moderately dilated (quantitative measurements suggest more severe left ventricular dilation but qualitative assessment is more suggestive of mild to moderate enlargement) with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 118 ml/m2 (normal range: 65+/-11), the LVEDV is 188 ml (normal range 109+/-23), the LV end systolic volume index is 54 ml/m2 (normal range 18+/-5), the LVESV is 85 ml (normal range 31+/-10), the LV mass index is 59 g/m2 (normal range 67+/-11), and the LV mass is 92 g (normal range 114+/-24). There is late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process on the epicardial side of the basal anteroseptal, anterior and anterolateral walls with associated hypokinesis of the basal antero-septal wall. This pattern of LGE is more on the apical side and is atypical for myocardial infarction. Left AtriumThe left atrium is at least moderately dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 134 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 63 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly to moderately 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 trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial 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 a small circumferential pericardial effusion.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. The left ventricle is mild to moderately dilated (quantitative measurements suggest more severe left ventricular dilation but qualitative assessment is more suggestive of mild to moderate enlargement) with low normal systolic function. The overall LV ejection fraction is 54% There is LGE of the subepicardial basal anteroseptal, anterior and anterolateral walls with associated hypokinesis of the basal antero-septal wall. This pattern of LGE is more on the apical side and is atypical for myocardial infarction. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%"}
{"instruction": "Generate impression based on findings.", "input": "Ms. Kasprzak is a 36-year-old female with personal history of left breast lumpectomy in July 2012 for DCIS and microinvasion treated with radiation and tamoxifen therapy. Personal history of benign right breast biopsy in 2012 for intraductal papilloma. Family history of breast cancer in maternal grandmother (diagnosed at the age of 37) and maternal aunt (diagnosed at the age of 42). There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the left upper breast. Mildly enhancing focus anterior to the biopsy clip in the right inferior breast is stable, compatible with prior history of benign breast biopsy. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "36 year old with family history of breast cancer presents for screening MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male, 18 years old, with drug resistant focal epilepsy, fMRI for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical stimulation maps as expected along the calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Language is left dominant. Broca's area is well visualized on all paradigms and identified as several foci of activation within the inferior left frontal gyrus. Wernicke's area is visualized only on the sentence completion paradigm and identified as a focus of activation along the posterior aspect of the left superior temporal sulcus.", "output": "Technically successful functional MRI for surgical planning. The sensorimotor and primary visual cortices are well demarcated. Language is left dominant with Broca's and Wernicke's areas identified in their customary locations."}
{"instruction": "Generate impression based on findings.", "input": "Right foot mass Tendons and ligaments: The visualized extensor tendons are intact. The visualized flexor tendons are intact. The peroneal tendons are intact. The Lisfranc ligament is intact. There is no subluxation or dislocation in the tarsometatarsal articulations.Bones: There is increased signal within the medial aspect of the navicular without a discrete fracture line identified. There is mildly increased signal within the soft tissue surrounding the navicular as well. Following contrast there is mild diffuse enhancement of the soft tissues surrounding the navicular however no discrete mass or fluid collection is identified. The remaining bone marrow signal is normal. There is no joint effusion. There are no osteochondral lesions identified.Alignment: There is normal alignment of the metatarsals. There is no hallux valgus deformity.Muscles: The plantar musculature is unremarkable.", "output": "Mild edema within the navicular which may represent a stress injury. There is surrounding edema and inflammation which is likely reactive but there is no discrete fluid collection, mass, or fracture line evident."}
{"instruction": "Generate impression based on findings.", "input": "Leg pain and swelling Left: Note that evaluation of the left proximal femur is limited secondary to metallic susceptibility artifact from the patient's left hip arthroplasty. There is diffuse skin thickening and subcutaneous edema of the medial compartment of the thigh. Scattered pockets of lobulated fluid are identified within the medial compartment particularly proximally at level of the sartorius. There is no definite abnormal signal intra or intermuscularly. Following contrast enhancement, there is mild diffuse soft tissue enhancement and mild peripheral enhancement of these lobulated, simple fluid collections but no findings suspicious for abscess. There is no abnormal marrow signal intensity.Right: There is diffuse skin thickening and subcutaneous edema of the medial compartment of the thigh. Scattered pockets of lobulated fluid are identified within the medial compartment particularly proximally at level of the sartorius. There is no definite abnormal signal intra or intermuscularly. Following contrast enhancement, there is mild diffuse soft tissue enhancement and mild peripheral enhancement of these lobulated, simple fluid collections but no findings suspicious for abscess. There is no abnormal marrow signal intensity.", "output": "Diffuse skin thickening, subcutaneous edema, and inflammation of the medial compartment of the thighs bilaterally. There are scattered lobulated pockets of fluid signal intensity within the medial compartment which may be reactive in nature or reflect areas of of surgical intervention however there are no findings to suggest abscess."}
{"instruction": "Generate impression based on findings.", "input": "Female, 51 years old, with history of multiple sclerosis and numbness. The previously demonstrated oval tumefactive lesion within the left posterior corona radiata has significantly decreased in size compared to prior examination. This lesion demonstrates a FLAIR hyperintense and minimally diffusion restricting rim with a T1 hypointense, T2 hyperintense and partially FLAIR suppressing center. Single voxel spectroscopy of this lesion demonstrates mild elevation of choline, reduction of creatine and NAA, and pathologic quantities of both lactate and lipid.Numerous additional smaller FLAIR hyperintense lesions are again seen within the juxtacortical and periventricular white matter and the corpus callosum without significant interval change. The brainstem and cerebellum are relatively preserved. Mild callosal thinning and generalized parenchymal volume loss are demonstrated. No evidence of significant mass effect is observed. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricles are stable in size and morphology.", "output": "1.Numerous small lesions are identified in the juxtacortical and periventricular regions compatible with multiple sclerosis. No new or growing lesions are evident.2.A dominant tumefactive lesion within the left posterior corona radiata has significantly diminished in size. Single voxel spectroscopy of this lesion demonstrates a spectrum with characteristic features of active inflammation. Decreased NAA within the center of the lesion likely reflects some degree of neuronal loss."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: 40-year-old with presumed viral meningoencephalitis and worsening neuro exam. Please reevaluate with Fiesta sequence. Signs and symptoms: Abnormal gaze, weakness and decreased tone. Pre and post enhanced brain MRI:Unremarkable diffusion weighted images.Examination demonstrates subtle diffuse FLAIR hyperintensity of bilateral cerebellar hemispheres and vermis (more conspicuous in the left cerebellum) with evidence of subtle associated mass effect however without hemorrhagic changes. This finding demonstrate diffuse enhancement on post enhanced series. Findings are suggestive of an inflammatory/infectious process and meningoencephalitis should be considered.There is no convincing evidence of signal abnormality of pons, medulla or the cerebral hemispheres and without abnormal enhancement.There is mild decreased size of fourth ventricle secondary to mass effect however the supratentorial ventricular system remain within normal size and without deviation of midline. The quadrigeminal plate and the cisterna magna remain patent.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are within normal with normal pattern of enhancement.Pre- and post enhanced total spine MRI:Images through the cervical spine are degraded in particular on sagittal T2 STIR and post enhanced series. Within this limitation there is no convincing evidence of signal abnormality of the cord or abnormal enhancement. No spinal stenosis or neural foraminal compromise is detected.Examination of the thoracolumbar spine demonstrate no evidence of cord signal abnormality or increased cord caliber and without detectable abnormal enhancement. No spinal stenosis or neural foraminal compromise at any level.Normal signal intensity and morphology of cauda equina without abnormal enhancement.Findings and concerns on this exam were discussed by phone with the clinical service Christine Carlos pager # 3729 at the time of review of the study at 8:15 AM.", "output": "1.Pre and postcontrast enhanced brain MRI demonstrates subtle diffuse FLAIR hyperintensity of cerebellar hemispheres and vermis and with diffuse enhancement however without associated hemorrhage or significant mass effect. Findings are highly suggestive of an inflammatory process and including meningoencephalitis. Unremarkable images through supratentorial space and without convincing evidence of abnormal signal intensity or enhancement.2.Pre- and post enhanced total spine MRI demonstrate no convincing evidence of abnormal cord signal intensity or abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "Newly diagnosed left severe sensorineural hearing loss: sickle cell disease with stroke. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. No evidence of retrocochlear or inner ear lesions.2. No evidence of intracranial hemorrhage, mass, or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for metastases, history of prostate cancer. Signs and symptoms: Bilateral lower extremity weakness. Pre- and post enhanced cervical MRI:Examination demonstrates a large focus of marrow signal replacement with enhancement involving vertebral body of C6 and with involvement of left pedicle and left articulating facet with enhancement. Finding is consistent with a metastatic lesion. There is no detectable extraosseous spread of tumor into the spinal canal. There is no convincing evidence of any additional osseous metastatic lesions of the cervical spine and no detectable metastatic lesion to the cord or the leptomeninges.Degenerative changes at C4-C5 and to a lesser degree at C3-C4 and C5-C6 results in central spinal stenosis. Significant bilateral neural foraminal compromise at C4-C5, C5-C6 secondary to degenerative changes are noted. Mild neural foraminal compromise at other levels.Pre and post enhanced thoracic MRI:Examination demonstrates extensive osseous metastatic lesions involving T2, T3, T4, T5, T6, T7, T8, T10, T11 and T12 vertebral bodies and some with involvement of posterior elements. No evidence of fracture or malalignment.There is evidence of tumor also in the epidural space posteriorly at T3, T4 and to a lesser degree T5 levels with resultant mass effect and flattening deformity of the cord and central spinal stenosis at C3 and C4 level. Although difficult to assess due to flattening deformity there is no convincing evidence of cord edema on this study, however this possibility cannot be entirely excluded. There is no evidence of central spinal stenosis or appreciable mass effect on the cord at any other level.There is normal signal intensity and caliber of thoracic cord otherwise and without detectable enhancement of the cord or the meninges.Pre and post enhanced lumbar MRI:Examination demonstrates diffuse osseous metastatic lesions of the vertebral column however without evidence of malalignment. Fracture of L4 vertebral body is again noted as well as seen on prior CT of the abdomen from 4-7-15.There is no detectable extraosseous spread of tumor into the spinal canal.There is normal signal intensity of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.Degenerative changes at L4-L5 and including a small central disc protrusion results in significant central spinal stenosis and moderate bilateral neural foraminal compromise. Degenerative changes at L3-L4 also result in moderate central spinal stenosis and moderate right neural foraminal compromise. Degenerative changes at L2-L3 results in mild central spinal stenosis and without neural foraminal compromise.", "output": "1.Pre and post enhanced MRI of cervical spine demonstrate metastatic lesion involving the vertebral body of C6, left pedicle and articulating facets with enhancement. No detectable extraosseous spread of tumor. Moderate central spinal stenosis at C4-C5 and to a lesser degree at C3-C4 and C5-C6 levels and significant bilateral neural foraminal compromise C4-C5 and C5-C6 levels secondary to degenerative changes are noted. No detectable but the meningeal enhancement.2.Pre and post enhanced MRI of thoracic spine demonstrate diffuse osseous metastatic lesions involving vertebral bodies and to a lesser degree of the posterior elements. There is also evidence of metastatic lesion in the dorsal epidural space at T3-T5 levels and with evidence of mass effect, flattening deformity and central spinal stenosis which is most noticeable at T3 and T4 levels. No fracture or malalignment and normal signal intensity of the cord without enhancement.3.Pre- and post enhanced lumbar MRI demonstrates diffuse intraosseous metastatic lesions. Fracture of metastatic L4 vertebral body without significant change since prior CT of abdomen. No evidence of leptomeningeal metastatic lesions. Significant central spinal stenosis secondary to degenerative disease at L4-L5 and moderate central spinal stenosis at L3-L4 as detailed above. Multilevel neural foraminal compromise as mentioned in the body of report."}
{"instruction": "Generate impression based on findings.", "input": " There are multiple punctate foci of T2 hyperintensity in bilateral frontal and parietal lobe subcortical white matter locations without restricted diffusion, enhancement, or susceptibility abnormality. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. 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. Mild mucosal thickening is present in the left axilla sinus. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Redemonstrated are changes from previous transsphenoidal approach pituitary tumor resection. Multisequence hyperintensity within the right aspect of the sella likely represents susceptibility related to chronic blood product and/or mineralization. The residual pituitary gland is heterogeneous and small. The pituitary infundibulum enhances normally and is deviated towards the right. The suprasellar space is clear and there is no impingement upon the optic apparatus. These findings are unchanged.", "output": "1.There are multiple punctate foci of T2 hyperintensity in bilateral frontal and parietal lobe subcortical white matter locations without restricted diffusion, enhancement, or susceptibility abnormality. These are nonspecific in appearance but abnormal for a patient aged 43 years. The differential diagnosis would most likely include small vessel disease or migraine sequelae and less likely residua from prior head trauma or from vasculitides. Given lesional appearance and locations, demyelination is unlikely.2.Stable MRI findings status post resection of a pituitary mass. The residual pituitary gland is small and heterogeneous, unchanged in appearance."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female with cervicalgia and radiculopathy The cranial-cervical junction is normal. Redemonstrated is reversal of the cervical lordosis. The cervical spine alignment is anatomic. The vertebral body heights are preserved. The bone marrow and end plates demonstrate a benign MR appearance. The signal of the visualized cord is normal. The paraspinal soft tissues are unremarkable.C2-C3: No neuroforaminal narrowing or spinal stenosis, unchanged. C3-C4: Mild disc bulge without neuroforaminal narrowing or spinal stenosis, unchanged. C4-C5: Left paracentral disc protrusion causing anterior left hemicord flattening without intrinsic cord signal abnormality. There is mild left neuroforaminal narrowing however no spinal stenosis. These findings are unchanged.C5-C6: A previously demonstrated central disc protrusion with partial effacement of the ventral thecal sac has progressed and is larger in the right paracentral location and has a new central extruded component extending inferiorly. There is new anterior cord flattening without intrinsic cord signal abnormality as well as new effacement of the CSF both anteriorly and posteriorly. There is no central stenosis, unchanged mild left neural foraminal stenosis, and worse proximal moderate right neural foraminal stenosis.C6-C7: No neuroforaminal narrowing or spinal stenosis, unchanged. C7-T1: No neuroforaminal narrowing or spinal stenosis, unchanged.Facet hypertrophy at T1/2 and T3/4 encroach bilateral neural foramina, unchanged.", "output": "1.C4-C5: Left paracentral disc protrusion causing anterior left hemicord flattening without intrinsic cord signal abnormality. There is mild left neuroforaminal narrowing however no spinal stenosis. These findings are unchanged.2.C5-C6: A previously demonstrated central disc protrusion with partial effacement of the ventral thecal sac has progressed and is larger in the right paracentral location and has a new central extruded component extending inferiorly. There is new anterior cord flattening without intrinsic cord signal abnormality as well as new effacement of the CSF both anteriorly and posteriorly. There is no central stenosis, unchanged mild left neural foraminal stenosis, and worse proximal moderate right neural foraminal stenosis.3.Facet hypertrophy at T1/2 and T3/4 encroach bilateral neural foramina, unchanged."}
{"instruction": "Generate impression based on findings.", "input": "55 years, Female, structural abnormality underlying epilepsy, seizure protocol.. Multiple sequences are motion degraded which limits assessment for subtle abnormalities. No focal lesion to suggest seizure focus is appreciated. No intracranial mass or mass effect. Bilateral hippocampi are symmetric in size and without signal abnormality. No evidence of infarct or hemorrhage. There is abnormal configuration of the lateral ventricles with dilation of the bodies and occipital horns of the lateral ventricles, right greater than left, which may be developmental or related to remote white matter injury. There is thinning of the adjacent white matter without discrete signal abnormality. No hydrocephalus. Several scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific and may represent mild chronic small vessel ischemic changes. Major flow-voids are preserved. There are bilateral lens implants. There is mild right maxillary sinus mucosal thickening and minimal mucosal thickening elsewhere. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.", "output": "1. No findings to suggest a seizure focus are appreciated within the limits of motion degraded study.2. Abnormal configuration of the lateral ventricles which are disproportionately enlarged in the parieto-occipital region (colpocephaly). This finding may be developmental or related to remote white matter injury.3. Scattered foci of T2/FLAIR hyperintensity in the white matter are nonspecific and may represent mild chronic small vessel ischemic changes, sequela of prior inflammation, or less likely demyelination. "}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status [780.97], Reason for Study: ^Reason: 73 y/o M with metastatic colon ca, altered mental status, r/o brain metastasis History: altered mental status There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Mild diffuse brain atrophy with appropriate ventricular system size.Multifocal patchy bihemispheric periventricular white matter indicate non specific small vessel ischemic disease.On gradient echo images, there are multiple variable sized susceptibility lesions on bilateral hemispheres without evidence of surrounding edema or restricted diffusion. These lesions may indicate chronic petechial hemorrhagic foci or calcifications. The midline structures and cranial-cervical junction are normal. Intracranial arterial system appears to be tortuous in course and slightly ectatic indicating atherosclerotic changes.The paranasal sinuses and mastoid air cells are clear.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. Diffuse mild brain atrophy with non specific small vessel ischemic changes.3. No evidence of abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "53 years Female (DOB:9/5/1962)Reason: radiculopathy History: right hand weaknessPROVIDER/ATTENDING NAME: AASIM I PADELA JAMES R. BRORSON The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.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. There is loss of disc space height and disc desiccation. There is a disc bulge at this level. There are endplate uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally. There is encroachment of the exiting nerve roots on the right side and to a lesser degree the left side.At C6-7 there is no significant compromise to the spinal canal. There is loss of disc space height and disc desiccation. There is a disc bulge at this level. There are endplate uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally with mild encroachment of exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.", "output": "There are degenerative changes present in the cervical spine which are worse at C5 and C6. There are some encroachment of the exiting nerve roots on the right side at C5-6."}
{"instruction": "Generate impression based on findings.", "input": "45 year old male patient with prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.1 x 2.4 x 3.4 cm. Peripheral Zone: There are areas of T2 hypointensity in the right apex measuring 1.1 x 0.5 cm (image 13, series 501), right mid-gland measuring 1.2 x 0.6 cm (image 16, series 401), and left mid-gland measuring 0.8 x 0.7 cm (image 15, series 401). The ADC sequences are technically limited, however, there is the suggestion of corresponding low signal for these lesions. Additional bilateral smaller T2 hypointense foci are also seen.Central Gland: Scattered BPH nodules.Seminal Vesicles: No evidence of involvement.Extracapsular Extension: There is focal capsular thickening with indistinct margins overlying a right mid-gland lesion and may represent focal extra-prostatic extension (image 16, series 401).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple foci of signal abnormality compatible with tumor with possible focal extraprostatic extension of tumor in the right mid-gland."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with right lateral epicondylitis. Evaluate common extensor tendon and median nerve for compression. LIGAMENTS: Although this examination was not protocoled for detailed evaluation of the ligaments, the ulnar collateral ligament appears intact. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact, within the limitations of a non arthrogram study.TENDONS: There is increased signal abnormality and thickening of the common extensor tendon indicating tendinosis. There are small foci of fluid signal intensity within the origin of the common extensor tendon indicating a small partial-thickness interstitial tear. The common flexor tendon appears intact. The triceps tendon appears intact. The biceps and brachialis tendons appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. SURROUNDING STRUCTURES: The imaged musculature of the elbow is normal in appearance.ADDITIONAL", "output": "1. Findings consistent with moderate to severe common extensor tendinosis with a small interstitial tear.2. Increased signal abnormality within the ulnar nerve proximal to and within the cubital tunnel indicating a neuritis.3. No evidence of median nerve compression as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old woman with history of right upper quadrant pain, nausea, and vomiting. ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma appears normal.The patient is status post cholecystectomy. There is mild intra and extrahepatic biliary duct dilatation with the common bile duct measuring up to 8 mm to the level of the distal common bile duct.SPLEEN: Spleen is normal.PANCREAS: The pancreas is normal and there is no mass in the pancreatic head. Pancreatic duct size is at the upper limits of normal.ADRENAL GLANDS: Adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: Small perineural cysts are noted.OTHER: No significant abnormality noted.", "output": "Mild intra and extrahepatic biliary duct dilatation, likely due to a benign stricture at the level of the distal common bile duct or ampulla (latter considered less likely considering pancreatic duct only measures upper limits normal). No obstructing mass or stone identified."}
{"instruction": "Generate impression based on findings.", "input": "73 year old with hypertension and dyslipidemia now with acute myeloid leukemia found to have left ventricular systolic dysfunction and a possible LV apical thrombus. MEDICATIONS: metoprolol and lasix First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted.Viability/ Myocardial ScarThere was no evidence of myocardial infarction. There is a small amount of an atypical pattern of late gadolinium enhancement involving the epicardial half of the basal inferior wall suggesting the presence of underlying myocardial fibrosis, inflammation, or infiltration. This segment has an indeterminate probability of viability. The remainder of the myocardium is likely to be viable. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 110 ml/m2 (normal range: 65+/-11), the LVEDV is 217 ml (normal range 109+/-23), the LV end systolic volume index is 70 ml/m2 (normal range 18+/-5), the LVESV is 139 ml (normal range 31+/-10), the LV mass index is 69 g/m2, and the LV mass is 136 g. The left ventricular systolic dysfunction is global with regional variation. The apical \"mass\" noted on echo most likely represents a small muscular band rather than a thrombus or tumor.Left AtriumThe left atrium is moderate to severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 132 ml/m2 (normal range 69+/-14), the RVEDV is 260 ml (normal range 110+/-24), the RV end systolic volume index is 96 ml/m2 (normal range 22+/-8), and the RVESV is 189 ml (normal range 35+/-13). Right AtriumThe right atrium is moderate to severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a variant brachiocephalic branching pattern. There is an aberrant brachiocephalic vessel (either the innominate artery or just the right subclavian artery) originating from the proximal portion of the descending aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsModerate bilateral pleural effusions and right lower lung consolidation. 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. No perfusion defects/ \"ischemia\" present during hyperemia.2. There was no evidence of myocardial infarction. There is a small amount of an atypical pattern of late gadolinium enhancement involving the epicardial half of the basal inferior wall suggesting the presence of underlying myocardial fibrosis, inflammation, or infiltration. This segment has an indeterminate probability of viability. The remainder of the myocardium is likely to be viable. 3. Severe LV dilation with moderately reduced systolic function (LVEF 36%). No evidence of LV apical mass or thrombus. The finding noted on echo most likely represents a small muscular band.4. Severe RV dilation with severely reduced systolic function (RVEF 28%).5. Mild mitral and tricuspid regurgitation.6. Mild dilation of the main pulmonary artery. 7. Variant brachiocephalic arch branching pattern.8. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: History of atypical meningioma status post partial resection. Signs and symptoms: Surveillance prior to additional resection. Pre and post enhanced brain MRI:Examination demonstrates interval improvement of postoperative changes of a large right sided craniotomy for removal of tumor.Examination redemonstrates a large irregular and loculated tumor in the entire length of right cerebellopontine angle and into the right petrous bone, right internal auditory canal, right jugular fossa, right carotid canal, right cavernous sinus, right Meckel's cave, right medial aspect of the middle cranial fossa and through the expanded right foramen ovale into the right infratemporal fossa, extensively in the skull base on the right, sella turcica, left cavernous sinus and the sphenoid sinus. Although there is no significant change in the extent of tumor there is evidence of interval increased size of this meningioma in particular in the right cerebellopontine region.There is resultant interval increased vasogenic edema in the right cerebellum, right middle cerebellar peduncle and pons. Increased tumor size as well as surrounding edema results in increased mass effect on the fourth ventricle which appears smaller than prior study. Similar to prior exam to mass is abutting and mildly displacing the basilar artery without evidence of encasement or change in caliber of basilar artery. This is similar to prior exam. Dedicated vascular imaging, however is needed for better assessment.The tumor in the right petrous bone and carotid canal results in encasement, irregularity and mild decreased caliber of right internal carotid artery through the skull base, right cavernous sinus and proximal supraclinoid segments. This appearance is relatively similar to prior exam.Significantly expanded right cavernous sinus secondary to tumor and the component of tumor extends through the foramen ovale into right infratemporal fossa demonstrate no significant change either. There is however mild interval increased size of tumor component in the sphenoid and right orbital apex since prior exam.Extensive interval right temporal lobe cystic encephalomalacia at the site of previously noted parenchymal edema is identified. There is resultant ex vacuo dilatation of right lateral ventricle since prior exam.Interval significant decreased extra axial collection at the surgical site on the right results in resolution of midline shift to the left since prior study.", "output": "1.There is interval increased size of a large loculated extra-axial meningioma in the right cerebellopontine angle and with resultant increased vasogenic edema and mass effect as detailed.2.Extensive residual tumor in the right skull base, right jugular fossa, right carotid canal, right cavernous sinuses, right Meckel's cave, right orbital apex, sphenoid sinus, right middle cranial fossa and right infratemporal fossa as detailed above. The measurement suggests subtle interval increased size of different components of tumor at other locations as detailed above.3.Significant interval improvement of postoperative changes of right-sided craniotomy and interval evolution of previously noted right temporal lobe edema into a large focus of encephalomalacia as detailed.4.Interval decreased overall mass effect in the supratentorial space and with resolution of leftward midline deviation since prior exam. Please see above comments."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female with history of shunt, now with difficult to control seizures and altered mental status. Evaluate ventricles. Evaluate shunt. CT at outside hospital two weeks ago said there was subarachnoid hemorrhage. Possible PRES. There is diffuse cerebral edema with increased density surrounding the basal cisterns and cerebellar tentorium compatible with pseudo-subarachnoid hemorrhage. Low attenuation is seen throughout the cerebral convexities bilaterally involving the bilateral frontal and occipital lobes. There is crowding at the level of the foramen magnum suggestive of ectopia versus artifact. All the cisterns are effaced.There is a focus of high attenuation within the right posterior occipital lobe compatible with hemorrhage this may be secondary to hypertensive hemorrhage.The ventricles are mildly enlarged however not significantly different compared to the previous MRI brain dated 3/11/2005.Again noted is a shunt catheter which traverses the right lateral neck soft tissues the catheter tip terminates within the foramen magnum and upper cervical spine. Within the limits of CT examination there is no evidence of shunt discontinuity or kinking.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. Diffuse cerebral edema with multifocal patchy white matter hypoattenuation with focus of parenchymal hemorrhage in the right occipital lobe compatible with hypertensive hemorrhage. Further evaluation with MRI may be considered as clinically indicated2. No evidence of subarachnoid hemorrhage as clinically questioned.3. Shunt catheter at the level of the foramen magnum and upper cervical spine without evidence of discontinuity or kinking."}
{"instruction": "Generate impression based on findings.", "input": "24 year old with hypertrophic cardiomyopathy presenting for CMR as part of VANISH trial. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 84 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 42 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is a small amount of nontransmural, mid myocardial late gadolinium enhancement in the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The LV walls are mostly normal in thickness (8-10 mm) with slight asymmetric hypertrophy in the basal anteroseptum (maximal15 mm). Native T1 time is normal ( < 1000 ms) including in hypertrophied area. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 156 ml (normal range 142+/-31), the RV end systolic volume index is 23 ml/m2 (normal range 31+/-9), and the RVESV is 42 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 leaflets appear elongated with chordal SAM. 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is scoliosis of the thoracic spine. 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. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 72%. There are no regional wall motion abnormalities present. There is a small amount of nontransmural, mid myocardial late gadolinium enhancement in the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The LV walls are mostly normal in size with slight asymmetric hypertrophy in the basal anteroseptum (max 15 mm). Native T1 time is normal ( < 1000 ms) including in hypertrophied area. 2. Normal right ventricular size and function. "}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Brachial neuritis or radiculitis NOSClinical question: assess for L.C 6/7 radiculopathySigns and Symptoms: LUE radicular pain and weakness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is T2 signal hyperintensity within the C6 and C7 vertebral bodies. The endplates appear intact at C6-7 and the disc has similar signal to other levels. There is no associated perivertebral signal hyperintensityAt 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. There is a minor disc bulge at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based right lateral recess disc protrusion at this level which mildly narrows the right neural foramen and mildly encroaches on the right-sided exiting nerve roots at this levelAt C5-6 there is no significant compromise to the spinal canal. There are small bilateral uncovertebral osteophytes present at this level associated with a diffuse disc bulge and some mild narrowing of the neural foramina with mild encroachment of the exiting nerve roots..At C6-7 there is no significant compromise to the spinal canal. There is a broad-based left lateral recess disc extrusion present which extends into the left lateral recess and left neural foramen and encroaches on the left-sided exiting nerve roots within the left neural foramen. Some disc material tracks behind the C7 vertebral body. There are associated uncovertebral osteophytes present.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The left vertebral artery flow-void is not readily identified. There is an MRI of the brain from July 10, 2009 demonstrating that the left vertebral artery was patent at that time intracranially. The right vertebral artery flow voids appears to be intact.", "output": "1.The left vertebral artery flow-void is not readily identified. This raises the question of occlusion or near occlusion of the left vertebral artery. If clinically appropriate additional imaging of the vertebrobasilar vascular system may be helpful to further evaluate this. There is an MRI of the brain from July 10, 2009 demonstrating that the left vertebral artery was patent at that time. 2.There is encroachment of the left exiting nerve roots at C6-7 due to disk extrusion and uncovertebral osteophytes.3.There are degenerative changes present in the cervical spine. There are associated signal changes within the C6 and C7 vertebral bodies which are suggestive of subacute inflammatory change most likely due to degenerative change. There is mild encroachment of exiting nerve roots bilaterally at C5-6 and on the right side at C4-5 due to degenerative change.4.An email and an alphanumeric page were sent to Dr. Rezania regarding the above findings."}
{"instruction": "Generate impression based on findings.", "input": "Diabetes insipidus with right ptosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution. There is a punctate focus of susceptibility effect in the left posterior temporal lobe, which may represent chronic microhemorrhage. There is no abnormal intracranial enhancement. There is septum cavum pellucidum and vergae. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Scattered cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution is nonspecific, but may represent chronic small vessel disease. 3. Diffuse cerebral volume loss."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with history of meningioma resection, surveillance exam Post operative changes of high right posterior frontal/parietal paramedian craniotomy. Residual parenchymal encephalomalacia and gliosis at the site of resected meningioma is redemonstrated. Mild dural thickening and enhancement immediately adjacent to the right side of the superior sagittal sinus and the craniotomy flap is not significantly changed. Left anterior middle cranial fossa arachnoid cyst with mild mass effect on the left temporal tip is unchanged.The cerebral cortex and ventricles are otherwise unremarkable. No diffusion-weighted signal abnormality. Trace fluid in the mastoid air cells. The visualized paranasal sinuses are clear.", "output": "1. Postoperative changes of high right paramedian meningioma resection without evidence of recurrence.2. Stable left middle cranial fossa arachnoid cyst."}
{"instruction": "Generate impression based on findings.", "input": "32 year old female 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.Moderate motion artifacts are noted in the subtraction images.A focal non-mass enhancement is again seen in the right breast at 6 o'clock position without any interval changes.No abnormal enhancement is seen in either breast. No abnormal axillary 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": "Ms. Klipstein is a 69-year-old woman with a personal history of right simple mastectomy for invasive mammary carcinoma in 2007 presents for follow-up. Patient also received hormonal therapy for 8 years. There is heterogeneous amount of fibroglandular tissue in the left breast. Minimal parenchymal enhancement is noted in the left breast. There is no abnormal enhancement seen in the left breast. A few cysts are seen in the left breast. There are postsurgical changes of right breast mastectomy with implant-based reconstruction. There is no abnormal enhancement surrounding the retropectoral silicone implant or in the right chest wall. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Possible T1 lucency on recent CT, status post recent chemoRT for head and neck cancer. There is diffuse fatty bone marrow signal in the imaged C6 through T1 vertebrae. There are also more focal areas of fat signal with spiculated bony trabeculae and minimal enhancement in the T2 vertebral body that measure up to 12 mm. Otherwise, there is no evidence of abnormal enhancement or tumors elsewhere in the thoracic spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a small posterior disc-osteophyte complex at C6-7, but no significant spinal canal stenosis in the thoracic spine. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.", "output": "Radiation effects in the C6 through T1 vertebrae and hemangiomas in the T2 vertebral body. Otherwise, no evidence of metastatic disease in the thoracic spine."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with HCV and cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Small right transient hepatic intensity difference (THID) is redemonstrated. No evidence of HCC. The portal vein appears patent.SPLEEN: Mildly enlarged.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Cirrhotic liver morphology without evidence of HCC. Unchanged right THID."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other specified disorders of muscleClinical question: STROKE ROSigns and Symptoms: L WEAKNESS MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is proximal bifurcation of the right middle cerebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally with associated small P1 segments. The A1 segments are similar in diameter.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The thyroid gland has a somewhat heterogeneous appearance.", "output": "1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.There is no evidence for acute cerebral ischemic infarction.4.Heterogeneous appearance to the thyroid gland is a nonspecific finding."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other intervertebral disc displacement, lumbar region Sacrococcygeal disorders, not elsewhere classified Low back painClinical question: eval for disc herniationSigns and Symptoms: lbp for 2 years Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a small central disc protrusion present at this level. This is stable compared to the prior exam.At L4-5 there is a right lateral recess disc extrusion present which encroaches on the nerve roots of the right lateral recess and extends behind the L5 vertebral body at the right lateral recess. There is also loss of disc space height and endplate reactive change present at this level. The endplate reactive changes T1 hyperintense. When compared to the exam from 6/5/2014 the disc extrusion has changed. It now tracks behind the L5 vertebral body whereas it previously was centered at the disc space level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "Since the prior exam, a disc extrusion at L4-5 which compresses the nerve roots of the right lateral recess has migrated further behind the L5 vertebral body that on the prior exam."}
{"instruction": "Generate impression based on findings.", "input": " The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is redemonstration of a chronic right orbital floor blowout fracture with caudal extension of orbital fat. There is also associated deformity with rounding of the right inferior rectus muscle. There is minimal adjacent patchy opacity within the right maxillary sinus.MRA HEAD", "output": "1.No MR evidence of demyelinating disease within the brain or cervical spine.2.Unremarkable MRA of the head and neck, although with limited evaluation of the V2 segments secondary to venous contamination. Grossly, cervical vertebral artery flow voids are present on MRI of the cervical spine.3.Minimal lower cervical spondylotic changes without significant stenosis at any level.4.Redemonstration of chronic right orbital floor blowout fracture."}
{"instruction": "Generate impression based on findings.", "input": "69 years Female (DOB:9/22/1946)Reason: new stroke, normal pressure hydrocephalus? History: weakness, falls, hx of dementiaPROVIDER/ATTENDING NAME: AMBER T PINCAVAGE AMBER T PINCAVAGE There is a moderate degree of confluent periventricular T2 and FLAIR hyperintense and T1 hypointense white matter lesions associated with punctate T2 and FLAIR hyperintense lesions. Additional patchy T2 and FLAIR hyperintensity is present in the brainstem and left anterior limb of the internal capsule. This is stable compared to the previous exam from 1/19/2015.There is ventriculomegaly present. This is stable compared to the previous exam from 1/19/2015.No foci of diffusion restriction are appreciated within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.", "output": "1.Moderate to marked degree of periventricular and subcortical white matter lesions associated with brainstem lesions which were also present on the prior exam. Most likely these are vascular related. Please, the patient's clinical history. This is stable compared to the previous exam from 1/19/20152.Mildly enlarged lateral ventricles could be related to atrophy or normal pressure hydrocephalus. This correlates clinical symptoms. This is stable compared to the previous exam from 1/19/20153.Exam is mildly degraded due to patient motion which may obscure more subtle abnormalities.4.There is no evidence for acute ischemic cerebral infarction on the current exam."}
{"instruction": "Generate impression based on findings.", "input": "Encounter for other preprocedural examination [Z01.818] / Hemangioma of intracranial structures [D18.02] / Unspecified convulsions [R56.9], Reason for Study: ^Reason: PRE-OP please do in CCD at 6:00am - PLEASE PAGE NEUROSURGERY RESIDENT TO PLACE FIDUCIALS Multiple fiducial markers attached on scalp for the preparation of stealth registration.There is a 13.2 mm x 14 mm x 12.7 mm sized cavernous malformation on the right side anterior inferior aspect of middle temporal gyrus with the peripheral hemosiderin deposition, unchanged since prior scan.There is a developmental venous anomaly at the right cerebellar hemisphere, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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": "Right middle temporal gyrus cavernous malformation as described above."}
{"instruction": "Generate impression based on findings.", "input": " Evaluation is limited due to lack of coronal T2-weighted images, and axial T2-weighted images are not of usual FSE technique. 3-D SPGR images are degraded by artifact. Axial T1 inversion recovery images are also not available to aid with myelination evaluation.There are numerous scattered foci of susceptibility, slightly more tubular in appearance along the right parietal lobe near the convexity, possibly representing hemosiderin deposition along the gray-white junction. Additional punctate foci are seen along the left anterior mid frontal lobe, the right anterior temporal lobe, the right greater than left occipital lobe, along the left greater than right tentorium, as well as near the cerebellar tonsils, perhaps along the fourth ventricular outflow on the left side. These are predominantly peripheral in location, possibly at the gray-white junction. The most conspicuous area of abnormal susceptibility is seen along the anterior left temporal lobe which may be subarachnoid in location given its plaque-like configuration. The right occipital lobe finding may involve the peripheral cortex, with possible foci in the adjacent extraparenchymal space.On axial T2-weighted images, there is prominence of extra-axial space along the frontal lobes with no significant traversing vessels, most conspicuous laterally. The collections are near isointense to CSF on all sequences, and remain only minimally hyperintense as suggested on coronal T1 postcontrast images. These measure up to approximately 5 mm in greatest thickness bilaterally. There is no significant prominence of extra-axial space along the anterior temporal lobes or anterior interhemispheric fissure to suggest underlying benign enlargement of subarachnoid spaces of infancy.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. There is no diffusion abnormality.Normal flow-voids are demonstrated in the major intracranial vascular structures. The left cerebellar tonsil is minimally pointed in configuration, although does not appear to extend abnormally below the level of the foramen magnum. The remainder of the midline structures and craniocervical junction are within normal limits. There is scattered paranasal sinus opacification. There is also fluid opacification of bilateral middle ears and mastoids, greater on the right.", "output": "1.Essentially chronic small bilateral predominantly frontal subdural hematomas, with signal only very minimally greater than CSF on T1-weighted images, although evaluation is somewhat limited as detailed above.2.Multiple scattered areas of hemosiderin staining, with most conspicuous areas in the left anterior temporal region which may be subarachnoid in location, as well as more tubular appearing areas along the right parietal cortex likely near the gray-white junction. Other scattered foci are also more peripheral in location as well as possibly along the tentorium. Findings may relate to a shear injury mechanism, resulting in areas of focal axonal injury. Please correlate with any history of trauma, including nonaccidental trauma.3.Bilateral mastoid and middle ear fluid opacification. Please correlate clinically."}
{"instruction": "Generate impression based on findings.", "input": "A 56 year-old woman with history of left breast tubular cancer and DCIS diagnosed at age 44, status post left lumpectomy and radiation therapy. History of benign right biopsies. Family history breast cancer in her mother and maternal great-grandmother. There is heterogeneous amount of fibroglandular tissuein both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 2 years s/p resection of MPNST of left posterior thigh, hx of NF1, evaluate for recurrence History: above Again seen are postsurgical changes of prior resection of the patient's reference mass within the posterior compartment of the left thigh. There are multiple foci of metallic susceptibility artifact which are likely postsurgical in etiology. Again seen are multiple subcentimeter foci of enhancement within the subcutaneous tissue along the posterior aspect of the thigh which appear similar to the prior study and may reflect postsurgical granulation tissue. No new foci of enhancement are identified.The reference lobulated heterogeneous mass interposed between the semimembranosus and long head of the biceps femoris along the distal aspect of the femoral metaphysis at the bifurcation of the tibial and peroneal nerve, measures 2.8 x 1.7 cm, previously 2.5 x 1.8 cm (image 71; series 11) consistent with the patient's known history of neurofibromas. The reference cutaneous mass along the medial aspect of the knee measures 4.0 x 1.8 cm, previously 4.0 x 1.7 cm (image 73; series 11), not significantly changed. Multiple additional foci of signal abnormality along the course of the sciatic nerve and cutaneous nodules are also consistent with the patient's known history of neurofibromatosis.", "output": "Findings consistent with patient's history of neurofibromatosis. Surgical changes of prior resection of the patient's known left thigh mass. No significant interval change in multiple nonspecific punctate foci of enhancement within the subcutaneous tissues along the posterior aspect of the thigh which likely represent granulation tissue from prior surgery. Otherwise no findings to suggest residual or recurrent tumor."}
{"instruction": "Generate impression based on findings.", "input": "Female, 67 years old. Reason: Rule out cuff tear History: Right shoulder pain ROTATOR CUFF: There is a full-thickness tear of the supraspinatus without muscle retraction. There is thickening and intermediate signal within the infraspinatus tendon likely representing a tendinopathy. There is a small amount of fluid in the subacromial bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "1. Full-thickness tear of the supraspinatus without retraction. 2. Tendinopathy of the infraspinatus tendon."}
{"instruction": "Generate impression based on findings.", "input": "Female, 86 years old, with virtigo that woke the patient up from sleep, nystagmus, nausea and vomiting. Evaluate for brain stem stroke from posterior circulation No restricted diffusion is seen. There is, however, patchy and confluent periventricular T2 hyperintensity. Involvement of the subcortical white matter, basal ganglia, thalami, and the pons is also evident. No parenchymal mass effect or edema is seen. No intracranial hemorrhage or any other abnormal extra-axial fluid collection is seen. The ventricles and sulci are proportionately prominent compatible with volume loss.", "output": "1.No acute intracranial abnormality, and in particular, no evidence of acute ischemia.2.Moderately extensive chronic small vessel and lacunar ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "25 year-old woman with bilateral basal ganglia hypodensity. Evaluate question of increased swelling. Portable head CT. Examination of the brain stem and posterior fossa structures is limited due to artifact.The basal ganglia, surrounding subcortical white matter, and internal capsule exhibit marked hypoattenuation bilaterally consistent with edema. Accounting for differences in technique, these findings appear to be stable from the MRI dated 8/14/2008. On the current study, there are two focal areas of hyperattenuation in the region of the right internal capsule which are consistent with punctate hemorrhage. On the prior MRI, there are no corresponding findings in this region, suggesting interval change.There is effacement of the cortical sulci suggestive of cerebral edema. Gray-white differentiation is preserved. The right basal ganglia exert mass effect upon the right lateral ventricle causing partial effacement. There are no findings of obstructive hydrocephalus.The calvaria and skull base are radiographically normal. Mucosal thickening is present in the sphenoid sinus and ethmoid air cells. There is partial opacification of the mastoid air cells bilaterally.An endotracheal tube is present. A nasogastric tube enters through the left naris.", "output": "1. Bilateral hypoattenuation of the basal ganglia and surrounding white matter consistent with edema. Accounting for differences in technique, this finding appears roughly stable from the prior MRI.2. Focal areas of hyperattenuation in region of right internal capsule consistent with punctate hemorrhage.3. Effacement of cortical sulci consistent with cerebral edema.4. Limited evaluation of brainstem and posterior fossa."}
{"instruction": "Generate impression based on findings.", "input": "83 year old with previously treated right breast cancer and newly diagnosed left axillary cancer. Evaluate for disease. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally. The right breast is smaller than the left, compatible with her surgical history.No abnormal enhancement is seen in either breast. Within the left axilla, multiple (4 or 5) abnormal lymph nodes are seen. The largest contains the Hydromark biopsy clip and measures 1.2 x 1.1 cm. No abnormal lymph nodes are identified in the right axillary region. Post-operative changes are seen.", "output": "Multiple suspicious left axillary lymph nodes, including the biopsy proven malignant node. No MRI evidence for malignancy within the breasts. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": " There is straightening of the normal lumbar lordosis. The vertebral body heights are well-maintained. There is moderate loss of disc height at L3-4 and severe loss of disc height with endplate degenerative changes at L4-5. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.T12-L1: No significant disc bulge, herniation, spinal canal or foraminal stenosis. L1-L2: No significant disc bulge, herniation, spinal canal or foraminal stenosis.  L2-L3: Mild disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum. No significant spinal canal or foraminal stenosis. L3-L4: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild bilateral foraminal stenosis and mild spinal canal stenosis. L4-L5: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild right and mild to moderate left foraminal stenosis with encroachment at the right lateral recess. No significant spinal canal stenosis. L5-S1: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild to moderate right and mild left foraminal stenosis with encroachment of the nerve roots at the right lateral recess, unchanged. No significant spinal canal stenosis.", "output": "No significant interval change in the degenerative changes of the lower lumbar spine, which contribute to mild bilateral foraminal and spinal canal stenosis at L3-L4, variable foraminal stenosis and encroachment of the right lateral recesses at L4-L5 and L5-S1. No significant spinal canal stenosis at the other levels."}
{"instruction": "Generate impression based on findings.", "input": "Lower left back pain, grossly reduced sensation in left lower back and left anterior thigh, 3/5 strength in left leg and left ankle Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is straightening of the lumbar spinal curvature; alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Postcontrast images demonstrate no abnormal enhancement within the spine.Individual levels 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: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Cyst involving the inferior pole of the right kidney incidentally noted.", "output": "No compromise to the lumbar spinal canal or neural foramina. No abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "Female, 44 years old, with obesity, left lower extremity weakness, and incontinence of bowel and urine, also with radicular low back pain. Assess for cord compression. No significant spinal canal stenosis or cord compression is seen in the cervical region.In the thoracic spine, there is prominence of the dorsal epidural fat most notably from T3-4 through T8-9 which results in moderate to severe spinal canal narrowing and perhaps some mass effect on the spinal cord. In addition, there is significant facet arthropathy and ligamentum flavum thickening at T4-5, T5-6 and T6-7. At T4-5, there is questionable abnormal cord signal intensity.Beginning with T5, the endplates of the thoracic vertebral bodies are irregular and most levels show a slight anterior wedging which could reflect Scheuermann's disease.In the lumbar spine, disc degeneration and endplate signal abnormality are seen at L5-S1. In addition, there is a large inferiorly directed L5-S1 disc extrusion which narrows the spinal canal at the S1 level, potentially impinging on transiting nerve roots. Elsewhere, no significant stenosis seen within the lumbar spine.Spinal alignment is relatively anatomic allowing for straightening of the cervical lordosis. Except as discussed in the thoracic region, vertebral body heights are preserved. Scattered degenerative marrow signal change is noted.", "output": "1.Prominence of the dorsal epidural fat is seen in the thoracic spine, most notably from T3-4 through T9. This, along with facet hypertrophy and ligamentum flavum thickening at T4-5, T5-6 and T6-7, contributes to a moderate to severe generalized narrowing of the thoracic spinal canal with perhaps some mass effect on the cord. There is questionable cord signal abnormality at T4-5. Findings could be better assessed with dedicated thoracic spine imaging.2.Disc degeneration is seen at L5-S1, and in particular, there is a large inferiorly directed disc extrusion which significantly narrows the spinal canal at the S1 level potentially impinging on traversing nerve roots. Findings could be better assessed with dedicated lumbar spine imaging."}
{"instruction": "Generate impression based on findings.", "input": "Male; 71 years old. Reason: eval for fistula vs. abscess History: rectal pain, bleeding PELVIS:PROSTATE/SEMINAL VESICLES: Prostatomegaly with the prostate gland measuring up to 3.7 x 5.2 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Findings of acute proctitis with moderate circumferential rectal wall thickening with enhancement and mild perirectal fluid, particularly posteriorly. 7 x 5 mm intramural rectal abscess located posteriorly near the anus (series 801/124). No perirectal or perianal fistula or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Findings compatible with acute proctitis with small intramural rectal abscess."}
{"instruction": "Generate impression based on findings.", "input": "Assess for vascular malformation: neck mass. There is a rather well defined multicystic mass in the left parapharyngeal and retropharyngeal spaces with minimal peripheral enhancing components. The mass measures up to 50 mm in height and spans the C2 through C6 vertebral body levels. The mass displaces the left internal carotid artery and internal jugular vein posteriorly. There is no significant cervical lymphadenopathy. The tumor indents the left thyroid lobe. The thyroid tissue and salivary glands are otherwise unremarkable. There is lack of the usual cervical lordosis. The osseous structures are otherwise intact. The patient is intubated. The orbits and imaged intracranial structures are grossly unremarkable.", "output": "A rather well defined multicystic mass in the left parapharyngeal and retropharyngeal spaces that measures up to 50 mm likely represents a macrocystic lymphatic malformation versus less likely a previously infect branchial apparatus anomaly, for example."}
{"instruction": "Generate impression based on findings.", "input": " Images are limited by patient motion despite repeated sequences. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is suggestion of mild cord thinning at the cervicothoracic junction. There is a focus of T2/STIR hyperintensity centrally within the cord at the C5-C6 level, not well delineated on the motion degraded axial images. There is an additional linear T2/STIR hyperintensity suggestive the upper thoracic cord at least at the T1 level.At C6-C7, there is a shallow central disc protrusion which indents the thecal sac.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine.There is prominent patchy hyperintensity within the pons and right brachium pontis previously seen on MRI of the brain.", "output": "Severely motion degraded exam. Suggestion of mild cord atrophy along the cervicothoracic junction with focal abnormal signal at C5-C6 level and likely spanning the T1 level. Follow-up diagnostic axial imaging through the cervical spine is likely helpful for further characterization although findings are suspicious for demyelinating disease."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review is MRI performed on 2/5/16. For comparison, her previously submitted outside studies are available. MRI MRI was performed as per outside protocol and uploaded to DynaCAD. There is an extreme amount of fibroglandular tissue in the breasts. Mild background parenchymal enhancement is noted. There are total of 4 masses in the right upper central breast which span more than 5 cm. From the superiormost to the inferior most, these masses measure 1.3 x 2.1 x 1.7 cm, 1.6 x 1.4 x 1.5 cm, 0.9 x 1.0 x 1.1 cm, and 0.9 x 0.9 x 1.0 cm. Clip artifacts are within or adjacent to the two most superior masses and the most inferior mass. The most inferior mass approaches to within 7 mm of the nipple. The most superior mass abuts the pectoralis posteriorly over a distance of nearly 2 cm, though there is normal muscle enhancement. No suspicious left breast enhancement. No enlarged axillary lymph nodes are seen.", "output": "Four enhancing masses on MRI in the right breast spanning more than 5 cm together, with the largest mass measuring up to 2.1 cm.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "23 years Male (DOB:7/2/1992)Reason: eval acute cva History: acute cva per head ctPROVIDER/ATTENDING NAME: MARION A HOFMANN-BOWMAN MARION A HOFMANN-BOWMAN MRI of the brainThere is a 32x27 mm focus of diffusion restriction associated with T2 and FLAIR signal hyperintensity present involving the left superior parietal lobule associated with subcentimeter foci of diffusion restriction in the left post central gyrus and the posterior aspect of the left middle frontal gyrus. Punctate foci of susceptibility within the left inferior parietal lobule likely represent petechial blood.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The left vertebral artery is large in diameter compared to the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.", "output": "1.Subacute infarction involving the middle cerebral artery territory - predominantly left superior parietal lobule with satellite foci of infarction in the left post central gyrus and left middle frontal gyrus. No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease."}
{"instruction": "Generate impression based on findings.", "input": " Direct comparison to the previous MRIs is difficult, given technical limitations of those studies. Multiple periventricular white matter lesions appear more conspicuous and confluent than on the prior study, which may be due to technique and/or progression. For example, a posterior left frontal lobe lesion was not definitely apparent on the prior study and may represent a new lesion. Additionally, there are several punctate lesions in the bilateral cerebral hemispheres, which were not apparent previously and which may indicate new lesions. Furthermore, the T2 signal surrounding the right occipital horn of the lateral ventricle appears more pronounced than on the prior study. Many of these lesions demonstrate T1 hypointensity indicating chronicity. In particular, a right pons/midbrain lesion appears to have developed T1 hypointensity along with decreased T2 hyperintensity. The ventricles and sulci are unchanged. The basal cisterns remain patent. There is no midline shift or mass effect.", "output": "Numerous supratentorial and infratentorial demyelinating lesions. Comparison with the prior exam is limited due to differences in technique, although some lesions may have slightly progressed and some now exhibit more chronic features."}
{"instruction": "Generate impression based on findings.", "input": " Redemonstrated is a T2 hyperintense lesion within the cerebellar vermis with regions of intrinsic T1 shortening and several foci of susceptibility artifact corresponding to previously noted calcifications as well as patchy regions of enhancement, not significantly changed from prior exams. Mild mass effect on the posterior wall the fourth ventricle is again noted without associated hydrocephalus. The mass measures 2.9 x 1.9 cm (previously 2.9 x 1.9 cm), not significantly changed compared with multiple prior exams (image 154, series 14). Low-lying cerebellar tonsils extending 6-7mm below the foramen magnum without peg-like appearance. There is moderate crowding. No evidence of acute ischemia or midline shift. No additional suspicious enhancement is identified. Normal flow voids are identified in the major intracranial vessels. Right maxillary sinus retention cyst and mild mucosal thickening.", "output": "1. Unchanged midline cerebellar vermian lesion with foci of calcification and enhancement with unchanged differential.2. Low lying but rounded cerebellar tonsils, equivocal for Chiari I malformation and possibly acquired secondary to the cerebellar vermis lesion - correlate with symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Eval for MPFL tear History: Patellar instability MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema along the anterolateral aspect of the lateral femoral condyle likely from recent patellar dislocation. The superior aspect of the femoral trochlea appears shallow indicating femoral trochlear dysplasia, but the articular cartilage of the patellofemoral articulation appears intact. The articular cartilage of the medial and lateral compartments appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is mild increased signal intensity within the posterior fibers of the superficial band of the MCL which may represent a mild sprain, but we see no tear.EXTENSOR MECHANISM: The patellar tendon appears intact. The quadriceps tendon appears intact. There is thickening and abnormal signal intensity of the medial retinaculum indicating tearing. The MPFL is not well visualized as a discrete structure in this patient and is likely torn. Of note, the retinacular structures appear abnormal and likely torn at both the patellar and femoral attachments. There is also edema superficial to the vastus medialis muscle.ADDITIONAL", "output": "Findings indicating prior transient lateral dislocation of the patella including bone marrow edema along the anterolateral aspect of the lateral femoral condyle as well as tearing of the medial retinaculum and MPFL as described above."}
{"instruction": "Generate impression based on findings.", "input": "Insidious dementia. There is moderate diffuse cerebral white matter T2 hyperintensity bilaterally, predominantly in a periventricular distribution. There is a subcentimeter area of encephalomalacia in the right cerebellar hemisphere. There is no evidence of intracranial mass or acute infarct. There is no abnormal intracranial enhancement. There is a punctate focus of susceptibility effect in the left pons, which may represent a chronic microhemorrhage. There is prominence of the lateral and third ventricles, perhaps out of proportion to the other cerebrospinal fluid spaces. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. Prominence of the lateral and third ventricles, perhaps out of proportion to the other cerebrospinal fluid spaces, may indicate normal pressure hydrocephalus. 2. Moderate chronic small vessel ischemic white matter disease and a chronic right cerebellar lacunar infarct, but no acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "70 years Female (DOB:11/6/1946)Reason: pain History: painPROVIDER/ATTENDING NAME: RODERICK H. BIRNIE RODERICK H. BIRNIE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is disc desiccation present at this level associated with a diffuse disc bulge marked bilateral facet and ligamentum flavum hypertrophy there is associated narrowing of the neural foramina. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. There are some partial effacement of the fat at the lateral recess bilaterally resulting in encroachment of the nerve roots at the lateral recess bilaterally.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated marked bilateral facet and ligamentum flavum hypertrophy. There is mild anterior subluxation of L4-5. There is crowding of the nerve roots within the thecal sac. There is narrowing of the neural foramina bilaterally with encroachment of the nerve roots within the neural foramina bilaterally worse on the left side compared to the rightAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild to moderate degree of facet and ligamentum flavum hypertrophy at this level. There is a mild disc bulge at this level.At L2-3 there is no significant compromise to spinal canal. There is mild facet and ligamentum flavum hypertrophy at this level there is a right far lateral disc protrusion at this level encroaching right-sided exiting nerve root within the neural foramen. There are Schmorl's nodes at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge at this level.", "output": "1.There are multilevel degenerative changes present in the lumbar spine worse at L4-5 where there is moderate degree of spinal stenosis associated with encroachment of the exiting nerve roots within the neural foramina predominantly on the left side.2.There is encroachment of nerve roots at the lateral recess bilaterally at L5-S1 related to degenerative change3.There is a right far lateral disc protrusion present at L2-3 which encroaches the right-sided exiting nerve root"}
{"instruction": "Generate impression based on findings.", "input": "Right lower extremity numbness 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 normal in position.There is minimal disc desiccation and trace disc bulge at the L2-L3 and L4-L5 levels. There is otherwise no significant disc disease at any level. No spinal canal or neural foraminal stenosis at any level. Incidentally seen is a tiny perineural cyst associated with the right L5 and left T12 nerve roots, which are of doubtful clinical significance.Paraspinous soft tissues are within normal limits.", "output": "Examination is essentially unremarkable. There are minimal degenerative changes without spinal canal or neural foraminal stenosis at any level."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female with a new foci mass. Evaluate mass. A vitamin E capsule overlies the medial soft tissues of the left thigh, presumably representing the patient's palpable area of concern. Note is made of a focus of fat signal intensity within the subcutaneous tissue along the medial aspect of the thigh/femoral diaphysis, underlying the aforementioned skin marker, with increased signal abnormality peripherally on fluid sensitive sequences, measuring approximately 17 x 7 x 13 mm (AP by TR by CC). There is thin peripheral enhancement on postcontrast sequences. No additional masses or pathologic enhancement is identified. The imaged musculature is normal in appearance. No bone marrow signal abnormality is identified.", "output": "17 mm mass with fat signal intensity which appears most consistent with a lipoma, although atypical lipoma remains as a differential consideration. Follow-up evaluation by an orthopedic oncologist is recommended."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male with abdominal pain and prior CT with 1.5 cm enhancing lesion in the liver. Evaluate hepatic lesion. ABDOMEN:LIVER, BILIARY TRACT: There is a T2 hyperintense focus in segment 7 which demonstrates peripheral nodular enhancement with filling in of the lesion on the delayed contrast enhanced phase. No evidence of washout. This lesion measures proximally 1.5 x 0.9 cm (series 7, image 30).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys enhance symmetrically without evidence of hydronephrosis.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": "Segment 7 hepatic lesion most consistent with a hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "16 years, Male, follow-up contusion. Diffuse traumatic brain injury. There are areas of T2 hypointensity with susceptibility involving the right anterior inferior frontal lobes centered on the gyri recti consistent with contusion and similar to recent CT head. There is surrounding edema and minimal local mass effect. There is also minimal extra-axial T2 hyperintensity along the bilateral frontal cerebral convexities without suppression on the FLAIR sequence suggesting minimal subdural fluid.No midline shift or herniation. No hemorrhage is seen elsewhere in the brain. No evidence of ischemia, intracranial mass, midline shift, or herniation. Ventricles remain normal in size. Major flow-voids are preserved. Remainder of the brain is unremarkable. Calvarium and extra cranial soft tissues are grossly unremarkable.", "output": "Bilateral frontal lobe contusions with surrounding edema similar to recent CT allowing for differences in technique. Minimal subdural fluid/blood products also suspected along the frontal convexities without mass effect. No evidence of traumatic injury elsewhere in the brain."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Jones-Hansbrough submitted outside mammogram dated 6/30/2014, from Regenstein Breast Imaging Center. She was recently diagnosed with right breast IDC in March 2015. Submitted outside study was compared to multiple recent examinations spanning from 02/18/2015 to 03/18/2015. The breast parenchyma is composed of scattered fibroglandular elements. No suspicious masses, microcalcifications or areas of architectural distortion are present on the submitted prior mammogram dated 06/30/2014.  However, there is development of a new ill-defined mass in the right retroareolar breast on mammogram dated 02/18/2015, which was eventually biopsied with pathology of IDC. Patient has since also had an MRI dated 03/18/2015 that demonstrated unifocal malignancy.", "output": "Patient has a known unifocal malignancy in the right breast. She is being followed by surgery. No additional imaging is warranted at this time.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old male with ischemic cardiomyopathy, coronary artery disease, DM, HTN and CHF. Because of limited function capacity, patient is referred to rule out ischemia for pre-operative risk assessment prior to hip surgery. MEDICATIONS: Amlodipine, aspirin, carvedilol, ergocalciferol, multivitamin, lovaza, quinapril, simcor, xarelto. First Pass PerfusionDuring hyperemia, a perfusion defect corresponding with the below described myocardial infarction is noted. No ischemic territories are present.Viability/ Myocardial ScarThere is a large, predominantly, transmural myocardial infarction involving the basal and mid inferoseptal, inferior, and inferolateral walls. Additionally, the apical inferior wall is involved. These infarcted myocardial segments are predominantly not viable and are the cause of the above described perfusion defect. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 145 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 76 g/m2, and the LV mass is 125 g. There is subtle hypokinesis of the basal to mid inferior wall and the basal inferolateral wall.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 68 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 FindingsMultiple, large, bilateral renal cyst are noted. Sternal wires are noted. 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. There is a large mostly transmural myocardial infarction involving the above described walls. This infarction is predominantly not viable. The remainder of the myocardium is free of myocardial infarction and viable. There are no areas of residual myocardial ischemia.2. Normal LV size and systolic function (LVEF 62%). There is subtle hypokinesis of the basal to mid inferior wall and the basal inferolateral wall.3. Normal RV size and systolic function (RVEF 51%).4. See extracardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old woman with history of pelvic mass. PELVIS:UTERUS, ADNEXA: In the cul-de-sac posterior to the uterus, there is a 117 x 99 x 94 mm multilobulated, irregularly-shaped mass. This mass is predominantly T2 hypointense, however contains reticular T2 hyperintensity. There is no definite cystic change within this mass. Only a small portion of this mass enhances (10011/273). This lesion is distinct from the uterus and the rectum.A second lesion with similar appearance is seen along the superior right aspect measuring 26 x 19 mm (4/32).Within the left uterine fundus (3/48) there is a 9 mm T2 hypointense intramural lesion, likely a fibroid. The ovaries are not identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Hemangioma in the L5 vertebral body.OTHER: No significant abnormality noted.", "output": "Large, irregular shaped pelvic mass in the cul-de-sac and smaller, satellite mass with similar imaging characteristics. Imaging and enhancement characteristics are nonspecific but differential considerations include fibrous tumor of the adnexa (such as an ovarian fibrothecoma) or pedunculated, torsed fibroid."}
{"instruction": "Generate impression based on findings.", "input": "Male, 67 years old, with right lower extremity weakness. Image quality is significantly degraded by motion artifact. Within this limitation the following observations are made.There is a grade 1 anterolisthesis of L4 relative to L5. The lumber spine is mildly scoliotic. Vertebral body heights are preserved. No evidence of marrow replacement or significant marrow edema is seen.Visualized spinal cord and conus are unremarkable. The nerve roots of the cauda equina are not well assessed due to motion artifact, but no significant abnormalities are suspected.L1-2: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disk preferentially towards the neural foramina. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Bulging disk preferentially towards the neural foramina. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Bulging disk with effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. Severe right neuroforaminal narrowing with nerve root impingement secondary to posterior element hypertrophy and disk degeneration. Mild left foraminal narrowing. L5-S1: Mild facet hypertrophy. Mild bulging disk. No significant spinal canal stenosis. Mild right neuroforaminal narrowing.", "output": "1. Significantly limited examination due to motion artifact.2. Multilevel degenerative findings, most severely affecting the L4-5 level, where there is a bulging disk and posterior element hypertrophy which result in severe narrowing of the right L4-5 neural foramen with probable nerve impingement."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female for follow-up thyroid nodules. RIGHT LOBE MEASUREMENTS: 1.8 x 1.9 x 5.9 cmLEFT LOBE MEASUREMENTS: 1.6 x 1.7 x 6.4 cm . There was a typographical error on prior exam with an actual left lobe length of 6.8 cm.ISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Homogeneous echotexture without mass.LEFT LOBE: There is a complex although predominantly solid mass in the left lobe which abuts in the isthmus mass (see below). When remeasuring the same] as the prior exam this measures 1.9 x 3.7 x 2.4 cm, not significant changed when compared to prior exam. Medial portion of the nodule is difficult to identify due to abutting Isthmus nodule.ISTHMUS: Within the isthmus, there is a predominant solid nodule with cystic components which appears somewhat spongiform measuring 1.9 x 2.9 x 3 cm without change.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable isthmus and left lobe thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Left knee pain and OCD lesion of tibia. MENISCI: The posterior horn of the lateral meniscus is frayed, similar to the prior study. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a heterogeneous lesion with small cysts in the lateral tibial plateau without significant change from the previous study. There is no disruption of the articular cartilage. There may be an old osteochondral defect with subchondral cystic change, but this appears stable from the prior study. There is no evidence of loosening. There is mild adjacent bone marrow edema, similar to the prior study. LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: What was previously described as a short segment partial-thickness tear through the distal patellar tendon is most likely a normal variant of the patellar tendon with a cleft, appearing similar to the prior study.ADDITIONAL", "output": "1. OCD lesion of the lateral tibial plateau without disruption of the articular cartilage, similar to prior.2. Fraying of the posterior horn of the lateral meniscus, similar prior."}
{"instruction": "Generate impression based on findings.", "input": " There is no evidence of acute infarct. Numerous bilateral supratentorial enhancing lesions have decreased in both size and degree of enhancement although the latter may be secondary to technical factors. For example, a left frontal parafalcine lesion measures up to 13 mm, previously 15 mm, and demonstrates decreased surrounding edema and unchanged susceptibility effect compatible with blood products. As an additional example, a right frontal parafalcine lesion previously measured 6 mm and is not currently visible. There are no new lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is minimal mucosal thickening within the maxillary sinuses and minimal fluid within the mastoid air cells. There is a right lens implant.", "output": "Improvement of intracranial metastatic disease when compared with the March 5, 2015 MRI."}
{"instruction": "Generate impression based on findings.", "input": "Left shoulder pain. ROTATOR CUFF: There is a full-thickness insertional tear of the anterior fibers of the supraspinatus with less than 1 cm of retraction. The tear is approximately 1cm in AP dimension. Additionally, there is thickening and increased signal intensity of the tendon more proximally suggesting tendinosis. The supraspinatus muscle is unremarkable. The infraspinatus tendon and muscle as well as the teres minor tendon and muscle are within normal limits. Increased signal intensity in the distal fibers of the subscapularis tendon suggesting tendinosis, but no discrete tear is evident. The muscle appears normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. A small amount of fluid is noted within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is trace fluid in the glenohumeral joint, without frank effusion. Given the limitations of a non-arthrogram study, the glenoid labrum appears normal.BICEPS TENDON: Given the limitations of a non-arthrogram study, the long head of the biceps appears normal.", "output": "1.Rotator cuff tendinosis with full-thickness insertional tear of the anterior fibers of the supraspinatus, as described above.2.Osteoarthritis affects the acromioclavicular joint."}
{"instruction": "Generate impression based on findings.", "input": "Sickle cell disease. Evaluate for stenosis or moyamoya. Brain MRI:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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. There is fluid in the right mastoid air cells and middle ear cavity which can be congestive or inflammatory. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Head MRA:The right internal carotid artery is slightly larger and more hyperintense compared to the left. The left A1 segment is small but there is a large right A1 segment along with a large anterior communicating artery providing preserved flow in the downstream right anterior cerebral artery and branches. The vertebral arteries codominantly supply the basilar artery. There is no left P1 segment but a large left posterior communicating artery provides the preserved flow in the more downstream left posterior-superior cerebral artery. There is no stenosis or aneurysm.", "output": "1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Fluid in the right mastoid cells can be congestive or inflammatory. 3.There is no vascular occlusion or moyamoya transformation. 4.Normal variations involving the anterior and posterior circulations are described above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o tendon History: R pain with limited ROM ROTATOR CUFF: There is partial-thickness tearing of the anterior fibers of the articular surface of the infraspinatus at the level of its insertion on the greater tuberosity measuring approximately 4 mm in AP dimension. The infraspinatus muscle appears intact. There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is partial thickness tearing of the anterior fibers of the articular surface of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 10 mm in the AP dimension and involving less than 50% of the tendon width. There is also interstitial tearing of the supraspinatus more proximally. There is no significant retraction. There is mild fatty infiltration along the myotendinous junction of the supraspinatus and infraspinatus muscles. Evaluation of the subscapularis is limited due to lack of external rotation, however the subscapularis appears grossly intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of a non arthrogram study. There is cyst formation within the greater tuberosity.BICEPS TENDON: The tendon of the long head of biceps appears intact. There is circumferential fluid within the tendon sheath which may represent fluid extension of the joint. ADDITIONAL", "output": "Partial thickness insertional tearing of the rotator cuff as described above. No evidence of a full-thickness rotator cuff tear or retraction. Rotator cuff tendinosis."}
{"instruction": "Generate impression based on findings.", "input": "Patient with history of stenosis presenting with severe right-sided lumbar radiculopathy. The axial T1-weighted images are degraded by patient motion. There is multilevel degenerative spondylosis. At L1-L2, there is hypertrophy of ligamentum flavum and degenerative facet joint disease without significant spinal canal or neural foraminal stenosis. There is mild loss of intervertebral disc space at this level. At L2-L3, there is mild facet joint degenerative disease without significant spinal canal or neural foraminal stenosis. At L3-L4, there is thickening of the ligamentum flavum, facet joint hypertrophy, and epidural lipomatosis, resulting in severe spinal canal and mild right neural foraminal narrowing. At L4-L5, there is loss of disc height with mild disc bulging, ligamentum flavum thickening, facet joint hypertrophy, and epidural lipomatosis, resulting in moderate to severe central spinal canal stenosis and moderate bilateral neural foraminal narrowing. At L5-S1, there are mild disc herniations, prominent ligamentum flavum thickening, facet joint hypertrophy, and epidural lipomatosis, resulting in moderate right and severe left neural foraminal narrowing. There are endplate degenerative bone marrow signal alterations and scattered areas of fatty marrow at multiple levels of the lumbar spine. The imaged portions of the spinal cord are unremarkable. The lumbar spine alignment is anatomic and the vertebral body heights are preserved. The paraspinal soft tissues are unremarkable. There is nodularity of the left adrenal gland.", "output": "1. Multilevel degenerative spondylosis and epidural lipomatosis, with marked narrowing of the spinal canal at L3-4 through L5-S1 and variable degrees of neural foraminal narrowing.2. Nonspecific nodularity of the left adrenal gland, which can be further evaluated via dedicated imaging.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Temporary aphasia - concern for TIA. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral white matter T2 hyperintensity, particularly in a periventricular distribution. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive cerebrovascular lesions or aneurysms. There is a fetal left posterior cerebral artery and a hypoplastic left A1 segment, which are anatomic variants.Neck MRA: The proximal portions of the bilateral vertebral arteries are not well-delineated, likely due to artifact, although stenosis cannot be excluded. Otherwise, there is no evidence of significant steno-occlusive lesions.", "output": "1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. Mild diffuse cerebral white matter T2 hyperintensity, particularly in a periventricular distribution may represent chronic small vessel ischemia.2. No evidence of significant steno-occlusive lesions or aneurysms. 3. The proximal portions of the bilateral vertebral arteries are not well-delineated, likely due to artifact, although stenosis cannot be excluded. Otherwise, no evidence of significant steno-occlusive lesions in the neck arteries. However, a CTA may be useful for further delineation if the status of the vertebral arteries are of clinical concern."}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: lung cancer, evaluate for brain mets History: recent fall and loss of conscious, headaches There is no evidence of acute ischemic or hemorrhagic lesion.There is about 12.5mm (AP) x 11.4mm (CC) x 9.4mm (RL) sized extra-axial enhancing mass attached on the right side of the proximal which shows low signal intensity on T2 weighted images, and isointense signal intensity on T1 weighted image suggest possible meningioma, unchanged since prior scan in terms of size and MR characteristics.There are bihemispheric scattered somewhat patchy T2/flair high signal intensity lesions on periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no intra-axial mass, 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.2. No abnormal enhancement.3. Non specific small vessel ischemic disease.4. Unchanged right parafalcine extra axial enhancing lesion most likely represent a meningioma (about 11mm x 12mm) since prior scan."}
{"instruction": "Generate impression based on findings.", "input": " There is no acute infarct, mass effect, or cerebral edema. There is moderate diffuse global volume loss with superimposed diffuse ventriculomegaly which is out of proportion to the degree of sulcal prominence, with the right lateral ventricle larger than the left. There is also volume loss in the brainstem and the cerebellar hemispheres. There are few small foci of susceptibility effect in the brainstem, left anterior temporal lobe, and right frontal and parietal lobes likely representing chronic microhemorrhages, some of which may be subarachnoid in location. There is moderate periventricular and subcortical white matter T2 signal abnormality which is nonspecific, likely representing chronic microvascular ischemic changes, including multiple chronic lacunar infarcts along the thalami and possibly the basal ganglia likely superimposed upon prominent perivascular spaces in the bilateral basal ganglia. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening in the maxillary sinuses.", "output": "1.No acute infarct or mass effect.2.Moderate diffuse global volume loss including the brainstem and bilateral cerebellar hemispheres.3.Ventricular prominence may still be slightly out of proportion to the degree of volume loss, please correlate clinically for superimposed normal pressure hydrocephalus.4.Moderate chronic microvascular ischemic changes. Scattered foci of susceptibility likely representing chronic blood products, some of which may be in the subarachnoid space along the brainstem.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Anoxic brain damage, not elsewhere classified [G93.1] / Extrapyramidal and movement disorder, unspecified [G25.9], Reason for Study: ^Reason: f/u MRI, anoxic brain injury History: 12 yr F with anoxic brain injury secondary to hanging There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Previously seen bilateral basal ganglia restricted diffusion are not demonstrated anymore on today's scan.On T2/FLAIR images, posterior aspect of basal ganglia which showed diffusion restriction on prior scan now shows almost normalized.The most prominent difference of this scan from prior scan is global brain volume loss. Bilateral supra and infra tentorial brain parenchyme show more prominent sulci and slightly increased ventricular system. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Mucosal thickening on ethmoid sinuses.Bilateral mastoid air cells show opacifications.", "output": "1. Interval resolution of bilateral posterior basal ganglia restricted diffusion lesions on today's scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. Diffuse volume loss on bilateral supra and infra tentorial brain parenchyme comparing to prior scan. "}
{"instruction": "Generate impression based on findings.", "input": "History of malignant mesothelioma in the right hemithorax status post pleurectomy and decortication. Epithelioid subtype. Presents for MRI evaluation of new left pleural effusion with nodularity on recent CT. LUNGS AND PLEURA: Postsurgical changes of the right lung base with moderate atelectasis and minimal pleural fluid. There is a small left pleural effusion as seen on the recent CT. There are left sided small pleural plaques. There are several small foci of subtle restricted diffusion and questionable foci of linear enhancement on post-contrast imaging in the left pleural space. No discrete measurable sites of disease are identified in the left hemi-thorax.Left lung base pleural enhancement is present and may be reactive to the pleural effusion. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Numerous nonspecific right greater than left subcentimeter axillary and anterior abdominal wall lymph nodes.UPPER ABDOMEN: The upper abdomen is partially imaged. A large right renal cyst is partially seen.", "output": "Suspicious but not conclusive evidence of tumor involvement of the left hemi-thorax, including several small foci of subtle restricted diffusion and questionable foci of post-contrast enhancement in the left pleural space but no discrete measurable sites of disease are identified in the left hemi-thorax. Stable non-specific small left pleural effusion and pleural enhancement which may be reactive. A follow-up surveillance MRI examination may be of value to assess the evolution of these findings."}
{"instruction": "Generate impression based on findings.", "input": "Chiari decompression with syrinx spine, yearly follow up: Back, shoulder, and neck pain, and headache. Brain: There are postoperative findings related to Chiari decompression and right tonsillar reduction. There is now encephalomalacia within the remaining right cerebellar tonsil and right biventral lobule. There is no evidence of pseudomeningocele. There is biphasic cerebrospinal fluid flow anteriorly and posteriorly across the neo-foramen magnum. The cerebellum extends to the level of the superior aspect of the odontoid. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no evidence of acute infarction of hemorrhage.Spine: There has been interval decrease in caliber of the cervical and thoracic syringohydromyelia, which measures up to 5 mm in width, previously 7 mm. 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.", "output": "1. Expected postoperative findings in the posterior fossa related to prior Chiari malformation surgery. 2. Interval decrease in caliber of the cervical and thoracic syringohydromyelia."}
{"instruction": "Generate impression based on findings.", "input": "Radicular low back pain, lumbosacral spondylosis without myelopathy. 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. There is mild disc desiccation at L2-L3 and L3-L4 levels and moderate desiccation at L5-S1 level. The conus medullaris is normal in position. There is prominent epidural fat at various levels resulting in moderate developmental narrowing of the distal spinal canal. There is mild grade I retrolisthesis of L5 on S1, approximately 3 mm. Minimal retrolisthesis as well as prominent epidural fat was demonstrated on previous CT dated 9/19/2014.Mild to moderate multilevel degenerative changes are seen, as described below:T11-T12: On sagittal imaging there is prominent ligamentum flavum thickening with moderate central spinal canal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is mild ligamentum flavum hypertrophy. There is facet arthropathy with joint effusion on the right. No spinal canal or neural foraminal stenosis.L3-L4: There is annular disc bulge with left-sided prominence causing mild left foraminal narrowing. There is mild to moderate spinal canal stenosis.L4-L5: There is diffuse disc bulge causing mild to moderate bilateral neural foraminal narrowing. There is mild hypertrophy of ligamentum flavum and bilateral facet hypertrophy and bilateral joint effusion. There is mild to moderate spinal canal stenosis.L5-S1: There is uncovering of the disc with superimposed mild disc bulge, left more than right, causing causing moderate to severe bilateral neural foraminal narrowing. There is ligamentum flavum hypertrophy and mild to moderate bilateral facet arthropathy. There is mild to moderate spinal canal stenosis. Paraspinous soft tissues are within normal limits.", "output": "1. Moderate degenerative disc disease predominantly involving L5-S1 causing moderate to severe bilateral neural foraminal stenosis.2. There is mild to moderate spinal canal stenosis at various levels predominantly due to prominent epidural fat.3. Unchanged minimal grade I retrolisthesis of L5 on S1."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Left basal ganglial hemorrhage follow-up. Signs and symptoms: Right-sided weakness. CT of brain without infusion:A well-demarcated hematoma in the left basal ganglia measures 19 mm in transverse axis (axial image 13) and 31.8-mm in AP axis (axial image 14) in comparison with the prior MRI and CT examination there is no evidence of increase in the size of the hematoma. The periphery of hematoma is less defined than prior study which is consistent with breakdown of hemorrhage. There is subtle mass effect on the adjacent left lateral ventricle. This examination is otherwise unremarkable and stable and without any new additional findings.", "output": "No evidence of new hemorrhage and essentially stable exam since prior study."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for stroke. Signs and symptoms: Dysarthria and aphasia. Nonenhanced brain MRI:There is no detectable acute intracranial process and diffusion-weighted images are negative.Examination redemonstrates extensive patchy and confluent foci of FLAIR hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres, minimally in bilateral basal ganglia and moderate the in the pons and minimally in bilateral cerebral hemispheres without detectable change since prior study. Findings are consistent with chronic nonhemorrhagic small vessel ischemic strokes. Similar to prior exam there is a punctate focus of susceptibility in the left paramedian lower pons representing a punctate focus of chronic hemorrhage.Extra-axial dilatation of lateral ventricles similar to prior exam and with maintained midline. Prominence of cortical sulci are stated age similar to prior study.Signal void of major intracranial arterial branches are identified.Calvarium and soft tissues of the scalp as well as the orbits and paranasal sinuses are unremarkable.", "output": "1.No acute intracranial process and no evidence of diffusion weighted abnormalities.2.Stable extensive findings of small vessel ischemic strokes since prior exam as detailed.3.Prominence of cortical sulci and supratentorial ventricular system for patient's stated age similar to prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Reason: fell on previous shoulder injury History: fell on right shoulder with pain. Suboptimal evaluation secondary to patient motion artifact.ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is a small interstitial insertional tear of the supraspinatus at the level of its insertion on the greater tuberosity. There is mild fatty atrophy of the supraspinatus. There is mild tendinosis of the infraspinatus tendon. The infraspinatus muscle and tendon appear intact. There is mild fatty infiltration of the infraspinatus at the level of the myotendinous junction. The subscapularis and teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is articular cartilage degeneration affecting the anterior inferior glenoid with underlying subchondral cyst formation. The anterior and inferior glenoid labrum is heterogeneous and indistinct indicating degeneration and tearing.BICEPS TENDON: The tendon of long head of the biceps appears intact. There is increased signal abnormality within the intra-articular portion of the tendon the long head of the biceps indicating moderate tendinosis.ADDITIONAL", "output": "1. Minimally displaced fracture of the distal clavicle.2. Tendinosis and small insertional rotator cuff tear without evidence of a full-thickness tear or retraction.3. Osteoarthritis of the right shoulder including full-thickness articular cartilage degeneration along the glenoid and degeneration/tearing of the labrum."}
{"instruction": "Generate impression based on findings.", "input": "65 years Male (DOB:8/13/1951)Reason: orbital tumor left History: collateralsPROVIDER/ATTENDING NAME: SUSAN M. KSIAZEK SUSAN M. KSIAZEK MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact . The right eye lens is thinSome mucosal thickening is present in the paranasal sinuses.", "output": "There is no evidence for an orbital mass."}
{"instruction": "Generate impression based on findings.", "input": "Chemoradiation for left orbital stage 1 rhabdomyosarcoma: light sensitivity in left eye. There are post-treatment findings in the left orbit with mild high signal in the superotemporal region. There is no evidence of left optic nerve abnormality or evidence of gross measurable tumor. The right orbital contents are intact. The imaged portions of the brain appear unremarkable. The skull base appears unchanged. There is scattered paranasal sinus mucosal thickening and secretions. There is bilateral tympanomastoid fluid, left more than right.", "output": "1. Post-treatment findings in the left orbit without evidence of gross locoregional tumor.2. Persistent scattered paranasal sinus inflammation.3. Nonspecific inflammatory changes in the bilateral mastoid air cells, perhaps associated with Eustachian tube dysfunction, particularly on the left side."}
{"instruction": "Generate impression based on findings.", "input": "Breast density study, exam 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": "35 year old male with right hip pain and discomfort. Evaluate for labral tear. ACETABULAR LABRUM: There is linear increased signal abnormality traversing the anterior superior acetabular labrum, best seen on series 801 image 15, consistent with labral tear.ARTICULAR CARTILAGE AND BONE: There is heterogeneous bone marrow signal abnormality affecting the imaged axial and proximal appendicular skeleton, which is nonspecific but may reflect residual islands of red marrow.SOFT TISSUES: The visualized musculature is normal in appearance. ADDITIONAL", "output": "Tearing of the acetabular labrum as described above. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "59 year old with diabetes admitted to outside hospital with volume overload and chest pain. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 231 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 119 ml (normal range 47+/-19), the LV mass index is 41 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). The left ventricular dysfunction is global and largely related to right ventricular pressure and volume overload. There is non-specific late gadolinium enhancement in a pattern not typical of coronary artery disease to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The differential for this non-specific pattern includes previous myocarditis, sarcoidosis or other nonischemic cardiomyopathy. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated qualitatively (quantitatively EDV is normal in size indexed for BSA) with moderate-severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVEDV is 261 ml (normal range 142+/-31), the RV end systolic volume index is 72 ml/m2 (normal range 31+/-9), and the RVESV is 183 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.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 mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion. The pericardium appears to be thickened (4-6 mm) with some suggestion of adherence to the myocardium in the apical right ventricle. There is increased bowing of the interventricular septum towards the left ventricle during inspiration. These findings are suggestive of constrictive pericarditis. 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. There is pericardial thickening with some suggestion of adherence to the myocardium in the apical right ventricle and supportive findings of interventricular dependence on real time imaging. These findings are highly suggestive of constrictive pericarditis. 2. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%.The left ventricular dysfunction is global and largely related to right ventricular pressure and volume overload. There is a small amount of diffuse, non-specific late gadolinium enhancement in a pattern not typical of coronary artery disease to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is moderately dilated qualitatively (quantitatively EDV is normal in size indexed for BSA) with moderate-severely reduced systolic function. The overall RV ejection fraction is 30%"}
{"instruction": "Generate impression based on findings.", "input": "Aphasia and left-sided weakness. Stenosis potentially requiring intervention. Brain MRI: Many of the sequences are degraded by patient motion. There are small areas of restricted diffusion and high T2 signal in the right superior and middle frontal gyri. There is underlying encephalomalacia in the right basal ganglia, middle frontal gyrus, and right corona radiata. There is also diffuse patchy cerebral white matter T2 hyperintensity without corresponding restricted diffusion. There is no evidence of intracranial hemorrhage or mass. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: The images are largely degraded by patient motion. There is paucity of flow-related enhancement in the right internal carotid vein. There is tenuous reconstitution of flow-related enhancement in the right middle cerebral artery at the circle of Willis, with a relative paucity of flow-related enhancement in the distal middle cerebral artery branches. There also appears to be asymmetrically less flow-related enhancement in the right anterior cerebral artery. There also appears to be irregular narrowing of the bilateral posterior cerebral arteries. The intradural vertebral arteries and Neck MRA: There is no discernible enhancement of the entire right internal carotid artery. The right common carotid and external carotid arteries appear to be patent. The left internal carotid, common carotid, and external carotid arteries also appear to be patent. However, there appears to be stenosis of the bilateral vertebral artery origins.", "output": "1. Acute right middle cerebral artery territory infarct superimposed upon chronic small vessel ischemic disease and chronic infarcts, without gross hemorrhagic transformation.2. Critical steno-occlusive disease at the origin of the right internal carotid artery. Further evaluation via Doppler ultrasound may be useful.3. Apparent stenosis of the bilateral vertebral artery origins. Discussed with Physician: AGNIESZKA A ARDELT at 2:40 PM on 10/28/15."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Brown is a 66 year old female with newly diagnosed right breast cancer in two locations. She has a family history of breast cancer. Preoperative MRI is requested at this time. There is heterogeneous amount of fibroglandular tissue in both breasts.There are scattered foci of enhancement seen in both breasts, compatible with mild background parenchymal enhancement. However, no one focus is more suspicious than the rest. In the right upper outer breast, there are two areas of mass-like enhancement identified, that correspond to the two biopsy-proven malignancies. - The first area of mass-like enhancement is in the 11:00 location, measuring approximately 1.6 x 0.9 x 1.5 cm. A biopsy marker clip is seen at the peripheral aspect of this enhancement. - The second area of mass-like enhancement is in the 10:00 location, measuring approximately 1.4 x 1.3 x 1.7 cm. This measures slightly larger on the MRI, likely due to related post-biopsy changes. Of note, a 1.2 cm hematoma with increased T1 signal is identified just abutting the inferior aspect of this area of enhancement. A biopsy marker clip is also seen at the peripheral aspect of this area of enhancement. There is no additional site of abnormal enhancement seen in the right breast. There is no abnormal enhancement seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "Biopsy proven multifocal breast cancer in the right breast. No additional MR evidence of malignancy identified. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Male 70 years old with recurrent cirrhosis status post OLT 4/05 for HCC and HCV cirrhosis. Evaluate for lesions, assess hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: The transplanted liver has a nodular contour and heterogeneous signal intensity consistent with chronic liver disease as seen on the previous exam. Perfusion artifact is noted at the periphery of the liver. A serpentine focus of enhancement in hepatic segment 7 is consistent with a portal venous to hepatic venous shunt (series 19/45). No suspicious arterial enhancing liver lesions are identified. The hepatic vasculature is patent.There is mild narrowing of the common bile duct at the expected location of the anastomosis but no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic native kidneys contain multiple cysts. There is no hydronephrosis within the partially visualized right iliac fossa transplant kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the imaged spine.OTHER: No significant abnormality noted.", "output": "1.Allograft liver with findings of chronic liver disease. No suspicious liver lesion.2.Patent hepatic vasculature.3.Mild narrowing at the common duct anastomosis without significant intra or extrahepatic biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Thunderclap headache. Signs and symptoms: Transient loss of focus while driving and thunderclap headache. The CSF spaces are appropriate for the patient's stated age of 75 with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities in the ethmoid air cells and some mucosal thickening in the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental notes are made of partial empty sella and an 8mm Thornwaldt cyst. These are likely of little clinical significance.", "output": "1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. They are associated with increasing age and most likely vascular related."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old BRCA-positive female. Strong family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A few enhancing foci in the lateral inferior left breast are stable. No abnormal lymph nodes are identified in either axillary region. Stable left lobe liver cysts are noted.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Right knee pain MENISCI: The posterior horn of the medial meniscus is small and irregular in contour, compatible with multidirectional tearing. The body of the medial meniscus is partially extruded. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema involving the medial tibial plateau and lateral tibial spine. There is a large area of full-thickness cartilage loss involving the medial femoral condyle measuring up to nearly 2 cm in AP dimension and 5 mm in medial-lateral dimension. There is also a large area of full-thickness cartilage loss involving the medial tibial plateau measuring between 1.5 and 2 cm in AP dimension and 8 mm in medial-lateral dimension. There is mild cartilage thinning involving the lateral tibiofemoral articulation, with a small (3-5 mm) focal full-thickness defect in the lateral femoral condyle. There is diffuse cartilage thinning of the patella without focal defects identified.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1.Complex tearing of the medial meniscus as above.2.Large areas of full-thickness cartilage loss involving the medial femoral condyle and medial tibial plateau with less severe cartilage loss involving the lateral compartment and patellofemoral articulation as above."}
{"instruction": "Generate impression based on findings.", "input": "67 year-old female history of RCC. ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar subcentimeter nonenhancing simple cysts. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Subcentimeter nonenhancing right 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": "Postoperative changes of left nephrectomy with no evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Numbness and tingling unilaterally. There are several, approximately 10, scattered punctate T2 hyperintense supratentorial lesions in the periventricular and subcortical white matter. Some of the lesions are T1 hypointense. There is no abnormal intracranial enhancement. There is a small nodular convex contour of the right lateral aspect of the medulla. The brainstem and cerebellum otherwise appear to be unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. Findings suggestive of demyelinating disease, such as multiple sclerosis.2. A small nodular convex contour of the right lateral aspect of the medulla may represent an accessory cuneate nucleus rather than neoplasm or heterotopion."}
{"instruction": "Generate impression based on findings.", "input": "96 years Female (DOB:6/5/1920) PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are patchy T2 and FLAIR hyperintense lesions also present in the brainstem.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "Periventricular and subcortical white matter and brainstem lesions of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: right elbow pain History: right elbow pain Due to technologist error, the sagittal STIR sequence was not performed.LIGAMENTS: The ulnar collateral ligament appears intact within the limitations of this non arthrogram study. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact.TENDONS: There is increased signal intensity within the common extensor tendon at its origin indicating tendinosis/mucoid degeneration and likely chronic partial thickness tearing. There is additional mild edema within the soft tissues adjacent to the lateral epicondyle. The common flexor tendon appears intact. The biceps and brachialis tendons appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: The articular cartilage of the radiocapitellar articulation appears thinned relative to the ulnotrochlear articulation and there are perhaps small cysts within the underlying capitellum suggesting mild osteoarthritis. The bone marrow signal intensity is otherwise normal. SURROUNDING STRUCTURES: The imaged musculature of the right elbow is unremarkable. Nerves appear normal.ADDITIONAL", "output": "1. Common extensor tendinosis/partial thickness tearing with mild adjacent soft tissue swelling.2. Mild osteoarthritis of the radiocapitellar articulation."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: evaluate for bleed. Signs and symptoms: Altered mental status. Status post fall. Nonenhanced head CT:Examination demonstrates no evidence of intracranial hemorrhage.Large area of low-attenuation involving the left posterior temporal and extending into the left occipital lobe and further superiorly into the parietal lobe. There is only suspected subtle mass effect and effacement of adjacent cortical sulci in particular in the parietal component. This finding although has the appearance of an old stroke possibility of a subacute component cannot be ruled out. There is no associated hemorrhage. Recommend further follow-up weighted and MRI exam to exclude acute/subacute stroke. One there is no evidence of hemorrhage midline shift or hydrocephalus.Calvarium is intact. Visualized mastoid air cells and middle ear cavities are pneumatized and unremarkable.Debris within bilateral external auditory canals.CT of cervical spine:Images through the skull base are unremarkable. The articulation of C1 and C2 remains within normal no fracture is detected. Degenerative changes of cervical spine with multilevel neural foramina compromise is identified. There is however no evidence of cervical spinal fracture. The alignment the vertebral column is unremarkable. There is however scoliosis.No detectable soft tissue abnormality of the neck.CT of orbits:Examination demonstrates preseptal periorbital swelling likely result of recent trauma. There is no evidence of fracture. The retro-orbital fat is within normal limits. There is normal morphology and density of globes with intact lenses. The extraocular musculature is unremarkable. Visualized paranasal sinuses are unremarkable.", "output": "1.Negative CT of cervical spine for fracture. Degenerative disk disease is noted.2.Head CT demonstrates large area of low-attenuation in the left posterior temporal extending to occipital and left parietal lobe. Although large segment of this finding appears as an old cortical stroke there are suspected areas of effacement of cortical sulci in the parietal region may indicate an overlapping acute/subacute new stroke. Recommend further follow-up with an MRI. There is no evidence of posttraumatic intracranial abnormality.3.CT of orbits demonstrate right sided preseptal periorbital swelling likely result of recent trauma. No evidence of fracture or any abnormality in the retroseptal region."}
{"instruction": "Generate impression based on findings.", "input": "Male, 13 years old. Reason: Please evaluate extent of Crohn's involvement History: Newly diagnosed Crohn's disease, abdominal pain, diarrhea, weight lossEXAMINATION: MR enterography without and with IV contrast 3/23/15, 1327 ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic ductal dilatation. The gallbladder is normal.SPLEEN: Normal size and enhancement.PANCREAS: Normal size and enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No focal lesions or significant hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A segment of distal ileum approximately 20 cm in length up to the ileocecal valve shows multiple areas of bowel wall thickening and enhancement alternating with short segments of saccular dilation (series 2101, image 339). These findings suggest active inflammatory process. No evidence of stricture, fistula, or bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A segment of distal ileum approximately 20 cm in length up to the ileocecal valve shows multiple areas of bowel wall thickening and enhancement alternating with short segments of saccular dilation (series 2101, image 339). These findings suggest active inflammatory process. No evidence of stricture, fistula, or bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Areas of bowel wall thickening/enhancement and saccular dilatation involving a 20cm segment of distal ileum up to the ileocecal valve, compatible with a suspected history of Crohn's disease."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral renal cysts and right renal cystic lesion inadequately characterize on noncontrast CT 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: Incomplete evaluation given lack of intravenous contrast. There are multiple bilateral renal lesions, some with the appearance of simple cysts with homogeneous T2 signal seen, others are more complex and are T2 hypointense/T1 hyperintense. The largest lesion is in the right mid pole and measures 4.4 x 3.4 cm (series 6 image 22, series 9 image 21), previously measuring 4.1 x 3.4 cm on CT. Thin internal septations (as opposed to multiple cysts next to one another) suggested. There are several foci of T1 hyperintensity and scattered fluid fluid levels within several of the renal lesions, consistent with hemorrhage or proteinaceous material. Overall the lesions appear grossly unchanged in size over the interval.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "Incompletely evaluated renal lesions given the lack of intravenous contrast. Overall, the lesions are grossly unchanged in size and include simple cysts and complex cysts containing hemorrhage or proteinaceous material. Continued surveillance is recommended in 6-12 months using contrast enhanced MRI as the patient's renal function permits. Special attention should be given to the right mid pole lesion due to its heterogeneity, size and suggestion of thin internal septations."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female with history of spindle cell sarcoma status post left nephrectomy. 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: Status post left nephrectomy. No evidence of disease recurrence.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence of recurrence or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Low thoracic and high lumbar back pain with history of neurofibromatosis type I. BRACHIAL PLEXUS: There is dextroconvex scoliosis of the mid cervical spine. The cervical vertebral bodies and a intervertebral disc spaces appear dysplastic. There is severe kyphosis of the cervical spine centered at C3-4 with lordosis centered at C6-7. A grade 1 retrolisthesis of C4 on C5 is seen.There is a 1.8 x 3.1 cm heterogeneously T2 hyperintense soft tissue lesion extending between the anterior arch of C1 and the dens causing expansion of the atlantodens interval up to 6 mm (series 501, image 47). This lesion is new or significantly increased since prior examination. The transverse ligament appears grossly intact but is stretched.There is a 1.6 x 1.4 cm T2 hyperintense lesion, likely a neurofibroma, expanding the left hypoglossal canal (series 701, image 74). In addition, there is a 1.4 x 2.0 cm expansile lesion involving the left C2-C3 neural foramen, also likely a neurofibroma. There appears to be a small amount of epidural fluid located along the posterior right margin of the thecal sac at the C3 level (series 701, image 51), similar to prior examination. There is moderate right neuroforaminal stenosis at C4-5 and C5-C6 secondary to right posterior disc osteophyte complex formation. The spinal cord demonstrates normal caliber and signal intensity.There are numerous ovoid T2 hyperintense lesions along the left jugular chain within the neck. The largest lesion measures 4.3 x 2.4 cm (coronal by transverse) (series 201, image 26). This lesion appears to impinge upon or perhaps arise from the exiting left upper cervical spine nerve roots. There are numerous small lesions along the distal left brachial plexus as well, however these lesions do not appear to significantly impinge upon the nerves. THORACIC SPINE: The thoracic alignment is preserved. The vertebral body heights and intervertebral disc spaces are maintained. There is no significant neuroforaminal or central spinal stenosis. The spinal cord demonstrates normal caliber and signal intensity.LUMBAR SPINE: The lumbar alignment is preserved. The vertebral body heights and intervertebral disc spaces are maintained. No worrisome focal marrow signal is identified. The spinal cord and conus demonstrate normal signal and morphology. The conus terminates at L2. A fatty filum is noted. No neuroforaminal stenosis or central stenosis is noted. Several T2 hyperintense lesions in the periaortic and retroperitoneal space are nonspecific and may be related to lymph nodes versus additional small neurofibromas.", "output": "1. There is a 1.8 x 3.1 cm heterogeneously T2 hyperintense soft tissue lesion extending between the anterior arch of C1 and the dens causing expansion of the atlantodens interval up to 6 mm. This lesion has increased significantly since prior examination. Given the heterogeneity and relatively rapid interval increase in size, malignant degeneration of a nerve sheath tumor should be considered. A CT of the cervical spine with contrast can be obtained to evaluate for bony erosion.2. Expansile lesions in the left hypoglossal canal and left C2-3 neural foramen and likely related to neurofibromas.3. Multiple bilateral jugular chain lesions are consistent with neurofibromas. The largest lesion in the left neck involves the exiting left upper cervical nerve roots and also potentially impinges on these nerve roots. 4. Multiple small probable neurofibromas involving the distal left brachial plexus are demonstrated. No definite right brachial plexus neurofibromas are seen.5. The cervical vertebral bodies are dysplastic with severe kyphosis of the mid cervical spine. 6. A fatty filum terminale is seen. However, the conus terminates at a normal level. The thoracic and lumbar spine appear otherwise unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "Male, 75 years old, with low back pain status post L4-5 surgery. The lumbar lordosis is straightened, but sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen.The visualized distal spinal cord, conus and cauda equina are unremarkable. No epidural abnormalities are suspected.Postoperative findings are seen at the L4-5 level including partial spinous process resection and probable laminectomy and thickening of the ligamentum flavum.Loss of disc height is evident at L2-3 and L4-5. With the exception of L1-2, all of the lumbar discs demonstrate loss of T2 signal. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild disc bulging. No significant spinal canal narrowing. Mild bilateral foraminal narrowing. No interval changes.L3-4: Facet hypertrophy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal narrowing. Mild bilateral foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Mild disc bulging. No spinal canal stenosis. Severe right and moderate left foraminal narrowing. No interval changes. L5-S1: Facet arthropathy and ligamentum flavum thickening. Disc bulging and left paracentral annular fissuring. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. No interval changes.", "output": "1.Relatively mild degenerative findings with no significant interval change. 2.There are no areas of high-grade spinal canal stenosis, though there is a severe narrowing of the right L4-5 neural foramen.3.Postoperative findings at L4-5 appear similar to the prior examination."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral sciatica. There is no significant spinal canal or neural foraminal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable, aside subcentimeter focal fat or hemangioma in the L4 vertebral body. The caudal spinal cord and conus medullaris display normal signal and morphology. The tip of the conus medullaris is located at the L1-L2 level. The paravertebral soft tissues are unremarkable.", "output": "No significant spinal canal or foraminal stenoses in the lumbar spine. "}
{"instruction": "Generate impression based on findings.", "input": "Right renal mass. Assess for interval change. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size, morphology, and signal characteristics. Note is made of several hepatic cysts. No intrahepatic or extrahepatic biliary ductal dilatation. Gallbladder is normal in size without evidence of cholelithiasis. Note is made of focal adenomyosis in the gallbladder fundus. The portal vein and hepatic arteries are patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal in size, morphology, and signal characteristic. The main pancreatic duct remains minimally prominent, however it is better visualized today extending all the way into the pancreatic tail. No evidence of stricture as previously questioned.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Redemonstration of a T1 intrinsically hyperintense lesion in the interpolar region of the right kidney. This is not significantly changed in size from prior measuring 1.6 x 1.2 cm in the coronal plane, previously 1.5 x 1.1 cm. There is no appreciable enhancement on the postcontrast images. This is compatible with a benign proteinaceous or hemorrhagic cyst. There are additional simple renal cysts bilaterally. No hydronephrosis.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.Stable nonenhancing intrinsically T1 bright lesion in the right kidney compatible with a hemorrhagic/proteinaceous cyst.2.No evidence of pancreatic duct stricture as previously questioned."}
{"instruction": "Generate impression based on findings.", "input": " There are multiple, at least 10, supratentorial and infratentorial lesions with variable enhancement, many showing susceptibility effect consistent with hemorrhagic products, with variable surrounding confluent T2 hyperintensity. Aside from the calcified right hippocampus lesion, the lesions and associated edema are new from the prior MRI. Most of the larger lesions enhance irregularly along the periphery and are centrally necrotic. For example, a left cerebellar hemisphere lesion measures up to 6 mm, a left medial temporal lobe lesion measures up to 9 mm, a left temporal lobe lesion measures up to 11 mm, a left superior frontal gyrus lesion measures up to 12 mm, a right cuneus lesion measures up to 14 mm, and a right inferior parietal lobule lesion measures up to 19 mm. There is mild mass effect on the posterior horn and atrium of the lateral ventricles, right greater than left. However, there is no significant midline shift. There is a background of punctate T2 hyperintense signal abnormality scattered in the supratentorial periventricular and subcortical white matter which are nonspecific. There is no evidence of acute infarct. The orbits, skull, and scalp soft tissues appear unremarkable.", "output": "Multiple supratentorial and infratentorial metastases, many of which are hemorrhagic, but no evidence of acute infarct, midline shift, or herniation.Discussed with Dr. Lukas at 10:30 AM on 4/24/15."}
{"instruction": "Generate impression based on findings.", "input": " Note the left sagittal oblique images could not be acquired as the patient requested the study be terminated.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Heterogeneous foci are noted within bilateral thyroid lobes, with a left left focus demonstrating a mixture of both T2 hyperintense and hypointense contents measuring up to 14 mm.C2/3: Mild degenerative changes without stenosisC3/4: Posterior osteophyte disc complex with a central extruded component which causes anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and ligamentum flavum thickening. There is mild central, severe left neural foraminal, and moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central and severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is severe bilateral neural foraminal stenosis.C7/T1: Bilateral facet hypertrophy without stenosis.T1/2: Bilateral facet hypertrophy and endplate spurring causes mild bilateral neural foraminal stenosis.T2/3: Right facet hypertrophy and endplate spurring causes mild bilateral neural foraminal stenosis.T3/4: Right facet hypertrophy and endplate spurring causes moderate right neural foraminal stenosis.T4/5: Right facet hypertrophy and endplate spurring causes mild right neural foraminal stenosis.", "output": "1.Heterogeneous foci are noted within bilateral thyroid lobes, with a left left focus demonstrating a mixture of both T2 hyperintense and hypointense contents measuring up to 14 mm. A dedicated thyroid ultrasound is recommended for further characterization, especially of the more heterogeneous, greater than 1 cm left thyroid nodule.2.C3/4: Mild central, severe left neural foraminal, and moderate right neural foraminal stenosis.3.C4/5: Mild central and severe bilateral neural foraminal stenosis.4.C5/6: Mild central and severe bilateral neural foraminal stenosis.5.C6/7: Severe bilateral neural foraminal stenosis.6.T1/2: Mild bilateral neural foraminal stenosis.7.T2/3: Mild bilateral neural foraminal stenosis.8.T3/4: Moderate right neural foraminal stenosis.9.T4/5: Mild right neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Disturbance of skin sensationClinical question: please do Dr Javed MS protocol on 3 Tesla MRI, compare to image in PAXSigns and Symptoms: numbness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a punctate T2 and T2 and FLAIR hyperintense lesion present in the right temporal lobe subcortical white matter which is unchanged since the prior exam. Additionally there are several more subcortical white matter lesions in the subcortical white matter of the frontal lobes which also present on the prior exam and are unchanged.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is straightening of the normal cervical curvature present with mild reversal centered at C5-6. Mild disc bulge present at C5-6.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. There is a minor disc bulge present at this level.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.", "output": "1.There are several subcortical white matter lesions present in the brain which are nonspecific and most likely of little clinical relevance given their number and stability.2.No cervical spinal cord lesions are appreciated to explain the patient's symptoms.3.There is a minor disc bulge present at C5-6 without significant compromise to spinal canal or exiting nerve roots"}
{"instruction": "Generate impression based on findings.", "input": "68 year old female with possible right patellar tendon tear on plain film. MENISCI: The medial meniscus appears intact. There is globular increased signal abnormality within the body of the lateral meniscus consistent with intrasubstance degeneration. Some of this signal extends to the femoral articular surface consistent with degenerative tearing/superficial fraying.ARTICULAR CARTILAGE AND BONE: There is a focal full thickness articular cartilage cleft along the medial facet of the patella with underlying degenerative subchondral signal abnormality and cyst formation. There is subjective thinning of the lateral tibiofemoral compartment articular cartilage. There is a focal full-thickness articular cartilage degeneration along the lateral tibial plateau with underlying subchondral signal abnormality. There is full-thickness articular cartilage degeneration along the posterior aspect of the medial femoral condyle with underlying degenerative subchondral signal abnormality.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is increased signal abnormality within the distal fibers of the patellar tendon indicating mild patellar tendinosis.ADDITIONAL", "output": "1. Findings consistent with mild patellar tendinosis. The patellar tendon appears intact.2. Full-thickness articular cartilage cleft and degeneration as described above.3. Intrasubstance degeneration/degenerative tearing of the lateral meniscus.4. Nonspecific subcutaneous edema along the anterior aspect of the patellar tendon."}
{"instruction": "Generate impression based on findings.", "input": "Newly diagnosed prostate cancer. Evaluate extent of disease. Pathology dated 7/8/2015 showed 3+3 disease in the right medial and lateral apex PELVIS:PROSTATE:Prostate Size: 2.9 x 4.4 x 4.3 cmPeripheral Zone: Extensive intrinsic T1 weighted hyperintensity throughout the peripheral zone reflecting hemorrhage from biopsy. No discrete measurable lesion.Central Gland: Approximately 8 mm focus in the apex anterior transition zone (series 501/42) demonstrating restricted diffusion and T2 weighted hypointensity abutting the anterior capsule.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right apex lesion abuts the anterior capsule.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Extensive post biopsy changes of the peripheral zone without a discrete focus of disease in the peripheral zone. Small focus in the anterior transition zone of the apex may represent site of prostatic carcinoma. The lesion abuts the anterior capsule."}
{"instruction": "Generate impression based on findings.", "input": "Hip pain drainage Note that the examination is limited by inability to optimally position the patient, and the patient's body habitus, and by motion artifact.Within the posterior lateral subcutaneous tissues of the left hip is an ill-defined rim-enhancing mixed air and fluid collection measuring approximately 14 x 7.8 x 13 cm in the greatest transaxial and craniocaudal dimensions. This collection extends to the posterior skin surface and abuts the lesser trochanter which demonstrates marrow signal intensity consistent with osteomyelitis. Additional areas of abnormal marrow signal intensity are identified within the left posterior superior acetabulum and left inferior pubic ramus representing additional areas of acute/chronic osteomyelitis.There is a moderate-sized joint effusion. Marked edema of the left pelvic musculature is also present particularly the obturator internus and gluteus medius.", "output": "Septic arthritis of the left hip with associated subcutaneous abscess and chronic osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female presents for MR directed ultrasound of the left breast. The patient has known right breast DCIS. MRI (11/21/2016) demonstrated a small benign-appearing mass in the left 3:00 position. MR directed ultrasound was performed. Detected was a circumscribed oval mass without blood flow measuring 5 x 4 x 6 mm at 3:00 position, 2 cm from nipple in the left breast. This mass corresponds to the enhancing lesion on the MRI.", "output": "Benign mass in the left breast at 3:00 position, corresponding to the MR findings. Because this is benign, no further assessment is needed. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female with C2 -- C3 neurofibroma. Preplanning for surgical resection. Images through the skull base including cavernous sinuses are unremarkable. Calcific and atrophic right globe is noted. Paranasal sinuses and mastoid air cells are unremarkable.Images through the soft tissues of the neck demonstrate a very large non-enhancing mass on the right side of the neck measuring approximately 37 mm in transverse axials and 26-mm in AP axis (axial image 49). This mass extends into the right C3 -- C4 neural foramina with significant expansion and remodeling of the bone. There is also extension of mass into the vertebral body of C4 as well as C4 -- C5 neural foramina which also demonstrates significant expansion. There is suggestion of significant extension of mass into the spinal canal at C3 -- C4 and C4 there C5 the findings are consistent the patient's known neurofibroma. Multiple additional small nonenhancing masses consistent with patient's known neurofibromatosis is also noted. None of these lesions demonstrate any significant enhancement.These findings are better visualized on MRI examination of soft tissues of the neck.", "output": "Findings consistent with neurofibromatosis as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female with left lower quadrant and abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is gallbladder sludge versus cholelithiasis. No definite evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: The uterus is enlarged and there is a central fundal mass which measures 5.6 x 6.4 cm, most likely due to a fibroid, at axial image 114/157. There is a larger anterior and superior central pelvic mass extending from the uterus which appears circumscribed with a thickened wall that measures 8.2 x 10 x 14.3 cm on axial image 91/157 of series 3 and coronal image 67/100. This mass contains fluid and central fat density. There are peripheral calcifications best seen at axial images 86 - 87/157 and coronal image 57/100. These findings suggest the presence of a mature cystic teratoma. Further evaluation with transvaginal ultrasound and/or MRI may be helpful, if indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: A small amount of pelvic free fluid is present.", "output": "Central pelvic mass(es) as probably consisting of a fibroadenoma and teratoma, as described above. Further evaluation with transvaginal ultrasound and/or MRI may be helpful, if indicated.Cholelithiasis without cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "53 years, Male, Reason: history of RALP for prostate cancer, now with biochemical recurrence. Evaluate for any nodules, nodes, or signs of recurrence History: biochemical recurrence of prostate cancer. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy. A small tubular focus with enhancement but no abnormal ADC/T2 signal in the surgical bed (1001/14 and 1901/1468) most likely represents a vessel. No definite evidence of recurrence.Seminal Vesicles: Status post removal of seminal vesicles.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Small inguinal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence of local recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Finger mass Just deep to the flexor tendons of the index finger and slightly distal to the A2 pulley is a well-circumscribed mass measuring approximately 5 x 2 mm. The mass appears intimately associated with the flexor tendon sheath and flattens the underlying flexor tendon. The underlying bone is normal in signal with no evidence of erosive change. This mass demonstrates isointense signal on T1 and is slightly hyperintense on T2 sequences. Following contrast administration, there is suggestion of some enhancement on the coronal postcontrast sequence although there is no significant difference in signal between the axial pre and post images. Probable cyst noted in the head of the third metacarpal.", "output": "Well-circumscribed mass appearing intimately associated with the flexor tendon sheath of the index finger. The location and signal characteristics is most suggestive of a giant cell tumor of tendon sheath."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out posterior circulation stroke. Evaluate centrum semiovale CT hyperintensity for hemorrhage or tumor. History: Sudden onset unsteadiness, vomiting, vertical nystagmus. There is no evidence of acute infarct. There is a lesion with substantial susceptibility effect and central T1 hyperintensity in the right posterior centrum semiovale that measures up to 10 mm. There is no surrounding edema or abnormal enhancement. There are a few scattered punctate foci of nonspecific cerebral white matter T2 hyperintensity. 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": "A lesion in the right posterior centrum semiovale that measures up to 10 mm likely represents a cavernous malformation. No evidence of developmental venous anomaly, acute hemorrhage, or acute posterior circulation infarction."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Postop. Signs and symptoms: Seizures. Pre and post enhanced brain MRI:Examination demonstrates a surgical cavity in the right posterior parietal and extending inferiorly into the right posterior temporal lobe abutting the trigone of right lateral ventricle. Surgical cavity demonstrates expected serosanguineous fluid content. Its irregular shape makes precise measurements difficult however it measures maximum of 29 mm in transverse, 20 mm in AP and 44 mm in craniocaudad dimensions. There is surrounding vasogenic edema and with resultant mass effect and including trace deviation of midline to the left.T1 hyperintensity within the surgical cavity representing blood products precludes precise assessment for presence of enhancement or detection of tumor. Within this limitation however subtle patchy thin linear enhancement along the surgical cavity wall is detected which is within expected postoperative change. Further follow-up is needed to exclude residual tumor.Unremarkable exam otherwise and without detectable abnormal focus of enhancement or signal abnormality.There is a small epidural collection under the craniotomy flap measuring approximately 9 mm in thickness with subtle mass effect on the adjacent parenchyma. Subgaleal serosanguineous fluid and air overlapping the calvarium in the surgical region is also noted. Expected postoperative pneumocephalus in the right frontal subarachnoid space is noted.", "output": "1.Surgical cavity measuring 29 x 20 x 44 mm extending from right posterior parietal inferiorly abutting the right trigone of the lateral ventricle. No convincing evidence of residual tumor on this initial study. Follow-up is needed.2.Vasogenic edema surrounding the surgical cavity and postoperative changes results in regional mass effect as well as trace deviation of midline to the left.3.Expected postoperative changes of 9 mm thick epidural collection under the flap and subgaleal fluid/air as well as right frontal subarachnoid pneumocephalus as detailed."}
{"instruction": "Generate impression based on findings.", "input": "Female with history of ovarian tumor. ABDOMEN:LIVER, BILIARY TRACT: Several images are degraded by artifact. The liver is normal in morphology, signal intensity and enhancement. No biliary ductal dilatation. No vascular abnormality.There are at least 3 lesions identified demonstrating mild T2 weighted hyperintensity and peripheral rim enhancement on postcontrast imaging, suspicious for metastatic disease. The segment 7/8 lesion measures 1.1 cm (series 12 image 11). The segment 5 peripheral lesion measures approximately 8 mm (series 12 image 30). The segment 2 peripheral lesion measures approximately 9 mm (series 12/28). Additional very small peripheral segment 7/8 T2-weighted hyperintensity. These lesions are decreased in size when compared to the 4/9/2015 CT.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Outside exam read:Several enhancing lesions in the liver are compatible with metastatic disease and are decreased in size compared to the 4/9/2015 outside hospital CT."}
{"instruction": "Generate impression based on findings.", "input": "16 year old status post patellar dislocation. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: No bone marrow edema. The articular cartilage is intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "No evidence of an acute injury. However, there is an abnormally shallow trochlear groove which places the patient at risk for recurrent patellofemoral dislocations. "}
{"instruction": "Generate impression based on findings.", "input": "History of prolactinoma. There is an unchanged 5 x 7 mm nodular lesion along the right anterior aspect of the pituitary gland with slight protrusion into the right cavernous sinus. The infundibulum is situated in the midline and not thickened. The optic apparatus is intact.", "output": "Unchanged subcentimeter lesion along the right anterior aspect of the pituitary gland, which may represent a prolactinoma. "}
{"instruction": "Generate impression based on findings.", "input": "Headache. CVA. Cerebral infarction.IMAGE ACQUISITIONS: 4.5-mm contiguous axial CT sections of the brain without contrast infusion. No acute intracranial hemorrhage, mass effect or shift of midline structures. Small low attenuation lesions in the cerebellum consistent with chronic infarcts are again noted. A low-attenuation lesion in the genu of the right corpus callosum, consistent with chronic lacunar infarction is unchanged. Multiple small foci of periventricular low-attenuation have not significantly changed. There is abnormal low attenuation in the genu of the corpus callosum, corresponding with high signal intensity on MRI. Low-attenuation is also present in bilateral periatrial white matter. Small juxtacortical foci of low-attenuation are again noted. A chronic left occipital infarct is unchanged.", "output": "Stable CT findings. No CT evidence of new infarction. No acute intracranial hemorrhage."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with history of chronic heart failure abdominal pain The study is limited due to poor perfusion secondary to patient's heart failure. Focal lesions and distal organs cannot be optimally evaluated.ABDOMEN:LUNG BASES: Significant cardiomegaly, bilateral pleural effusions, more prominent on the right compared to the left with dependent atelectasis consistent with patient's known heart failure.LIVER, BILIARY TRACT: Liver is enlarged with dilated hepatic veins and IVC secondary to heart failure. Focal, peripheral increased attenuation in the right lobe of the liver likely represents a perfusion abnormality. Focal lesions in the liver cannot be excluded.SPLEEN: No significant abnormality notedPANCREAS: Pancreas is atrophic with dilated duct and numerous parenchymal intraductal calcifications consistent with chronic pancreatitis.ADRENAL GLANDS: Slightly thickened left adrenal gland.KIDNEYS, URETERS: Perfusion of the kidneys is limited. Extensive atherosclerotic disease involving the aorta and renal arteries. Right renal cyst. Calcifications in the kidneys are likely vascular, however, small stones cannot be excluded.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications involving the entire vasculature atherosclerotic plaques and stenosis involving most of the visceral branches of the abdominal aortaBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites. Generalized anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: The tip of the left femoral venous catheter is in the right ventricle.Ill-defined enhancing lesions lateral to the right psoas muscle in the pelvis. On image number 79, series number 3, at the inferior aspect of this lesion, the lesion measures 2.4 x 2 cm. The etiology is unknown. MRI of the abdomen and pelvis may be helpful for further evaluation.", "output": "Limited study due to poor perfusion secondary to patient's congestive heart failure.Cardiomegaly, bilateral pleural effusions, hepatomegaly, ascites, generalized anasarca secondary to patient's known heart failure.Severe and extensive atherosclerotic disease involving the entire vasculature.The tip of the left femoral venous catheter is in the right ventricle.Severe chronic pancreatitis.Enhancing soft tissue density lesions in the right retroperitoneum, adjacent to the psoas muscle. There etiology is unknown. They may represent neoplasm versus abscess. Further evaluation with MRI may be helpful.Bilateral renal calcifications, most of the more vascular, however, small stones cannot be excluded.Dr. Anveroy (3123) was notified and acknowledged about these findings at the time of dictation. "}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female with endometrial cancer. Compared to last MRI and measure vaginal cuff mass, left inguinal lymph node, and right common iliac node. Status post immunotherapy 4 cycles. PELVIS:UTERUS, ADNEXA: The known vaginal cuff mass has slightly decreased in size with reference measurements listed below. Extension through the parametrial fat is again noted. The mass is associated with satellite nodules and peritoneal extension, and there are persistent areas of the peritoneal implants compatible with carcinomatosis. Large volume ascites is again partially visualized. Tumor is present along the peritoneal reflection of the bladder. The posterior aspect of the tumor abuts the rectosigmoid colon. Enhancing tumor is again identified along the anterior surgical scar.BLADDER: As above.LYMPH NODES: Decreased size of the right common iliac lymph node. Stable size of the left inguinal lymph node. Reference measurements listed below.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Mild anasarca.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/2/2016 14:15:00)LEFT INGUINAL LYMPH NODE: 0.9 x 0.4 cm (Image 30, Series 401); 0.9 x 0.5 cm on prior (8/10/2016) (Image 23, Series 1301).RIGHT COMMON ILIAC LYMPH NODE: 0.7 x 0.7 cm (Image 55, Series 401); 1.2 x 1.0 cm on prior (8/10/2016) (Image 48, Series 1301).VAGINAL CUFF MASS: 6.4 x 3.8 cm (Image 43, Series 401); 7.9 x 4.6 cm on prior (8/10/2016) (Image 38, Series 1301).", "output": "1.The known infiltrative soft tissue mass at the vaginal cuff with extension into the parametrial soft tissue, along the peritoneum, and abutment above the bladder and rectum and sigmoid colon has decreased in size. Reference measurements listed above.2.Decreased size of the right common iliac lymph node and stable size of the subcentimeter left inguinal lymph node. Reference measurements listed above."}
{"instruction": "Generate impression based on findings.", "input": "Dementia. There are small areas of encephalomalacia in the bilateral basal ganglia and cerebellar hemispheres. There is scattered cerebral white matter T2 hyperintensity as well. In addition, there are numerous scattered punctate foci of susceptibility effect in the bilateral cerebral hemispheres, basal ganglia, and pons. There is mild diffuse cerebral volume loss. There appears to be a defect in a portion of the septum pellucidum. There is no evidence of intracranial mass or acute infarct. 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": "Probable chronic lacunar infarcts in the bilateral basal ganglia and cerebellar hemispheres, chronic small vessel ischemic white matter disease, probable chronic hypertensive microhemorrhages, as well as mild diffuse cerebral volume loss, but no evidence of acute infarct."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate right liver dome lesion seen on CT. ABDOMEN:LIVER, BILIARY TRACT: The right hepatic dome lesion measuring 1.3 x 1.1 cm is moderately T2 weighted hyperintense and demonstrates peripheral nodular discontinuous enhancement which gradually fills in on delayed phase imaging compatible with a benign hemangioma. No additional liver lesion, biliary ductal dilatation or vascular abnormality.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "The right hepatic dome lesion most likely represents a benign hepatic hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female with history of right breast cancer status post neoadjuvant chemotherapy, partial mastectomy, sentinel lymph node biopsy and management radiation therapy. Now with new mammographic evidence of left focal asymmetry and new left nipple inversion. Please evaluate for new suspicious lesions. There is scattered fibroglandular tissue in both breasts. Postsurgical changes noted in the right upper-outer quadrant and axillary region.Mild parenchymal enhancement is noted bilaterally. New linear oriented area of non mass enhancement is seen in the left central breast at approximately 9:00 position measuring 32 x 7 x 7 mm (AP X ML X SI).No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.", "output": "New linear oriented area of non mass enhancement in the left central breast at approximately 9:00 position needs further evaluation with MRI guided biopsy. Findings conveyed to Joly Raju RN, at the time of dictation. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Lumbago with sciatica, unspecified sideClinical question: lumbar spine pain. LLE radicular symptomsSigns and Symptoms: LLE radicular symptoms Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level.At L4-5 there anterior subluxation of L4 on L5, disc desiccation and diffuse disc bulge associated with marked bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of spinal fluid within the thecal sac at this level with a moderate degree of spinal stenosis. There is partial effacement of fat surrounding the exiting nerve roots within the neural foramina at this level. Compared to the previous exam from 5/17/2008 there is been clear progression.At L3-4 there is no significant compromise to spinal canal or neural foramina. There are some ligamentum flavum hypertrophy present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 32mm right renal cyst which previously measured . The left kidney is not entirely included exam and appears to have associated enlargement of the renal cysts and appear smaller than the right kidney.There is some disc desiccation and minor disc bulges at T11-T12, T10 - T11 and T9-T10.", "output": "1.Degenerative changes are present which are worse at L4-5 where there is mild subluxation as well as marked facet hypertrophy, disc bulge and moderate spinal stenosis as well as mild encroachment of exiting nerve roots. Compared to the prior exam from 2008, there significant progression.2.Interval enlargement of renal cysts over the past 7 years. There appears to be some atrophy of the left kidney which to some degree is also present on the prior exam"}
{"instruction": "Generate impression based on findings.", "input": "Cervical spondylosis. Hand paresthesias and leg spasticity. The vertebral column is mildly straightening in the sagittal plane. The vertebral body heights are preserved. There is moderate spondylosis with disc-osteophyte complexes from C3/4 to C6/7 with Modic type II endplate signal changes. Otherwise, the vertebral bone marrow signal is unremarkable. There is overall moderate spinal canal and bilateral neural foramen stenosis from C3/4 to C6/7, with mild indentation of the spinal cord at some of these levels, but no abnormal spinal cord signal. The paravertebral soft tissues are unremarkable. There appear to be a Thornwaldt cyst and an adenoid retention cyst. There is a T2 hyperintense ovoid lesion in the right tracheoesophageal groove that measures up to 12 mm. There is an occipital scalp lipoma that measures up to 5 mm in thickness. There are punctate defects in the inferior right cerebellar hemisphere, which may represent chronic infarcts.", "output": "1. Multilevel degenerative cervical spondylosis with overall moderate spinal canal and bilateral neural foramen stenosis from C3/4 to C6/7.2. An ovoid lesion in the right tracheoesophageal groove that measures up to 12 mm may represent an exophytic thyroid nodule or parathyroid adenoma. A thyroid ultrasound may be useful for further characterization.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Dear male loss of consciousness and head laceration. A scalp laceration in the right frontal region is noted.A very small cortical based lucency in involves the cortex of high convexity right parietal lobe this is highly suspected of a very small cortical stroke. This is best demonstrated on axial image 22 and 23. Further follow-up with an MRI is recommended.No additional areas of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected.", "output": "Very small area of vertical low-attenuation in the right high convexity parietal suspected a very small cortical stroke."}
{"instruction": "Generate impression based on findings.", "input": " There is redemonstration of multiple punctate subcortical and periventricular white matter lesions which are hyperintense in FLAIR. There is no significant change in the size and number of the lesion with no evidence of enhancement.", "output": "No evidence of progression of the known MS disease. No evidence of enhancement to suggest acute exacerbation."}
{"instruction": "Generate impression based on findings.", "input": "66 year old female with cognitive impairment, altered mental status, evaluate for stroke or brain injury MRI Brain: 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. There is global parenchymal volume loss, relatively greater in the bilateral frontal and parietal lobes. There is hippocampal volume loss which is not disproportionate to the remainder of the brain. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Small foci of volume loss and FLAIR hyperintensity along the left lateral ventricle margin are compatible with lacunar infarcts. Brain parenchyma is otherwise unremarkable for age. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRA Brain: There is irregularity and moderate narrowing involving the bilateral cavernous internal carotid arteries likely related to atherosclerotic disease. There is diminished flow-related enhancement involving the left distal vertebral artery with reconstitution distally. The bilateral ACAs, MCAs, basilar artery, and PCAs demonstrate no significant stenosis. No aneurysms are appreciated.", "output": "1. No evidence of acute infarct, mass or mass effect. 2. Mild chronic small vessel ischemic disease. 3. Global parenchymal volume loss relatively greater in the bilateral frontal and parietal lobes.3. Intracranial atherosclerotic disease with moderate narrowing involving the cavernous internal carotid arteries and V3 segment of the left vertebral artery. These stenoses can be better visualized with CTA if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for PSC History: Recent MRI/MRCP with narrowing of the proximal common bile duct. ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis, unchanged. Geographic areas of T2 hyperintense signal and hyperenhancement likely due to fibrosis, unchanged. Previously seen hemangioma is not visualized on today's exam. Focal stricturing at the proximal common bile duct is unchanged. No intrahepatic or extrahepatic biliary ductal dilatation. The right hepatic duct again is poorly visualized. 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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Stable minimal narrowing of the proximal common bile duct and poor visualization of the right hepatic duct. No new areas of stricturing or dilatation. 2.Hepatic steatosis and fibrosis without suspicious focal lesion. Previously seen probable hemangioma is not visualized on today's examination."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Assess for rotator cuff tear - concern for supraspinatus and infraspinatus; acute injury 5/15 with new weakness and shoulder pain History: Right shoulder pain, supraspinatus and infraspinatus weakness after acute injury (fall) ROTATOR CUFF: Again seen is a full-thickness tear of the anterior fibers of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 2.2 cm in the AP dimension. There is associated retraction of the proximal tendon fragment by approximately 4 cm. There is thickening and intermediate signal intensity within the proximal tendon fragment indicating tendinosis. There is moderate fatty atrophy of the supraspinatus. The infraspinatus muscle and tendon appear intact. There is thickening and intermediate signal intensity within the subscapularis indicating moderate tendinosis. There is linear fluid signal intensity within the tendon indicating interstitial tearing. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa with foci of low signal intensity internally which may reflect a bursitis or debris. Severe osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality within the inferior labrum likely representing a combination of degeneration and degenerative tearing.BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of biceps tendon which may represent fluid extension from the joint. The tendon itself appears intact. ADDITIONAL", "output": "1. Full-thickness tear of the anterior fibers of the supraspinatus with retraction which appears increased in size when compared to the prior study. Interstitial tearing of the subscapularis. Rotator cuff tendinosis.2. Osteoarthritis of the shoulder.3. Findings suggestive of a subacromial subdeltoid bursitis and possible glenohumeral joint synovitis. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "History of long-standing endometriosis with known pelvic mass since 2012. Presenting with menorrhagia. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, and enhancement without a focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Loss of signal on out of phase imaging compatible with diffuse fatty infiltration. Normally distended gallbladder without cholelithiasis.SPLEEN: Normal size spleen without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few bilateral cystic lesions are not completely characterized without contrast. One in the right interpolar region appears at least minimally complex. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal small and large bowel caliber. No significant free or loculated fluid collection. Small fat-containing umbilical hernia without evidence of complication.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal basilar atelectasis.PELVIS:UTERUS, ADNEXA: The endometrial thickness is 10 mm, within normal limits. The inner myometrium/junctional zone is not well-defined with diffuse low signal intensity thickening of the uterine body particularly anteriorly with scattered T2 hyperintense foci compatible with diffuse adenomyosis.Small nabothian cysts.Well-defined 4.9 x 5.2 cm right uterine body subserosal mass is unchanged and likely a fibroid.In the rectouterine space there is a well-defined predominantly homogeneously T1 weighted hyperintense lesion with mild shading on T2-weighted imaging sequences. It is bilobed and measures 10.0 x 10.2 cm (series1501/38), not significantly changed from the prior study. However, it contains a large peripheral heterogeneous focal component which is partially exophytic measuring 6.9 x 4.5 cm (series 1601/40), increased from the prior study.The right and left adnexa are unremarkable in morphology size and signal intensity.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The rectouterine mass causes leftward mass effect on the sigmoid colon without evidence of invasion or obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No significant change in the overall size of the large cul-de-sac mass. However, the complex heterogeneous focal component of this lesion demonstrates interval increase in size. No postcontrast images were obtained due to the patient's contrast allergy. The lesion appears distinct from the ovaries which are otherwise unremarkable. A large endometrioma remains on the differential. Although uncommon, malignant transformation cannot be excluded especially given the limitation of a nonenhanced examination and the interval increase in size a focal component of the dominant. Without the provided history of endometriosis, a hemorrhagic cystic neoplasm could not be excluded.2.Diffuse adenomyosis.3.Fatty liver.4.Incompletely characterized renal cystic lesions."}
{"instruction": "Generate impression based on findings.", "input": "Reason: ganglioglioma. Status post left-sided temporoparietal craniotomy for sub dural hematoma History: 6 month follow up, eval for changes.. Postsurgical findings of left temporal ganglioglioma resection with left-sided craniotomy. A large left cerebral convexity subdural fluid collection with multiple adhesions is unchanged in size from the prior exam measuring 27 mm, previously 28 mm. Ventricular asymmetry with partial effacement of the left lateral ventricle and mild right ventricular enlargement is unchanged. 8 mm of left to right midline shift is unchanged. Subtle increased FLAIR signal in the left temporal lobe is unchanged. Volume loss in the left anterior temporal lobe is unchanged. Mild enhancement along the left anterior medial aspect of the resection cavity is unchanged with no new or enlarging enhancing lesions. Tenting of the left frontal lobe to the overlying dura is unchanged. No acute intracranial infarction or hemorrhage. No new enhancing lesions to suggest recurrence or metastases.", "output": "Stable examination including large chronic left subdural hematoma with midline shift."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic NSCLC to bone with new symptoms concerning for brain metastases. There are multiple, at least 10, supratentorial and infratentorial intraparenchymal and leptomeningeal enhancing lesions. For example, a heterogeneously enhancing dominant tumor with central foci of susceptibility effect in the left thalamic region with focal effacement of the third and lateral ventricles measures up to 36 mm, an irregular right anterior superior frontal gyrus lesion measures up to 11 mm, a peripherally enhancing left lateral orbitofrontal gyrus lesion measures 8 mm in diameter, an enhancing nodular along the superior vermis measures 6 mm in diameter, an enhancing focus in the interpeduncular cistern measures 4 mm in diameter, a focus of enhancement along the ependymal margin of the left occipital horn measures 4 mm, and there are enhancing foci along multiple cranial nerves. Many of the lesions are associated with vasogenic edema. There is an enhancing 5 mm wide left frontal convexity lesion without substantial mass effect upon the underlying brain parenchyma. There is a background of nonspecific mild scattered cerebral white matter T2 hyperintensity without associated enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. Multiple supratentorial and infratentorial intraparenchymal and leptomeningeal metastases, with a dominant left thalamic region tumor that measures up to 36 mm and may contain small areas of hemorrhage.2. A 5 mm wide left frontal convexity lesion may represent a meningioma."}
{"instruction": "Generate impression based on findings.", "input": "Female, 42 years old, with history of lung cancer and wobbly gait, assess for metastatic disease. Findings are seen related to prior right parietal craniotomy.A 10 mm rim-enhancing nodule is evident within or adjacent to the cortex of the right superior frontal gyrus with modest local edema. Thick irregular subarachnoid enhancement is also seen within the right central sulcus and to a lesser degree the right precentral sulcus, also with modest local edema. Very mild subarachnoid enhancement is also seen along the right paracentral lobule.Pathologic enhancement is evident within both IAC's. Minimal pathologic enhancement is also seen scattered throughout the cerebellar fissures without significant parenchymal edema.No evidence of significant generalized mass effect is seen. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The lesion along the right superior frontal gyrus demonstrates internal susceptibility compatible with chronic blood product.", "output": "1.Findings compatible with leptomeningeal carcinomatosis involving the right central sulcus and surface of the right paracentral lobule, the IACs, and the cerebellar fissures.2.An enhancing lesion along the right superior frontal gyrus may be either cortical or subarachnoid in location."}
{"instruction": "Generate impression based on findings.", "input": "History of HCC status post TACE/RFA of 3 hepatic lesions. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with a nodular contour, left hepatic lobe hypertrophy and fissural widening.Segment 5 ablation cavity measures 3.9 x 1.9 cm) (series 9/249). Adjacent to the anterolateral cranial aspect of this ablation cavity is a residual focus of arterial enhancement measuring 1.7 x 1.4 cm (series 9/35). This associated with restricted diffusion without definite washout.Segment 6 ablation cavity measures 2.8 x 1.0 cm (series 9/247). Adjacent to the medial cranial aspect of this ablation cavity is a 1.3 x 1.2 cm residual focus of arterial enhancement (series 9/30), increased in size from the prior where it measured 1.1 x 1.0 cm (series 10/44). This is associated with restricted diffusion without definite washout.Additional punctate subcentimeter enhancing focus in segment 8 (series 9/29) is unchanged, measuring 7 x 6 mm.Segment 3 ablation cavity measures 2.6 x 1.1 cm (series 9/242). SPLEEN: Splenomegaly measuring 18 cm in craniocaudal dimension. Numerous siderotic nodules.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Post-ablation changes of the liver. There are residual arterially enhancing lesions adjacent to the segment 5 and segment 6 ablation cavities. The segment 6 enhancing focus demonstrates interval mild increase in size. Stable non-specific enhancing subcentimeter focus in segment 8."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Disturbance of skin sensationClinical question: radiculopathy, numbness, right hip tightnessSigns and Symptoms: right sided lower extremity tightness, numbness diffusely Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a 27 mm predominantly T1 hyperintense lesion with a spiculated appearance located within the left side of the L3 vertebral body which most likely represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.No significant compromise to lumbar spinal canal or neural foramina. There is a minor disc bulge present at L5-S1 without significant compromise to the adjacent nerve roots.2.There is a lesion within the L3 vertebral body which most likely represents a vertebral body hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "55 year old female with PMHx of alcoholic cirrhosis admitted for abdominal pain, diarrhea, found to have an IVC mass. Referred for cardiac MRI to evaluate for RA mass. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%. The LVEDV is 125 ml (normal range 142+/-34), the LV end diastolic volume index is 78 ml/m2 (normal range: 74+/-15), the LVESV is 44 ml (normal range 47+/-19) and the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9). The LV mass is 82 g (normal range 164+/-36) and the LV mass index is 51 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Artifact over the basal inferior and inferolateral walls preclude accurate assessment of late gadolinium enhancement in these areas. The native T1 myocardial relaxation time is normal at 1060 ms. This value is suggestive off no underlying diffuse fibrosis or inflammation. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%. The RVEDV is 130 ml (normal range 142+/-31), RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVESV is 44 ml (normal range 54+/-17), and the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is upper normal in size. No right atrial mass appreciated. Aortic ValveThe aortic valve is trileaflet, 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 mild tricuspicd regurgitation.AortaThere is a left sided aortic arch with pseudo-bovine 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 drain normally into the right atrium. Turbulence noted at the level of the IVC/RA junction but a mass could not be appreciated. However, image quality is suboptimal at this level.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsModerate right and small left-sided pleural effusion. Atelectasis noted in the right lung base. 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.The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%.2.The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%.3.No right atrial mass/thrombus appreciated. 4.IVC mass not well seen on this study. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Left shoulder pain acute, persistent pain and immobility for 4 weeks. Unable to externally rotate or laterally abduct above horizontal. Evaluate for rotator cuff tear. ROTATOR CUFF: There is a partial thickness tear of the distal fibers of the supraspinatus tendon. The supraspinatus muscle appears normal for age. The infraspinatus tendon is intact and the muscle is normal in appearance for age. The teres minor muscle/tendon are intact. There is thickening and increased signal intensity within the subscapularis tendon compatible with tendinosis. Additionally, there is a full thickness insertional tear of the subscapularis without tendon retraction. The subscapularis muscle appears normal for age.SUPRASPINATUS OUTLET: Moderate to severe osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is thinning of the articular cartilage of the superior glenoid. The labrum is grossly intact.BICEPS TENDON: There is thickening and increased signal intensity within the proximal portion of the long head of the biceps tendon compatible with tendinosis. ADDITIONAL", "output": "1. Rotator cuff tears and tendinopathy as described above.2. Biceps tendinopathy.3. Bone edema of the posterolateral humeral head. "}
{"instruction": "Generate impression based on findings.", "input": "53 years Female (DOB:10/13/1962)Reason: please do dr javed MS protocol compare to prior History: leg weakness, fatigue, dysequilibriumPROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. There are periventricular and subcortical white matter lesions present within the brain parenchyma. These were also present on the prior exam. They have not significantly changed in number relative to the prior exam. No new lesions are appreciated. There are also several lesions present in the cerebellum and brainstem which are also unchanged. No abnormal enhancing lesions are appreciated within the brain parenchyma in association with these.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There is redemonstration of multiple white matter lesions present within the subcortical and periventricular white matter as well as in the posterior fossa which are stable when compared to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Patchy hepatic steatosis. No intrahepatic or extra hepatic biliary ductal dilatation. Simple right hepatic dome cyst. No suspicious liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: In the dorsal aspect of the pancreatic body there is a unilocular 3.2 x 2.0 cm cystic lesion demonstrating no internal enhancement or enhancing papillary projections. Lesion demonstrates very thin wall enhancement. The lesion does not clearly communicate with the main pancreatic duct which is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintense foci compatible with hepatic cysts and too small to characterize hyperintensities. Intrinsically hyperintense right renal formation/hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral breast prostheses.OTHER: No significant abnormality noted.", "output": "3.2 cm pancreatic body cystic lesion without definite communication with the main pancreatic duct which is normal in caliber. Differential considerations include a mucinous cystic neoplasm.Hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: STROKE History: R SIDE WEAKNESS Scattered restricted diffusion lesions on the left PCA territory including left occipital lobe, left side corpus callosum splenium, left thalamus, and left periventricular white matter. In addition, there are scattered restricted diffusion lesions on the right parietal lobe and bilateral cerebellar hemispheres.There is no evidence of hemorrhagic transformation.Underlying brain shows extensive patchy high signal intensities on periventricular white matter, cerebellar hemisphere and pons indicating non specific small vessel disease.In addition, there are multifocal tissue losses on bilateral basal ganglia and pons indicating chronic lacunar infarctions with encephalomalacia.The ventricles, sulci and cisterns are symmetric and unremarkable. 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. Multifocal acute/subacute ischemic infarctions mainly on the left PCA territory but also involves right parietal lobe and bilateral cerebellar hemispheres.2. There is no evidence of hemorrhagic transformation.3. Underlying brain demonstrated multifocal lacunar infarctions with tissue losses as well as extensive non specific small vessel disease."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male, evaluation of exposed hardware, left orbit, history of meningioma status post resection 2003 There are postsurgical changes of left anterior frontotemporal craniotomy with underlying encephalomalacia involving the anterior inferior frontal lobe and anterior temporal lobe presumably related to resection of prior meningioma. There is thickening of the left zygoma and left sphenoid wing which may be related to prior surgery and radiation, although this could represent residual hyperostosis as well. There may be some enhancement and thickening of the cutaneous tissues lateral to the left orbit which is nonspecific; inhomogeneous fat suppression could also account for these findings. There are no fluid collections or findings to suggest osteomyelitis. The surgical hardware is better assessed on recent CT study.There is no intraparenchymal restricted diffusion to suggest acute ischemia. There is no evidence of intraparenchymal hemorrhage. There are no extra-axial collections. There are no discrete intraparenchymal masses. There is no mass effect.There is scattered periventricular and subcortical T2/FLAIR hyperintense foci compatible with chronic small vessel ischemic disease.The left maxillary sinus is completely opacified with what may represent secretions or a large mucous retention cyst. There is near complete opacification of the left sphenoid sinus as well. The mastoid air cells and middle ear cavities are unremarkable. There are normal flow voids within the intracranial carotid and vertebral vasculature.", "output": "1. Postoperative changes of left anterior frontotemporal meningioma resection with encephalomalacia at the resection cavity.2. There maybe some cutaneous enhancement and thickening lateral to the left orbit which is nonspecific. Inhomogeneous fat suppression could also account for the findings. There are no fluid collections or findings to suggest osteomyelitis. "}
{"instruction": "Generate impression based on findings.", "input": " There is slight reversal of normal cervical curvature centered at C5. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Left facet hypertrophy and slight ligamentum flavum thickening. There is mild left neural foraminal stenosis.C3/4: Mild posterior osteophyte disc complex, slight ligamentum flavum thickening, and mild bilateral facet hypertrophy. There are no significant stenoses.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and minimal bilateral facet hypertrophy. There is mild anterior cord flattening without intrinsic cord signal abnormality. There is mild central, mild left neural foraminal, and mild to moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild anterior cord flattening without intrinsic cord signal abnormality. There is mild central and mild bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central and mild bilateral neural foraminal stenosis.C7/T1: Unremarkable", "output": "1.C2/3: Mild left neural foraminal stenosis.2.C4/5: Mild central, mild left neural foraminal, and mild to moderate right neural foraminal stenosis.3.C5/6: Mild central and mild bilateral neural foraminal stenosis.4.C6/7: Mild central and mild bilateral neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Pain and swelling 1 month after injury. MENISCI: No significant abnormality noted. Specifically menisci are well visualized, intact and anchored posteriorlyARTICULAR CARTILAGE AND BONE: No abnormal marrow signal, however mild osteoarthritic changes are observed. Small osteophytes and minimal narrowing. Cartilage is preserved throughout the medial and lateral compartments however moderate thinning of the patellofemoral surface with mild irregularity without focal cartilaginous defect, however small underlying small cysts are observed under the medial facet.LIGAMENTS: ACL and PCL are intact. Anterior extensor complex, LCL and patella are also unremarkable. The MCL however demonstrates minimal surrounding fluid and although intact in uniform throughout its entirety, a mild sprain is observed. Minimal waviness of the medial patellar retinaculum is observed, this may represent an old injury, however please correlate with physical exam for patellar stability.EXTENSOR MECHANISM: As aboveADDITIONAL", "output": "1. Questionable mild MCL sprain2. Mild degenerative changes involving the patella with retinacular minimal irregularity concerning for prior and likely remote dislocation, correlate with history.3. Moderate Baker's cystI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Known solitary cavernoma. Surveillance examination. Within the peripheral right pons there is a mixed T1 and T2 bright lesion with foci of internal and peripheral susceptibility compatible with the stated history of a cavernous malformation. This measures 1.7 x 1.0 x 1.5 cm (AP by transverse by CC). There is no adjacent edema or other findings to suggest acute hemorrhage. Postcontrast images demonstrate adjacent serpiginous vessels likely representing an associated developmental venous anomaly.No additional cavernomas are identified. Punctate focus of increased T2 signal in the left parietal lobe subcortical white matter without associated susceptibility or enhancement may represent a small focus of small vessel ischemic change. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.", "output": "Single cavernous malformation in the right lateral pons measuring 1.7 x 1.0 x 1.5 cm with an associated developmental venous anomaly. No additional cavernomas are identified."}
{"instruction": "Generate impression based on findings.", "input": "Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm [E05.20], Reason for Study: ^Reason: staging, newly diagnosed lung cancer History: newly diagnosed lung cancer There is about 5 mm sized ring-enhancing lesion on the right corpus callosum body without significant mass effect. The lesion shows restricted diffusion with FLAIR high signal intensity. There are also multiple FLAIR high signal intensity lesions located on subcortical white matter and deep white matter but those lesions do not show any evidence of enhancement.Diagnostic possibilities include demyelinating disease such as multiple sclerosis with active plaque, subacute ischemic infarction and considering the patient history of primary malignancy (lung cancer), the diagnosis of metastatic lesion cannot be excluded. There is no other abnormal enhancing lesion is seen.There is no evidence of acute hemorrhagic or ischemic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. 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": "Single ring enhancing lesion with restricted diffusion at the right corpus callosum body with multiple FLAIR high signal intensity lesions as described above. Diagnostic possibilities include demyelinating disease such as multiple sclerosis, subacute ischemic infarction and metastatic lesion.No evidence of acute hemorrhagic lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Complains of headaches. On Coumadin. Rule out chronic subdural? Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The pituitary gland appears a slightly enlarged and with apparent extension into the basal cistern. This is concerning for a pituitary adenoma and follow-up with an MRI exam is recommended. This finding measures approximately 15.2 mm in cranial cephalad access on sagittal reformatted images.The cortical sulci, ventricular system, cisterns cisterns and gray -- white matter differentiation is within normal limits.Calvarium is intact.Paranasal sinuses and mastoid air cells are well pneumatized and unremarkable.", "output": "1.Pituitary adenoma as described above. Follow-up with an MRI is recommended.2.Unremarkable non-infused CT of brain and calvarium.3.Visualized paranasal sinuses and mastoid air cells are unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "Right medullary thyroid now with rising calcitonin, possible left level 4/5 nodes. There are postoperative findings related to total thyroidectomy without evidence of measurable locoregional tumor or abnormal lymph nodes in the neck. The major salivary glands are unremarkable. There is atherosclerotic plaque at the bilateral carotid bifurcations and left vertebral artery origin. There is multilevel degenerative spondylosis. The imaged intracranial structures are unremarkable.", "output": "Postoperative findings related to total thyroidectomy without convincing evidence of measurable locoregional tumor recurrence or lymph node metastases in the neck. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 57 years old, with history of nasopharyngeal cancer, status post induction, evaluate response. Neck:The previously demonstrated nasopharyngeal mass has significantly decreased in size and definition. A discretely measurable lesion separate from the adenoids is no longer identified.Substantial decrease in the size of multiple metastatic lymph nodes is seen. The large aggregate at level II on the right now measures approximately 21 x 12 mm (image 30 series 20), previously 55 x 54 mm. A left level II node measures 23 x 13 mm (image 30 series 20), previously 37 x 18 mm. A left lateral retropharyngeal node now measures up to 19 x 11 mm (image 24 series 20), previously 21 x 12 mm.The salivary glands are within normal limits. The visualized airway is patent. Bone marrow signal characteristics are unremarkable. Disc herniations are seen at several levels in the visualized cervical spine with perhaps mild spinal canal stenosis at C4-5.Brain:No evidence of parenchymal edema, mass effect or pathologic intracranial enhancement is observed. Diffusion-weighted images are within normal limits. No intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. A few very small scattered foci of T2 hyperintensity within the cerebral hemispheres are nonspecific. Ventricular size and morphology are within normal limits.", "output": "1.Significant interval decrease in the size of a nasopharyngeal mass, such that there is no longer any discretely measurable lesion.2.Significant interval decrease in size of multiple pathologic lymph nodes and nodal aggregates in the neck.3.No evidence of intracranial metastasis."}
{"instruction": "Generate impression based on findings.", "input": "67 years Male (DOB:12/21/1948)Reason: assess limited MRI of head History: AMSPROVIDER/ATTENDING NAME: SHANNON K MARTIN HEMAL M. NAYAK MRI of the brainThere is redemonstration of diffusion restriction involving the right centrum semiovale and right periventricular white matter at the trigone and right occipital lobe. There is no evidence for hemorrhagic conversion. The extent has not changed since the prior exam, however, the signal intensity on DWI has decreased.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the PCA bilaterally associated with a hypoplastic p1 segment on the right and a small to medium sized p1 segment on the left. The right SCA is predominantly supplied via the anterior circulation. The RVA is hypoplastic intracranially", "output": "1.There is redemonstration and continued evolution of foci of subacute infarction involving the right centrum semiovale and right periventricular white matter at the trigone and right occipital lobe. These have not changed in extent compared to the prior exam. There is no evidence for hemorrhagic conversion at this time.2.There is bilateral fetal origin. The right SCA is predominantly supplied via the anterior circulation. The RVA is hypoplastic"}
{"instruction": "Generate impression based on findings.", "input": "40 year old with history of congenital cleft tricuspid valve requiring tricuspid valve repair presenting for evaluation of heart function. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 105 ml/m2 (normal range: 65+/-11), the LVEDV is 173 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 69 ml (normal range 31+/-10), the LV mass index is 35 g/m2 (normal range 67+/-11), and the LV mass is 57 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is small area of late gadolinium enhancement in the mid inferior wall of unknown signficance. This was seen on previous CMR exams. This may represent a previous fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 133 ml/m2 (normal range 69+/-14), the RVEDV is 219 ml (normal range 110+/-24), the RV end systolic volume index is 63 ml/m2 (normal range 22+/-8), and the RVESV is 105 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. 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 ValveThere is evidence of tricuspid valve repair. There is qualitatively moderate tricuspid regurgitation(appears slightly worse than previous study). 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 FindingsSternal wires are noted. 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. Moderate LV dilation with normal systolic function (LVEF 60%) with evidence of a small atypical pattern of late gadolinium enhancement seen in the basal inferior wall. 2. Severe RV dilation with normal systolic function (RVEF 52%).3. Moderate right atrial dilation.4. Moderate tricuspid regurgitation.When compared to the prior study, the patient's LV and RV are larger and the amount of tricuspid regurgitation is a little more. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Status post brain tumor resection. Assess extent of resection. There are expected changes related to the recent resection on the left temporal mass. Accounting for T1 hyperintensity along the surgical margin, which probably reflects the presence of blood products, there is a small area of contrast enhancement along the anterior-inferior-lateral surgical margin. Even smaller foci of contrast enhancement are present along the lateral aspect of the superior surgical margin. These may represent residual tumor tissue but may also reflect early post resection enhancement. Contrast enhancement along the posterior-superior surgical margin, which abuts the temporal horn of the left lateral ventricle, is likely reactive enhancement in the choroid plexus. There is hemorrhage in the anterior inferior lateral aspect of the left temporal lobe anterior to the surgical, likely within the anterior aspect of the fusiform gyrus. There is minimal volume of blood products in the occipital horn of the left lateral ventricle. The T2-hyperintensity surrounding the left temporal treatment bed is not significantly changed. While midline shift is slightly improved, now 4 mm compared to 6 mm at the level of the lower aspect of the septum pellucidum, impingement on the suprasellar cistern has slightly increased. There is no sign of perioperative infarct. There continues to be no other focus of brain enhancement. Noncontrast enhancing, non-diffusion-restricted foci of T2-hyperintensity in the cerebral white-matter probably reflect chronic microvascular ischemia. Major intracranial vascular flow voids are preserved, reflecting gross patency.The relatively large right nasopharyngeal mucosa retention cyst is unchanged. Focal T2-hyperintensity in the posterior aspect of the right masseter cells is unchanged and nonspecific.", "output": "1.The left temporal mass has been resected. Small foci of contrast enhancement along the surgical margin, especially along the anterior-inferior-lateral surgical margin, may reflect residual tumor or may reflect early post surgical contrast enhancement. Follow-up MRI imaging may better characterize the significance of these foci of contrast enhancement. 2.There is small hemorrhage extending from the anterior-inferior surgical margin into the anterior aspect of the left fusiform gyrus. There is also minimal hemorrhage in the occipital horn of the left lateral ventricle."}
{"instruction": "Generate impression based on findings.", "input": " There is slight prominence of lobulated soft tissue along the base of the tongue projecting into the vallecula, more prominent on the left side. The oral tongue is unremarkable. The right submandibular gland is slightly more prominent than the left with overlying prominent right level 1B lymph node measuring 1.4 cm.There is no abnormal enhancement. Nasopharynx, oropharynx, hypopharynx and the larynx are otherwise unremarkable.There is mild T1 and T2 hyperintense lesion in the upper pole of the right lobe of the thyroid gland which is nonspecific.There is no evidence of diffusion restriction.", "output": "1. Mildly prominent right greater than left submandibular gland with overlying prominent right level 1B lymph node, which may correlate with palpable area of concern.2. Mild prominent lobulated soft tissue along the base of the tongue which projects into the vallecula, more prominent on the left side, most likely reactive lymphoid tissue. Please correlate with findings from direct inspection.3. Mild T1 and T2 hyperintense lesion in the upper pole of the right lobe of the thyroid gland, which is a nonspecific finding, but may represent a small hemorrhagic or proteinaceous lesion. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "History of metastatic prostate cancer status post recent left frontal region tumor resection. There are postoperative findings related to recent resection of a left frontal convexity mass, along with overlying cranioplasty. There is no evidence of gross residual tumor. There is diffuse left cerebral convexity dural enhancement and a extra-axial fluid collection that measures up to 6 mm in thickness. 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. There is are small bilateral mastoid air cell effusions. There are bilateral lens implants. There is a small right maxillary sinus retention cyst.", "output": "Recent resection of a left frontal convexity tumor resection, without evidence of gross residual tumor."}
{"instruction": "Generate impression based on findings.", "input": "History of spinous process fractures of T10, T11, T12 and pelvic bones with worsening mid-lower back pain. Three views of the thoracic spine are provided. The bones appear perhaps slightly demineralized. Mild degenerative disc disease affects T12-L1. The previously described suspected T11-T12 spinous process fractures are not clearly evident on this study.Three views of the lumbar spine demonstrate mild degenerative disc disease at L5-S1. The L1 spinous process fracture described on prior MRI is not clearly evident on this study. Alignment is within normal limits. Vertebral body heights are preserved.A single AP view of the pelvis demonstrates mild deformity of the right superior pubic ramus and bilateral inferior pubic rami which may reflect the healing fractures seen on prior MRI. We see no acute fractures. Evaluation of the lower sacrum is limited by overlying bowel gas. The sacral and iliac fractures seen on prior MRI are not clearly visualized.Three views of the sacroiliac joints demonstrate minimal osteoarthritis of the bilateral sacroiliac joints.", "output": "Bilateral obturator ring deformities likely representing old healed fractures. We see no acute fractures. Mild degenerative disc disease of the lower thoracic and lumbar spine."}
{"instruction": "Generate impression based on findings.", "input": "Low back pain, history of herniated disk and lumbar radiculopathy. There is an eccentric left disc protrusion at L5-S1 that results in mild-to-moderate left neural foraminal stenosis, but no significant right neural foraminal or spinal canal stenosis. There is a slight disc bulge at L4-5 with minimal left neural foraminal stenosis. There are fatty and edematous degenerative endplate signal alterations at L4-5 and L5-S1 with loss of fluid signal and loss of height of the discs. There is no significant degenerative spondylosis at the other lumbar spine levels. The vertebral column alignment is within normal limits. The vertebral body are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable, aside from mild dependent edema in the posterior subcutaneous tissues.", "output": "Mild-to-moderate left L5-S1 neural foraminal stenosis related to a disc protrusion."}
{"instruction": "Generate impression based on findings.", "input": "Mental portion: Rule out hemorrhage. Signs and symptoms: Altered mental status, gaze deviation. Unenhanced head CT:Since prior CT examination from 9 -- 16 -- 2011 and MRI examination from 9 -- 19 -- 2011 there is interval noticeable increase in the size of the supratentorial ventricular system. There is also resultant partial effacement of cortical sulci throughout bilateral cerebral hemispheres. Finding is consistent with acute hydrocephalus. There is no definitive evidence of periventricular low attenuation to suggest transependymal CSF exudate. There is low attenuation and thickening of the posterior aspect of septum pellucidum when compared with prior two studies. This finding appears to extend posteriorly along the roof of the third ventricle and likely in the velum interpositum. Review post shunted the study demonstrate absence of this finding which is suggestive of exudate of CSF into the septum pellucidum and cisternal velum interpositum. This finding is best appreciated on axial images 13 and 14 and coronal reformatted image 32. Findings were discussed with referring clinical physician Dr Hadipour pager # 3068 at the time of review exam.", "output": "1.Interval development of hydrocephalus with resultant partial effacement of bilateral cerebral cortical sulci.2.Low-density soft tissue fullness at the level of septum pellucidum and cisternal velum interpositum likely representing CSF leakage into the cisterns due to patient's hydrocephalus. This finding has resolved on immediate follow-up exam to this study.3.No evidence of periventricular transependymal exudate, hemorrhage or midline shift. "}
{"instruction": "Generate impression based on findings.", "input": "Female 38 years old 10 weeks from repeat cesarean delivery with persistent left lower quadrant abdominal pain; evaluate for abscess, fluid collection or ventral hernia. PELVIS:UTERUS, ADNEXA: Susceptibility artifact along the anterior lower uterine segment and ventral wall soft tissues is consistent with the history of recent cesarean section. The uterus is normal in size and contour. A few follicles are seen within each ovary. No adnexal mass.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No free or loculated pelvic fluid. The visualized bowel is normal in caliber. Normal appendix.BONES, SOFT TISSUES: Susceptibility artifact in the lower anterior pelvic wall is related to recent cesarean section. No hernia is seen.OTHER: Note is made of a sacral Tarlov cyst.", "output": "MRI pelvis study showed:1.No pelvic fluid collection or abscess.2.No abdominal wall hernia.3.Expected postsurgical changes of recent cesarean section."}
{"instruction": "Generate impression based on findings.", "input": "Tingling/paresthesia in the left finger and the groin. Evaluate for demyelinating disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma is unremarkable. Specifically, there are no lesions suggestive of multiple sclerosis or other demyelinating disease. There is no abnormal intracranial enhancement. Slight asymmetric prominence of the posterior right lateral ventricle without significant abnormality in the adjacent parenchyma is probably a normal variation. Otherwise, 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 pituitary gland appears unremarkable. There are small retention cysts in the maxillary sinuses.", "output": "1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.There is also no brain abnormality to suggest multiple sclerosis or other demyelinating disease."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified fall [E888.9], Reason for Study: ^Reason: better define intracranial lesion History: S/P fall; s/p R craniotomy 2013; R proptosis Motion artifact degraded exam quality.There is no evidence of acute ischemic or hemorrhagic lesion on the scanThere is evidence of right frontal parietotemporal craniotomy with right temporal occipital encephalomalacia. Approximately 12 mm in thickness of dural thickening and enhancement are seen. No significant interval change since prior scan. There is no other abnormal enhancement.Patchy high signal intensities on bilateral periventricular white matter indicate mixed age indeterminate ischemic infarct and nonspecific small vessel ischemic disease. Again no change since prior scan.Susceptibility artifact lesion on the left parieto-occipital sulcus as well as right frontal parietal subdural space indicate prior hemorrhage related blood products. No change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. 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. Bilateral inguinal lens is not seen, no change since prior scan.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. Prior right frontal parietotemporal craniotomy with the underlying dural thickening with enhancement, no significant interval change in terms of dural thickening and enhancement pattern since prior scan.3. No change of right temporal occipital encephalomalacia with periventricular white matter changes since prior scan."}
{"instruction": "Generate impression based on findings.", "input": "Male, 74 years old, with progressive gait deterioration. Grade 1 anterolisthesis of C4 relative to C5 is seen, progressed from the prior examination. A mild reversal of the normal cervical lordosis has developed as well.Progressive disc degeneration is seen between C4 and C7 with further loss of disc height and endplate integrity and degenerative loss of vertebral body height. No significant marrow edema is detected. Ventral epidural thickening from C4 through C7 has also progressed, likely secondary to degeneration of the adjacent discs.Sequelae of prior laminectomy are again seen from C3-C7. The spinal canal remains decompressed in this region similar to prior. The spinal cord is thinned in the area of laminectomy and there is superimposed focal signal abnormality at the C5 level compatible with myelomalacia. Elsewhere, the cord is unremarkable.C2-3: Right facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes. C3-4: Facet arthropathy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. No interval changes. C4-5: Bilateral facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the right paracentral and foraminal zones. No spinal canal stenosis. Severe bilateral foraminal narrowing. No interval changes. C5-6: Facet arthropathy. Progressive disc and endplate degeneration with disc osteophyte formation. No significant spinal canal stenosis. Severe bilateral foraminal narrowing, likely progressed. C6-7: Facet arthropathy. Progressive disc and endplate degeneration with disc osteophyte formation. No significant spinal canal stenosis. Severe left foraminal narrowing, unchanged. C7-T1: Progressive disc and endplate degeneration with disc osteophyte formation. Moderate generalized spinal canal narrowing which has slightly progressed. Severe bilateral foraminal narrowing, similar to prior.", "output": "1.Multilevel disc degeneration has progressed between C4 and C7. Although most of these levels have been surgically decompressed, a moderate canal narrowing is evident at C7-T1.2.The spinal cord remains thinned between C4 and C7 with focal chronic myelomalacia at the C5 level. No other cord abnormalities are identified.3.Evidence of prior laminectomy for spinal canal decompression is seen between C3 and C7. "}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Neoplasm of unspecified behavior of respiratory system Neoplasm of uncertain behavior of brain, unspecified. Encounter for other preprocedural examinationClinical question: growth of sphenoid sinus/posterior fossa tumor, MRA and a MRI STEALTH for presurgery planning. No fiducials neededSigns and Symptoms: imaging for image guidance during surgery, and details of anatomy MRI of the brainThere is a mass centered in the left cavernous sinus involving the left sphenoid sinus involving the left sphenoid bone which displaces the cavernous LICA laterally. It extends into the left sphenoid sinus and left pterygomaxillary fossa. It protrudes into the lateral aspect of the pituitary fossa. It appears very vascular with multiple flow voids. It has significantly enlarged relative to the prior exam from 8/13/12.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is a vascular mass centered in the left cavernous sinus. Arterial supply can be identified from the LICA, RICA and left internal maxillary artery branches including the left middle meningeal artery.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is no stenosis of the left ICA at the level of the known cavernous sinus mass.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating arteries are intact and medium size. The vertebral arteries are similar in size.", "output": "1.There is a vascular mass centered in the left cavernous sinus which appears to erode into the adjacent sphenoid bone and extend into the sphenoid sinus, pterygomaxillary fossa and pituitary fossa,. Arterial supply can be identified from the LICA, RICA and LECA branches. It has significantly enlarged relative to the prior exam from 8/13/12.2.The MRI of the brain is a limited exam for the purpose of stereotactic guidance during surgery."}
{"instruction": "Generate impression based on findings.", "input": "Enlarging brain metastases. MRI for treatment planning. Redemonstrated are multiple subcentimeter enhancing lesions with susceptibility effect in the bilateral cerebral hemispheres at the grey-white matter junctions and right caudate subependymal surface. There is no midline shift or herniation. The ventricles are unchanged in size and configuration. There are inflammatory changes in the paranasal sinuses. The skull appears diffusely heterogeneous, but is incompletely characterized.", "output": "Limited treatment planning brain MR with redemonstration of multiple brain metastases. "}
{"instruction": "Generate impression based on findings.", "input": " Thoracic spine:At the T9/10 level, there is apparent lesion within the right lung measuring up to 16 mm in AP dimension (of its visualized aspects), best seen series 16 image 18.There is minimal anterior wedge deformity of T5, T6, and T7 without marrow edema. The remaining vertebral body heights are maintained. Marrow signal intensity is benign throughout. Degenerative changes are noted of the lower cervical spine with grade 1 anterolisthesis C5 and C6. Osteophyte disc complex, ligamentum flavum thickening, and facet hypertrophy result in mild central stenosis at C5/C6 as well as bilateral neural foraminal stenosis at C5/6 and C6/7.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates a small right paracentral disc protrusion with minimal anterior right hemicord flattening and no intrinsic cord signal abnormality. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates asymmetric bulge to the left causing minimal anterior left hemicord flattening and no intrinsic cord signal abnormality. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates a small right paracentral disc protrusion causing minimal anterior right cord flattening and no intrinsic cord signal abnormality. T9/10 demonstrates a small right paracentral disc protrusion without cord encroachment.T10/11 demonstrates asymmetric bulge to the right causing mild right neural foraminal stenosis. T11/12 demonstrates a left paracentral disc protrusion without cord encroachment. There is also bilateral facet hypertrophy.T12/L1 demonstrates no significant disc bulge or cord encroachment. Small Schmorl's nodes are present involving T11 and T12.Lumbar spine:There is partial lumbarization of S1 with a rudimentary S1/2 disc.Small Schmorl's nodes involving L1 and L2. Disc desiccation is present throughout.Mild superior endplate deformity is noted of L4 without marrow edema representing a chronic finding. The remaining vertebral body heights are maintained. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: Mild disc bulge and mild bilateral facet hypertrophy without stenosis.L2/3: Mild disc bulge, ligamentum flavum thickening, mild to moderate left facet hypertrophy, and mild right facet hypertrophy without stenosis.L3/4: Trace anterolisthesis L3 on L4, asymmetric bulge to the right, ligamentum flavum thickening, severe bilateral facet hypertrophy, and a small left facet effusion. There is moderate central, mild to moderate left neural foraminal, and moderate right neural foraminal stenosis.L4/5: Trace anterolisthesis L4 on L5, asymmetric bulge to the right, ligamentum flavum thickening, and severe bilateral facet hypertrophy. There is mild central and mild right neural foraminal stenosis.L5/S1:Mild disc bulge, severe left facet hypertrophy, moderate right facet hypertrophy, and bilateral facet effusions (left greater than right). There are no significant stenoses.,S1/2: Unremarkable", "output": "1.At the T9/10 level, there is apparent lesion within the right lung measuring up to 16 mm in AP dimension (of its visualized aspects). Recommendations are made to obtain a dedicated chest CT for verification of this lesion. The differential diagnosis would include phase encoding artifact.2.Multilevel degenerative changes of the thoracic spine. Specifically, there are multilevel disc bulges and disc herniations.3.Multilevel degenerative changes of the lumbar spine, worse at L3/4 were there is moderate central, mild to moderate left neural foraminal, and moderate right neural foraminal stenosis.4.Findings were discussed with Dr. Hekmat-panah on 9/26/2016 at approximately 1:40 PM."}
{"instruction": "Generate impression based on findings.", "input": "Left renal mass. History of orthotopic liver transplant for PSC. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from orthotopic liver transplant. The liver is normal in morphology size and signal intensity without a focal lesion. No intrahepatic biliary ductal dilatation.SPLEEN: Normal size without a focal lesion.PANCREAS: 9 mm cystic focus in the pancreatic tail without definite communication with the main pancreatic duct is unchanged. No main pancreatic ductal dilatation or focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 weighted hyperintense simple and minimally complex cysts. Several too small to characterize foci.In the left renal interpolar region there is a T2 weighted hypointense lesion measuring 1.7 x 1.4 cm, previously this measured 1.3 x 1.3 cm. The lesion is isointense to the medulla on precontrast images. The lesion demonstrates mild postcontrast enhancement relative to the cortex.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post colectomy. Right lower lower quadrant ileostomy with moderate-sized parastomal prolapse which is partially imaged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Slowly growing 1.7 cm left interpolar solid mildly enhancing T2 weighted hypointense lesion suspicious for renal cell carcinoma, specifically papillary subtype.2.Postsurgical changes from orthotopic liver transplant without complication.3.Subcentimeter pancreatic tail focus may represent a branch type IPMN without suspicious imaging features."}
{"instruction": "Generate impression based on findings.", "input": "4 month old male with history of cerebrovascular accident; please evaluate for interval change. Low attenuation and loss of gray-white differentiation within the left temporal lobe extending to the occipital lobe, bilateral frontal lobes and right temporal lobe extending to the parietal lobe compatible with CVA. When compared to the MRI performed on 12/5/2008, the extent of these infarcts is increased.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Increasing extent of bilateral, large infarcts as described above."}
{"instruction": "Generate impression based on findings.", "input": "Lumbosacral radiculitis with radiation down left leg. Re-assess lumbar degenerative disk disease. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is redemonstration of loss of disc space height, disc desiccation and a diffuse disc bulge associated with effacement of the fat at the left lateral recess and extension of disc material into the neural foramina bilaterally. There are associated endplate osteophytes as well. There is redemonstration of mild facet and ligamentum flavum hypertrophy at this level. Overall there is no significant interval change when compared to the previous exam.At L4-5 there is redemonstration of bilateral facet hypertrophy and ligamentum flavum hypertrophy which has mildly progressed since the prior exam. There is no significant compromise to spinal canal or exiting nerve roots at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level which has not changed substantially compared to the previous examAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level which has not changed substantially compared to the previous. There are new endplate reactive changes present at this level associated with a disc bulge and some mild narrowing of th neural foramina. The endplate reactive changes are heterogeneous signal on T2 and low signal on T1.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a new Schmorl's node present at T12-L1 associated with some adjacent marrow signal changes which are low signal on T1 and high signal on T2There is a left renal lesion which is bright on T2 and low signal on T1 which suspect was present on the prior exam but is only included on the very top image of this exam as well as a prior exam. Most likely this represents a renal cyst but is incompletely evaluated on this exam.", "output": "1.There is mild encroachment of the nerve roots at the left lateral recess at L5-S1 due to degenerative changes which is stable compared to the previous exam. 2.There is redemonstration of multilevel degenerative changes present in the lumbar spine which are not associated with compromise to spinal canal or exiting nerve roots. There is some progression of facet hypertrophy at L4-5 but otherwise no substantial change. There is also endplate reactive change at L2-3 as well as Schmorl's node at T12-L1 which has progressed since the prior exam and appears to be in a somewhat subacute stage."}
{"instruction": "Generate impression based on findings.", "input": "Daily headache obesity and sleep apnea. There is a partially empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The lateral ventricles are perhaps relatively narrow. 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": "Findings compatible with pseudotumor cerebri."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate lumbar pathology History: Low back pain radiating down right leg Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disk space height, disk desiccation and diffuse disk bulge as well as bilateral facet hypertrophy and a mild anterior subluxation of L5 on S1. There are bilateral pars interarticularis defects present at this level and the narrowing of the neural foramina bilaterally. There is effacement of the fat surrounding the exiting nerve roots within the neural foramina bilaterally at this level. This appears to be worse on the right versus the left side.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level and there is bilateral facet hypertrophy at the mild/moderate degree at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.There are degenerative changes present in lumbar spine with spondylolysis with spondylolisthesis at L5-S1 where there is encroachment of the exiting nerve roots within the neural foramina bilaterally right worse than left."}
{"instruction": "Generate impression based on findings.", "input": "52 year-old female with history of injury while shoveling snow. Evaluate for tendon rupture or fracture of left ankle. TENDONS: The tendons of the ankle are intact with no evidence of tendon rupture.LIGAMENTS: The visualized components of the deltoid ligament are intact. The ligaments of the sinus tarsus are intact.ARTICULAR SURFACES AND BONE: There is moderate edema within the head of the talus particularly in its medial aspect. In retrospect, the medial aspect of the talus appears demineralized on recent radiographs. We see no discrete fracture line. The remainder of the bone marrow signal intensity is unremarkable. ADDITIONAL", "output": "Edema within the head of the talus most pronounced along the medial aspect. The differential diagnosis includes a stress fracture/stress reaction (we see no discrete fracture line), a bony contusion or perhaps a small impaction fracture that is below the resolution of this study, or transient migratory edema. If there was an acute traumatic injury to this location, CT may be considered to evaluate for a fracture."}
{"instruction": "Generate impression based on findings.", "input": "Brain lesions concerning for pancreatic cancer metastasis: work finding difficulties. There is a heterogeneously enhancing mass in the posterior left inferior frontal gyrus that measures up to 35 mm. There is a small amount of susceptibility effect within the tumor, which may represent blood products. There is extensive surrounding vasogenic edema with partial effacement of the left posterior lateral ventricle. However, there is minimal midline shift and no herniation. There is a lobulated lesion in the right parietal white matter that measures up to 12 mm with circumferential susceptibility effect and an associated developmental venous anomaly. There is also a punctate focus of susceptibility effect in the right pons, with corresponding calcification on the prior CT. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.", "output": "1. A lesion in the left inferior frontal gyrus that measures up to 35 mm likely represents a metastasis.2. A lesion in the right parietal white matter that measures up to 12 mm with circumferential susceptibility effect and an associated developmental venous anomaly likely represents a cavernous malformation.3. A punctate focus of susceptibility effect in the right pons may also represent a cavernous malformation."}
{"instruction": "Generate impression based on findings.", "input": "48 years, Male, possible parkinsonism, gait difficulty. Question of hypoxic brain injury during birth. Per chart, patient also has history of recent fall with bruising on neck and back. Brain: No appreciable area of gliosis or volume loss to suggest prior ischemic injury. Mild hypoplasia of the inferior cerebellar vermis is suspected. Mild volume loss is also noted involving the cerebellar hemispheres. There is possible T1 hyperintensity along bilateral frontal dura which may be artifactual versus related to mineralization; finding is of doubtful clinical significance but can be correlated with prior CT if available. No corresponding signal abnormality is appreciated on the T2 or FLAIR sequences. There is no intracranial mass or mass effect. No focal parenchymal signal abnormality. No evidence of infarct or hemorrhage. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. No volume loss, focal lesions, or abnormal iron deposition is evident within the basal ganglia, brainstem, or cerebellum. Major flow-voids are preserved. Trace mucosal thickening is evident in the paranasal sinuses. Calvarium and remainder of the extracranial soft tissue structures are unremarkable. Cervical spine: Some of the cervical spine sequences are motion degraded slightly limiting evaluation. There is mild edema involving the posterior soft tissues at the C5-C6 level at the level of the interspinous and supraspinous ligaments. Anterior and posterior longitudinal ligaments as well as ligamentum flavum demonstrate no disruption or signal abnormality. Vertebral body heights and alignment are maintained. Craniovertebral junction also appears within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. No evidence of hematoma within the spinal canal.There is mild congenital narrowing of the cervical spinal canal with pedicle hypoplasia and superimposed mild degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild congenital narrowing of the spinal canal with superimposed thickening of the ligamentum flavum and small disc bulge. Mild left neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy. No significant right neural foraminal narrowing.C4-5: Mild spinal canal stenosis related to congenital narrowing and superimposed mild disc bulge. There is moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy. C5-6: There is mild to moderate narrowing of the spinal canal on a congenital basis as well as superimposed disc bulge and ligamentum flavum thickening. There is moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Mild spinal canal narrowing. There is moderate to severe bilateral neural foraminal narrowing related to disc bulge and uncovertebral hypertrophy.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to facet arthropathy..The vertebral artery flow voids appear to be intact.", "output": "1. No imaging findings to suggest sequela of prior hypoxic-ischemic injury. No intracranial mass or mass effect. No focal lesions involving the basal ganglia, brainstem, or cerebellum are appreciated.2. Mild volume loss involving the cerebellar hemispheres which is nonspecific and may be related to chronic antiepileptic medications for example. Mild hypoplasia involving the inferior cerebellar vermis also suspected.3. Images of cervical spine demonstrates mild edema involving the posterior soft tissues at the C5-C6 level which may represent mild ligamentous injury involving the interspinous and supraspinous ligaments at C5-C6. The anterior and posterior longitudinal ligaments and ligamentum flavum are intact. No cord signal abnormality, evidence of fracture, or hematoma within the spinal canal.4. Congenital narrowing of the cervical spinal canal with superimposed degenerative changes. There is up to mild to moderate spinal canal stenosis at the C5-C6 level. Relatively mild spinal canal narrowing at additional levels without cord signal abnormality. There is also high-grade neural foraminal stenosis at multiple levels. Please see details above."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old male patient with left shoulder pain. No definitive history of trauma. ROTATOR CUFF: There is mild supraspinatus tendinopathy at its insertion on the humeral head. No rotator cuff tear is identified.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is intact without evidence of tearing.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "1.Subchondral degenerative cysts at the insertion of the supraspinous tendon on the humeral head.2.Mild supraspinatus tendinopathy at its insertion.3.No evidence of labral tear."}
{"instruction": "Generate impression based on findings.", "input": "Male 72 years old with prostate cancer, evaluate for disease, fusion biopsy to follow. PELVIS:PROSTATE:Prostate Size: 5.1 x 3.0 x 4.3 cmPeripheral Zone: The previously described lesion in the left mid apex measures 4 x 3 mm (series 901, image 16), previously 3 x 3 mm. The reference lesion in the right peripheral zone measures 5 x 4 mm (series 901, image 16), previously 5 x 5 mm. The lesion in the midline left apex measures 6 x 4 mm (series 901, image 13), previously 6 x 4 mm. These lesions are hypointense on T2 and ADC. No new suspicious lesions are identified.Central Gland: Benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Stable size of bilateral small lesions suspicious for prostate adenocarcinoma.2.No new lesions, extracapsular extension or pelvic lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male with vertigo and left-sided fullness. Evaluate for mass. Asymmetric fullness of the left cavernous sinus and left intracranial internal carotid and middle cerebral arteries raises the question of left cavernous-carotid fistula. MRI/MRA could be performed to help exclude this possibility.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Asymmetric fullness of the left cavernous sinus and proximal internal carotid and middle cerebral arteries and raises the question of cavernous carotid fistula. MRI/MRA could be obtained to further evaluate as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Female 54 years old s/p craniotomy (6/8/2016) for meningioma resection Post-surgical changes of a left frontoparietal craniotomy and underlying tumor resection with associated dural thickening/enhancement. No residual tumor is definitively identified. Expected areas of increased susceptibility artifact underlying the craniotomy consistent with blood products. Vasogenic edema within the left frontoparietal lobes with mild mass effect causing downward effacement of the left lateral ventricle appears similar to prior exam.The ventricles remain normal in size. There is no midline shift or herniation. The major cerebral flow voids are intact.", "output": "Post-operative changes of a left parasagittal meningioma resection without evidence of residual tumor. "}
{"instruction": "Generate impression based on findings.", "input": "76 years Female (DOB:4/8/1940)Reason: eval pituitary mass History: strokePROVIDER/ATTENDING NAME: ANUBHA C GANJOO ANUBHA C GANJOO MRI of the brainThere is diffusion restriction present along the corpus callosum including the genu of the corpus callosum in the body of the corpus callosum eccentric to the left side. There is associated T2 and FLAIR signal ofA small focus of encephalomalacia in the left precentral gyrus..The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the left maxillary sinus with a T2 hypointense lesion in the infundibulum of the left maxillary sinus extending into the left hiatus semilunaris. There is associated loss of volume within the left maxillary sinus and thickening of the walls of the left maxillary sinus. There is also mild mucosal thickening in the sphenoid sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The exam is mildly degraded due to patient motion which can obscure more subtle abnormalities.MRI pituitary:There is redemonstration of a 25 x 21 mm sagittal dimension T1 hyperintense mass centered in the sella which extends into the suprasellar cistern This mass has heterogeneous signal on T2 and has not changed significantly since the previous exam. The optic chiasm drapes over the mass. The mass abuts the internal carotid arteries bilaterally. The left internal carotid artery appears narrowed.MRA brain:There is 70% stenosis present along the distal left internal carotid artery along the ophthalmic segment between the pituitary mass in the anterior clinoid. There is a 1 mm x 1.5 mm aneurysm at the ophthalmic segment of the right internal carotid artery which is directed medially.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.", "output": "1.There is a large pituitary mass with suprasellar extension which displaces the optic high as in an internal carotid arteries.2.There is an acute infarction present along the corpus callosum.3.There is 70% stenosis present at the ophthalmic segment of the left internal carotid artery adjacent to the pituitary mass.4.Small focus of encephalomalacia is present along the left precentral gyrus5.Findings are compatible with an obstructive lesion at the left maxillary sinus antrum and hiatus semilunaris. The possibility of the obstructing lesion cannot be excluded. There additional findings suggestive of silent sinus syndrome and chronic sinusitis involving the left maxillary sinus.6.Some of the images are degraded due to motion artifact."}
{"instruction": "Generate impression based on findings.", "input": " The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Note is made of a partially empty sella without other imaging features suggestive of idiopathic intracranial hypertension. 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 otherwise negative contrast enhanced MRI of the brain and orbits. Specifically, there are no MRI findings to explain the patient's visual symptoms. Present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. The optic nerves, chiasm, and tracts appear normal. There is no optic nerve sheath dilatation. The extraocular muscles are normal and symmetric with physiologic, homogeneous, and intense contrast enhancement. The globes appear normal with physiologic enhancement of the ciliary bodies and choroid. No retinal detachment or vitreous clouding. The lacrimal glands are symmetric and within normal limits for size. No orbital mass lesion. No enhancing pathology.", "output": "Note is made of a partially empty sella without other imaging features suggestive of idiopathic intracranial hypertension. Otherwise negative contrast-enhanced MRI of the brain and orbits. Specifically, there are no MRI findings to explain the patient's visual symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Renal cell carcinoma status post nephrectomy in June 2013 (clear cell papillary type, stage T2b). Evaluate for recurrence or distant metastasis. 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: Status post left nephrectomy. There is no evidence of recurrence within the nephrectomy bed. Within the right lower pole there is a 1.1 cm simple cyst, unchanged from prior. There is no right hydronephrosis. No suspicious lesion is identified within the right kidney.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": "Status post left nephrectomy, without evidence of recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old male with history of total proctocolectomy with IPAA with perforation indeterminate colitis. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Small left medial rectus stone measuring 8 mm.BOWEL, MESENTERY: IPAA anastomosis is noted without evidence of complication.BONES, SOFT TISSUES: There is an enhancing fistula arising from the 6:00 position of the anus below the external sphincter extending to the left gluteal cleft measuring approximately 3.4 cm in length. No abscess is evident. There is presacral edema.OTHER: No significant abnormality noted.", "output": "1.Perianal fistula as described above without abscess."}
{"instruction": "Generate impression based on findings.", "input": " There has been persistent reduction in the size of the enhancing pineal region mass which now measures 10 x 10 mm in AP and transverse dimensions, compared to 17 x 14 mm previously, and 7 mm craniocaudal currently which has been remeasured to be 8 mm previously. However, please note that a complete set of thin section pineal region images was inadvertently not obtained. No significant mass effect or ventricular dilatation is noted. Again seen is a prior biopsy tract along the right frontal lobe extending to the frontal horn of the right lateral ventricle but with interval decreased T2/FLAIR hyperintensity and enhancement. Foci of susceptibility are noted within the occipital horns of the lateral ventricles which may be related to the previous biopsy procedure. There are stable areas of FLAIR abnormality within the white matter posteriorly with some areas of cystic encephalomalacia which favors gliosis, less likely enlarged perivascular spaces.There is no evidence of intracranial acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The nasal sinuses and mastoid air cells are clear.", "output": "1.Persistent decrease in the size of the pineal region mass.2.Interval decreased T2 hyperintensity and enhancement along the previous biopsy tract coursing through the right frontal lobe.3.Normal sized ventricles."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old male with history of shoulder pain. ROTATOR CUFF: There is intermediate signal abnormality of the supraspinatus tendon at its insertion, however we see no discrete fluid filled tear. The remaining muscles and tendons of the infraspinatus, teres minor, and subscapularis are unremarkable.SUPRASPINATUS OUTLET: There is no evidence of fluid within the subacromial or subdeltoid bursa. Minimal osteoarthritis affects the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is intact. Minimal osteoarthritis affects the glenohumeral joint.BICEPS TENDON: The biceps tendon is unremarkable. ADDITIONAL", "output": "Mild supraspinatus tendinopathy without discrete tear. The glenoid labrum is intact."}
{"instruction": "Generate impression based on findings.", "input": "Re-evaluate abnormal T2/Flair signal in the white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Redemonstrated are multiple scattered foci of non-enhancing T2 hyperintensity in the bilateral cerebral periventricular and subcortical white matter, which are grossly unchanged since 2013, accounting for differences in technique. A previously demonstrated enhancing focus adjacent to the right anterior clinoid process is compatible with mildly prominent venous structures and is unchanged. 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. There is fluid within the right mastoid air cells.", "output": "1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Multiple scattered T2 hyperintensity in the bilateral cerebral hemispheres are nonspecific and appear to be unchanged since 2013.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Adenoid cystic carcinoma of the right pterygopalatine fossa with right V2 numbness treated with chemoradiation. There is unchanged enhancing tumor within the right cavernous sinus extending from the right foramen rotundum and pterygopalatine fossa, measuring up to 5 mm in width. The skull base and adjacent internal carotid artery flow voids are otherwise intact. Likewise, the Meckel caves and cisternal trigeminal nerves are intact. There is no evidence of acute infarction or midline shift. The ventricles are normal in size and configuration. There is moderate mucosal thickening and fluid in the right maxillary sinus, mild mucosal thickening in the left maxillary sinus, and secretions in the nasal cavity. There is fluid signal within the bilateral mastoid air cells. There are scattered foci of T2 hyperintensity in the cerebral white matter.", "output": "1. Unchanged treated perineural tumor involving the second division of the right trigeminal nerve with extension in the cavernous sinus.2. Findings suggestive of acute rhinosinusitis."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: WeaknessClinical question: evaluate for myelopathy, L hemisensory / hemi-motor symptomsSigns and Symptoms: evaluate for myelopathy, L hemisensory / hemi-motor symptoms MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is multilevel disc desiccation present.There is a disc bulge present at T3-4. There is a mild disc bulge present at T5-6, T6-7, T7-8, T9-T10 and T10-11. A Schmorl's node is present at the superior endplate of T8 associated with some reactive change.. Some endplate reactive changes are identified at T6-7 with high signal on T2 and low signal on T1.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge present at this level. At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with bilateral ligamentum flavum hypertrophy. The fat at the lateral recesses sees is not effaced.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a right far lateral disc protrusion at this level which mildly encroaches on the right-sided exiting nerve roots as they exit the neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are cystic lesions present in the kidneys. One in the left kidney measures approximately 6 8-mm in diameter", "output": "1.There are multilevel degenerative changes present in the thoracic spine without significant compromise to the spinal canal or exiting nerve roots. Similar degenerative changes appear to be in the subacute stage in the midthoracic spine at the T7-8.2.There are degenerative changes present in the lumbar spine without significant compromise to the spinal canal or neural foramina as detailed above. There is a right far lateral disc protrusion at L3-4 which encroaches on the right exiting nerve root.3.There is a tiny lesion in the left kidney which is suspected to represent a cyst but is not adequately imaged."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old male with left knee pain, swelling and decreased range of motion. Evaluate for ligament injury. MENISCI: There is linear branching signal abnormality within the posterior horn of the medial meniscus which extends anteriorly into the body of the medial meniscus consistent with a complex tear with both vertical and horizontal components. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is seen.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "Complex tear of the medial meniscus and joint effusion as described above."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female with history of pain. ROTATOR CUFF: There is a complete tear of the supraspinatus tendon with retraction to the level of the glenohumeral joint. There is moderate fatty atrophy of the supraspinatus muscle (Goutallier Stage 3). There is a near-complete to complete tear of the infraspinatus tendon with retraction of the majority of the fibers to the medial aspect of the humeral head. There is severe fatty atrophy of the infraspinatus muscle (Goutallier stage 4). The teres minor can be traced to its insertion on the humeral head, although there is increased signal intensity within and along its fibers which may represent partial thickness attritional tearing. There is also a full-thickness tear of the subscapularis tendon with retraction of the superior fibers to the level of the coracoid. Some of the inferior fibers of the tendon can be traced to their insertion on the humerus. The coracohumeral interval measures 5 mm. There is severe fatty atrophy of the superior portion of the subscapularis muscle.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the AC joint. There is a trace amount of fluid within the subacromial/subdeltoid bursal. The acromiohumeral interval is markedly narrowed. There is a small ossicle along the anterior margin of the acromion process. GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding. Mild osteoarthritis affects the glenohumeral joint. There is increased signal intensity and blunting of the superior labrum likely representing degeneration and tearing. The inferior labrum is grossly intact.BICEPS TENDON: The tendon of the long head of the biceps is visible anterior to the proximal humeral diaphysis with abnormal signal intensity within its substance indicating tearing. We suspect the tendon is completely ruptured more proximally as we do not see it within the rotator cuff interval.", "output": "Massive rotator cuff tear and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: pain History: pain. MENISCI: There is linear increased signal intensity within the posterior horn of the medial meniscus that extends to the tibial articular surface that likely represents a horizontal degenerative tear. Additional degeneration within the substance of the body of the medial meniscus. Anterior horn appears normal.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Moderate to severe thinning of the articular cartilage of the medial facet of the patella with foci of full thickness degeneration and underlying small subchondral cyst. Articular cartilage of the lateral facet appears relatively well preserved. Subjectively, the articular cartilage of the femoral trochlea appears thinned. There is also minimal subjective thinning of the articular cartilage of the tibiofemoral articulations, essentially within normal limits for age.LIGAMENTS: The anterior cruciate ligament and posterior cruciate ligament are intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1.Degenerative horizontal undersurface tear of the posterior horn of the medial meniscus.2.Cartilage degeneration, most pronounced along the medial facet of the patella with relatively mild degeneration elsewhere.3.Baker's cyst."}
{"instruction": "Generate impression based on findings.", "input": " Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.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 no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: UnremarkableL2/3: UnremarkableL3/4: UnremarkableL4/5: UnremarkableL5/S1:Unremarkable", "output": "Negative noncontrast thoracic and lumbar spine MRI without contrast. Specifically, there are no MRI findings to explain the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Female, 68 years old, with left-sided paresthesias and paresis. No restricted diffusion is seen. Numerous scattered foci of predominantly white matter T2 hyperintensity are seen. No edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular size and morphology are within normal limits.", "output": "1.No acute intracranial abnormality.2.Numerous scattered foci of prominently white matter T2 hyperintensity are nonspecific and may reflect chronic microvascular disease, sequelae of demyelinating disease, or sequelae of other prior inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Sacral mass, renal cell carcinoma An ill-defined soft tissue mass is noted at the left sacral ala extending from S1 to S2 which represents the known metastatic lesion. The mass is slightly hyperintense to muscle on T1 and hyperintense to muscle on T2/STIR sequence and enhances homogeneously. The mass measures approximately 5.1 x 3.7 x 4.2 cm in the greatest transaxial and craniocaudal dimensions. There is encroachment upon the left S1 neural foramen with the S1 nerve root coursing through the mass and the S2 neural foramen is poorly visualized. Additionally, there is asymmetric enhancement of the dura at this level which may be reactive in nature however the possibility of direct involvement must be considered.No additional soft tissue lesions are identified. There is no suspicious marrow signal throughout the remaining pelvis and lumbar spine.Note is made of a cystic mass within the left hemipelvis measuring 4.9 cm in the region of the left ovary. This is likely functional in nature however given the patient's age, attention on follow-up is recommended. This was present on the outside CT dated 6/10/2016. A similar, smaller focus is seen in the right hemipelvis which is also in close proximity to the right ovary.", "output": "1. Ill-defined soft tissue mass involving the left sacral ala consistent with known biopsy-proven metastatic focus. There is encroachment upon the left S1 neural foramen with poor visualization of the S2 neural foramen, concerning for direct invasion. Additionally, there is asymmetric enhancement of the dura which may be reactive in nature although the possibility of malignant involvement must also be considered.2. No additional soft tissue masses or abnormal marrow signal within the pelvis.3. Cystic foci within the pelvis are likely ovarian and functional in nature however given the patient's age, attention on follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "73 years Female (DOB: 4/17/1943)Reason: r/o stenosis History: neck painPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ 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.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. There are endplate uncovertebral osteophytes present this level associated with disc desiccation and loss of disc space height. There is encroachment of the right-sided exiting nerve roots related to osteophytes and disc material. There is mild ligamentum flavum hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal. There is right-sided facet hypertrophy present at this level as well as endplate and uncovertebral osteophytes with some narrowing of the right neural foramen.. There is ligamentum flavum hypertrophy at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Along the right anterior chest wall there appears to be a large T1 signal hyperintense mass which suppresses on the fat suppressed images. This is not entirely included on this exam. It displaces adjacent structures including the thyroid gland being displaced towards the left and displaces the right sternocleidomastoid muscle anteriorly. The subclavian artery and subclavian vein are deep to the lesion.", "output": "1.There are degenerative changes present in the cervical spine with encroachment of right-sided exiting nerve roots at C5-6.2.Fatty lesion possibly a lipoma is present along the right anterior chest wall and lower right neck which is located underneath the sternocleidomastoid muscle is not adequately included on this exam. It appears to displace adjacent structures. Please correlate with physical findings on clinical exam."}
{"instruction": "Generate impression based on findings.", "input": "Crohn's disease status post ileocecectomy x2. Evaluate for stricture or adhesions and active inflammation. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe cyst. Otherwise unremarkable liver.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: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable.There are postsurgical changes from an ileocecectomy. The small bowel including the terminal ileum is normal in caliber, wall thickness and demonstrates normal postcontrast enhancement without restricted diffusion or adjacent inflammatory changes. No free or loculated fluid. No evidence of sinus tract or fistula formation. No fixed stricture or prestenotic dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal bilobed cystic lesion measuring 5.4 x 2.6 cm without suspicious imaging features.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable.There are postsurgical changes from an ileocecectomy. The small bowel including the terminal ileum is normal in caliber, wall thickness and demonstrates normal postcontrast enhancement without restricted diffusion or adjacent inflammatory changes. No free or loculated fluid. No evidence of sinus tract or fistula formation. No fixed stricture or prestenotic dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No specific findings of active small bowel inflammation or fibro-stenotic disease.2.5.4 cm left adnexal cystic lesion. Follow-up ultrasound in 4-6 weeks is recommended to document resolution. "}
{"instruction": "Generate impression based on findings.", "input": "Female; 30 years old. Reason: Brachytherapy planning History: Brachytherapy planning PELVIS:UTERUS, ADNEXA: Eccentric soft tissue wall thickening of the cervix anteriorly on the right, consistent with known cervical carcinoma, has further significantly decreased with no discretely measurable tumor on the current exam. Brachytherapy therapy sleeve is in place within the endometrial and endocervical canal.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent left common iliac lymph nodes are not significantly changed with reference node measuring up to 12 x 9 mm (series 1105/770), previously 13 x 9 mm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Significantly decreased size of cervical carcinoma with no discretely measurable tumor evident.2. Stable prominent left common iliac lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "3-year-old female with history of intermediate-risk neuroblastoma, off therapy evaluation. Please visualize area of consolidation noted on MRI performed 10/20/10. LUNGS AND PLEURA: Nodular pleural thickening posteromedially in the left apex measures 8 x 6 mm (image 14/59, series #4). This is in the previous location of the large left paraspinal mass. Previously seen consolidation in the right lung base on prior MRI is no longer evident. There are no pulmonary consolidations, nodules, or pleural effusions.MEDIASTINUM AND HILA: Soft tissue density mass in the anterior mediastinum with concave margins and conforming to the contour of the aorta is not significantly changed and consistent with normal thymus. No lymphadenopathy. Normal heart size. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.", "output": "1. Consolidation in the right lung base on prior MRI has resolved.2. Residual nodular left pleural thickening in the region of the previously described paraspinal mass."}
{"instruction": "Generate impression based on findings.", "input": "18 year-old male with rupture of previous left knee ACL reconstruction. Evaluate tunnel position.IMAGE ACQUISITIONS: CT of the left knee; IV administration of 80 cc of iodinated contrast at 2 cc/sec. Transverse, coronal, sagittal re-formations provided. Patient is status post ACL reconstruction, although the graft appears disrupted as seen on recent MRI study. The tibial tunnel begins at the intercondylar eminence between the medial and lateral tibial spines and courses anteriorly and medially through the proximal tibia, breaching the anteromedial cortex. The slope of the tunnel is greater than that of Blumenstadt's line.The femoral tunnel originates near the junction of the physeal scar and posterior femoral cortex and courses superomedially, where it intersects with two tunnels created by crossed pins.Please note that the ACL itself is not well seen on this CT study nor are the menisci. The PCL is seen on the sagittal reformatted images. A small joint effusion is noted. The remaining visualized bone and soft tissue structures are within normal limits.", "output": "Postoperative changes as described above."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old male with hip pain. Evaluate for AVN. Note is made of increased heterogeneous signal abnormality in the left femoral head consistent with avascular necrosis. There is no evidence of femoral head collapse or fracture. There is also increased serpiginous signal abnormality within the right femoral head consistent with avascular necrosis. No evidence of femoral head collapse or fracture. There is diffuse bone marrow signal abnormality consistent with the patient's history of sickle cell disease. There is residual fatty marrow in the greater trochanters. There is also increased signal abnormality within the sacrum, left inferior pubic ramus and posterior right acetabulum which may represent bone infarcts. There is deformity of multiple vertebral bodies of the incompletely imaged lower lumbar spine also consistent with the patient's history of sickle cell disease. Large amount of fluid is identified within the bladder. There is a small amount of fluid within the left hip joint which is not necessarily of any current clinical significance.", "output": "Findings compatible with avascular necrosis of the hips and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "60 year old male with persistent atrial fibrillation after ablation. Referred for cardiac MRI prior to redo PVI and to assess pulmonary vein anatomy and LVEF. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%. The LVEDV is 139 ml (normal range 142+/-34), the LV end diastolic volume index is 67 ml/m2 (normal range: 74+/-15), the LVESV is 73 ml (normal range 47+/-19) and the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9). The LV mass is 72 g (normal range 164+/-36) and the LV mass index is 35 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is <1000 ms (normal), suggestive of absence of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly depressed systolic function. The overall RV ejection fraction is 48%. The RVEDV is 161 ml (normal range 142+/-31), RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVESV is 84 ml (normal range 54+/-17), and the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThere 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. The descending thoracic aorta is severely tortuous.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. The right middle lobe pulmonary vein drains independently into the left atrium, just anterior to the right lower pulmonary vein ostium. There is no apparent pulmonary vein stenosis.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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.Normal sized LV with mildly depressed systolic function (LVEF 48%).2.Normal sized RV with mildly depressed systolic function (RVEF 48%).3.No pulmonary vein stenosis. The right middle lobe pulmonary vein drains independently into the left atrium just adjacent to the right lower pulmonary vein ostium. 4.The left ventricular myocardium is completely viable.5.Mild biatrial dilation."}
{"instruction": "Generate impression based on findings.", "input": "61 year-old female with cognitive changes and memory loss. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Right cerebellar hemispheric encephalomalacia, compatible with remote infarction with mild associated vacuo dilatation of the fourth ventricle. There is complete loss of the flow void of the distal right V3 segment of the vertebral artery with partial distal reconstitution along the right V4 segment likely representing retrograde flow.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, pons and medulla which are nonspecific, but compatible with chronic small vessel ischemic changes. Sella and orbits are grossly within normal limits. Trace fluid in the right mastoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.", "output": "1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Moderate chronic small vessel ischemic changes as described above.3. Stable remote extensive right cerebellar infarction.4. Loss of the right vertebral artery (V3 segment) flow void flow as seen on prior ultrasound with partial distal reconstitution of right V4 segment likely representing retrograde flow. If further evaluation of the vasculature is clinically warranted, CTA or MRA may be considered."}
{"instruction": "Generate impression based on findings.", "input": "Reason: HCC screening, follow up pancreatic head cyst History: NASH cirrhosis, panc head cyst ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Loss of signal on out of phase images suggest steatosis. Subcentimeter right hepatic cysts are unchanged. Arterial enhancing lesion seen on the prior exam is no longer evident and was likely perfusional. There is a new focus of arterial enhancement (11/57) which is not seen on additional phases which may also be perfusional. Common bile duct appears normal. Vasculature is patent.SPLEEN: Mild splenomegaly, unchanged.PANCREAS: Pancreatic duct is nondilated. Cystic lesion in the pancreatic head measuring 1.1 x 1.5 cm (5/32), is unchanged and likely represents a sidebranch IPMN. Multiple adjacent cystic lesions more medially in the pancreatic head measuring overall 2.5 x 1.6 cm (5/35) with multiple small septations are also unchanged, most likely side branch IPMNs (versus dominant multiseptated lesion). Additional punctate cystic foci in the pancreatic body is also unchanged and likely represents a side branch IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left hepatic T2 hyperintensity, likely a cyst.RETROPERITONEUM, LYMPH NODES: Prominent portacaval and retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Stable cystic lesions in the pancreatic head, likely a side branch IPMNs; please refer to details above.2.Cirrhotic liver morphology. Arterially enhancing lesion seen on the prior exam is no longer evident and may have been perfusional in etiology."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with acute brainstem infarct. Evaluate for further swelling/progression of infarct. There is no evidence of intracranial hemorrhage or midline shift. There is increased hypodensity in the left cerebellar region consistent with an evolving infarct. An area of hypodensity on a single image in the right cerebellar hemisphere is identified. There is a previously described area of encephalomalacia on the image inferior to this slice. This could represent volume averaging versus an additional area of infarct. If clinically indicated, an MRI could be considered for further evaluation.The ventricles and basal cisterns are normal in size and figuration. There is opacification of the ethmoid air cells and mucoperiosteal thickening in the bilateral maxillary and sphenoidal sinuses.", "output": "Evolving cerebellar infarct. Area of hypodensity in the right cerebellar hemisphere on a single image may represent volume averaging or an additional area of infarct. An MRI may be considered for further evaluation if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Right-sided weakness and cerebellar signs. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged extensive cerebral white matter T2 hyperintensity and chronic infarcts in the pons, left gyrus rectus, and right basal ganglia. There is unchanged mild diffuse cerebral volume loss. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There are bilateral lens implants.", "output": "1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Unchanged extensive cerebral white matter T2 hyperintensity that likely represents chronic small vessel disease and chronic infarcts in the pons, left gyrus rectus, and right basal ganglia. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate post op, EVD clumped. Signs and symptoms: postop CT of brain without contrast:Expected postoperative changes of left suboccipital craniectomy.There is evidence of residual low density mass along the medial aspect of the left middle cranial fossa. There is evidence of hemorrhage within the expected location of more dorsal aspect of this tumor which was noted to project over the left petroclinoid ligament into the left cerebellopontine angle. There is also a small hematoma measuring approximately 10 mm times 10-mm which projects over the left cerebral peduncle and left aspect of the pons. I cannot entirely exclude the possibility of hemorrhage within the brain parenchyma however this hemorrhage may be within the residual component of tumor in the left cerebellopontine angle. Further evaluation with an MRI is recommended. There is evidence of residual blood within the prepontine cistern. There is suggestion of edema of the left cerebral peduncle.The fourth ventricle remains patent and no cerebellar abnormalities detectedThere is evidence of blood within the dependent portion of lateral ventricles and right frontal horn. In comparison with the prior examination there is no evidence of change in the above-described findings.There is a slight dilation of the supratentorial ventricular system which also remains stable since prior study.Expected postoperative changes of air within the intracranial space in bifrontal region with minimal interval decrease.", "output": "1.No detectable interval change since prior study of areas of hemorrhage or ventricular size.2.Approximately 10 mm hematoma may be within the residual component of tumor in the right cerebellopontine angle however possibility of hemorrhage within the left cerebral peduncle and pons cannot be ruled out. Further evaluation with an MRI is recommended.3.Residual low density and nonhemorrhagic tumor along the medial aspect of the left meconium fossa."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate possible bony lesion, calcification at C5-6IMAGE ACQUISITIONS: Cervical spine CT without contrast Cervical spine alignment is normal. Intervertebral disk spaces and vertebral body heights are normal.At C4-5, there is a small bony growth extending from posterior element of C4 into the spinal canal.At C5-6, there is a larger bony growth extending from the posterior element of C5 to the spinal canal with mass effect on the cord at C5 on the left.Both lesions appear to have cortical and medullary continuity suggesting osteochondroma. MRI is recommended to evaluate for any cord abnormality.", "output": "Bony growths extending from the posterior elements of C4 and C5 into the spinal canal. While there is mass effect on the cord at the C5 level, we cannot assess for cord injury. MRI is recommended to further evaluate."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate disc and stenosis History: lower back pain with bilateral LE radiculopathy Vertebral body heights are within normal limits. Minimal straightening of the lumbar spine, otherwise alignment is within normal limits. Mild endplate degenerative changes at L4-L5, unchanged. Multilevel disc desiccation with mild degenerative disc disease at L4-L5 is unchanged. No abnormal signal within the cord or conus which terminates at the lower L2 level at the lower limits of normal.T12-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Mild facet arthropathy and ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. Mild facet arthropathy and ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L4-L5: Broad-based disc bulge the superimposed right paracentral and foraminal extrusion which effaces the right lateral recess with possible impingement on the descending right L5 nerve root. This represents an increase from the prior exam, where a left-sided protrusion was noted, which is now less prominent. A dorsal annular fissure is noted. Ligamentum flavum thickening and facet arthropathy. Mild-to-moderate spinal stenosis is slightly increased. Mild to moderate right neural foraminal stenosis is slightly increased. Mild left neural foraminal stenosis is unchanged.L5-S1: Small central disc extrusion extending inferiorly. Mild ligamentum flavum thickening. No spinal stenosis. Minimal bilateral neural foraminal stenosis.Paraspinous soft tissues are within normal limits.", "output": "Right paracentral disc extrusion with mild foraminal extension at L4-L5 has increased from the prior exam. There is significantly increased effacement of the right lateral recess where there may be impingement of the descending right L5 nerve root. There is mild to moderate central spinal canal stenosis at this level which appears slightly worse."}
{"instruction": "Generate impression based on findings.", "input": "Status post liver transplant with biliary biliary stricture status post dilation. Increasing alkaline phosphatase. ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant. The liver is normal in morphology. There are several scattered subcentimeter hepatic cysts.There is mild intrahepatic biliary ductal dilatation. The donor duct measures 5 mm and the recipient duct measures 9 mm. There is focal narrowing at the anastomosis. The hepatic artery appears diminutive at the level of the porta hepatis. The portal and hepatic veins are patent.No focal suspicious lesion. The vessels appear patent. The gallbladder is surgically absent.SPLEEN: The spleen is normal in size.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Focal narrowing at the biliary duct anastomosis with mild intrahepatic biliary ductal dilatation. The hepatic artery appears diminutive at the level of the porta hepatis. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: MS, new L weakness, falls. Signs and Symptoms: L weakness, falls Unenhanced brain MRI:Negative diffusion weighted series.Examination demonstrate minimal findings of demyelinating disease with suggestion of subtle interval progression since prior MRI exam from 7 -- 1 -- 2013.The new small new lesions are identified in the subcortical white matter of left temporal and flair T2 series 8 image 16, left superior cerebellar peduncle on flair series 8 image 19 and a tiny lesion in the anterior medulla on flair series 8 image 22. Note should be made that this examination is performed without intravenous contrast.Previously noted focus of flair hyperintensity in the lower medulla is again identified on flair/T2 series and without convincing evidence of any change in size. This finding also is not associated with any change in the caliber of the medulla. There is slight generalized prominence of the cerebral cortical sulci for patient's stated age of 39 which appears more pronounced compared to prior exam however this observation may be secondary to better quality current exam.Signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.", "output": "White matter foci of flair hyperintensity consistent with mild demyelinating disease with evidence of few tiny new lesions since prior study as detailed."}
{"instruction": "Generate impression based on findings.", "input": " The last well formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. The vertebral body heights are preserved. There are type I degenerative endplate changes at L4-5 with disk desiccation and severe loss of disk height. There is desiccation and moderate loss of disk height and L3-4, with disk desiccation at L5-S1 without significant loss of disk height. The conus terminates at T12-L1 and is normal.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: Mild disk bulge, facet arthrosis and ligamenta flava thickening which along with posterior epidural fat causes mild spinal canal stenosis. No significant interval changes.L3-4: Diffuse disk bulge, ligament flava thickening, mildly prominent posterior epidural fat and moderate facet arthrosis causing severe spinal canal stenosis and moderate to severe bilateral neural foraminal stenosis. Findings have progressed at this level.L4-5: Diffuse disk bulge, ligamenta flava thickening, moderate facet arthrosis causing severe spinal canal and severe neural foraminal stenosis. Findings have progressed at this level.L5-S1: Diffuse disk bulge, moderate facet arthrosis and ligamenta flava thickening causing no significant spinal stenosis. No significant interval changes.", "output": "Multilevel lumbar spondylosis, with progressive disease at L4-5 and L3-4 where there are high grade spinal canal and neural foraminal stenoses."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status. There is a rounded T2 hyperintense subcentimeter lesion in the left hippocampus that corresponds to the hyperattenuating lesion demonstrated on CT. There are also nonspecific mild scattered foci of cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or 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, and scalp soft tissues are grossly unremarkable. However, there is an incompletely imaged C4 vertebral lesion. There is fluid in the bilateral ethmoid sinuses.", "output": "1. A subcentimeter lesion in the left hippocampus may represent metastatic disease, although assessment is limited due to the lack of intravenous contrast. 2. Incompletely imaged C4 vertebral metastasis."}
{"instruction": "Generate impression based on findings.", "input": "50yo gentleman with a history of ischemic cardiomyopathy status post heart transplant 4/30/15, HTN, and DM presenting with fevers and L sided pleuritic chest pain now with elevated filling pressures Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 81 ml/m2 (normal range: 74+/-15), the LVEDV is 177 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 99 g (normal range 164+/-36). There is a septal bounce consistent with previous sternotomy. There are no other regional wall motion abnormalities present. The myocardial native T1 time is 1231ms, which is significantly elevated and suggests that there is an intra-myocardial process present.The cardiac output is 8.9L/min and the cardiac index is 4.1L/min/m2.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 97 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a combined right innominate and left common carotid or \"pseudo-bovine\" branching pattern, which is a normal variant. 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.PericardiumThe pericardium is thickened (7 mm maximal). The pericardium is bright on T2-weighted imaging suggesting that it is edematous/ inflamed. The pericardium is somewhat tethered to the posterior wall based on myocardial tagging. On real-time cine imaging, there is no evidence of interventricular dependence. There is a small loculated pericardial effusion adjacent to the right atrium. There is a significant amount of pericardial fat present.Extracardiac FindingsThere are sternotomy wires present. There is gynecomastia. 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. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 54%. The native myocardial T1 time is significantly elevated suggesting that there may be an intramyocardial process present.2. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%3. The pericardium is thickened with evidence of edema/ inflammation. It is additionally tethered to the posterior wall of the myocardium. However, based on real-time cine imaging, there does not appear to be interventricular dependence. These finding suggest that there is ongoing pericarditis but the abnormality does not appear to be causing constrictive physiology.4. There is a small loculated pericardial effusion adjacent to the right atrium. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate prior ICH. Patient with recent diagnosis of multiple myeloma. Signs and symptoms: ICH. Pre and post enhanced brain MRI:Examination demonstrates a large focus of right anterior frontal hemorrhagic encephalomalacia at the site of previously noted large parenchymal hematoma.There is a thin irregular rim of enhancement surrounding the hemorrhagic cavity which is an expected finding and representing evolving hematoma.There is significant interval decrease in the overall size of this finding and with significant interval resolution of surrounding residual leak edema. Changes results in mild ex vacuo dilatation of right frontal horn and without evidence of mass effect and resolution of previously noted midline shift to the left. Expected postoperative changes of a right frontal craniotomy with subtotal underlying epidural thickening and enhancement.Few tiny foci of FLAIR hyperintensity only in the subcortical white matter of bilateral hemispheres remain similar to prior exam.Normal signal intensity and anatomical morphology of the brain parenchyma otherwise unremarkable MRI sequences. No detectable abnormal parenchymal or leptomeningeal enhancement other than above findings.Unremarkable images through the orbits and including axial fat sat post enhanced series.The signal intensity of the calvarium is bleeding normal and without abnormal enhancement.", "output": "1.Significant interval improvement of a resolving hematoma and postoperative changes in the right frontal lobe as detailed above.2.Resultant mild expansion of right lateral ventricle and resolution of midline shift.3.Negative diffusion weighted series.4.Few punctate nonspecific foci of FLAIR hyperintensity only in the subcortical white matter without change since prior exam."}
{"instruction": "Generate impression based on findings.", "input": "History of Hodgkin's lymphoma status post chemotherapy. PET scan shows FDG lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver contour is mildly lobulated. There are several T2 hypointense lesions which do not demonstrate significant restricted diffusion or postcontrast enhancement. Two of these lesions correspond to the new peripheral lesions described on the recent FDG PET which demonstrated FDG uptake. There are signal characteristics are not significantly different from the remaining liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum. No evidence of acute pancreatic inflammation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small mesenteric lymph nodes are noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple liver lesions are identified compatible with history of Hodgkin's lymphoma. There are lesions corresponding to the recently described FDG PET avid lesions whose MR signal characteristics are not different from the other known lesions which were not significantly FDG avid."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with medial compartment arthritis and recent new injury with locked left knee. Evaluate left knee for medial meniscus tear. Due to the patient's body habitus, the high resolution coil could not be utilized resulting in slightly suboptimal image quality.MENISCI: There is mild attenuation of the posterior horn of the medial meniscus likely representing chronic attritional tearing. There is also intermediate signal intensity within the posterior horn of the medial meniscus extending to the femoral articular surface likely representing degenerative tearing. There is globular intermediate signal intensity within the body likely representing a combination of intrasubstance degeneration and degenerative tearing. There is slight medial extrusion of the body of the meniscus. We see no fluid-filled meniscal tear or displaced meniscal fragment. The anterior horn appears intact. There is globular increased signal intensity within the posterior horn of the lateral meniscus, at its root, likely representing degeneration, but we see no fluid-filled tear.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the medial compartment with full-thickness cartilage loss along the weightbearing portions of the medial femoral condyle and medial tibial plateau with underlying degenerative signal abnormality within the subchondral bone. The articular cartilage of the lateral compartment is relatively spared, although there is degeneration of the articular cartilage of the lateral femoral condyle anterior to the lateral meniscus. Edema within the anterior aspect of the tibia may represent a direct bone contusion. There is also full-thickness articular cartilage loss along the lateral facet of the patella. There are subchondral cysts in the lateral femoral trochlea with overlying cartilage degeneration. Note is made of tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Severe osteoarthritis of the knee with full-thickness cartilage degeneration affecting the medial and patellofemoral compartments.2. Degeneration and degenerative tearing of the medial meniscus, but we see no fluid-filled tear or displaced meniscal tissue.3. Small joint effusion and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Other fatigue [R53.83] / Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: eval remote brain injury History: lethargy, facial droop Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan. There is suspicious focal nodular enhancement on the left precentral gyrus (Series1101, image 27/36) but the lesion is not conspicuous on other imaging sequences especially 3D SPGR post contrast images. Therefore, this lesion could represent vascular structure such as cortical vein. There is no other unusual enhancement on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickening on ethmoid sinus and left maxillary sinus were seen.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. There is a focal nodular enhancing lesion on the left frontal lobe precentral gyrus which likely represent cortical vein as described above. Otherwise no evidence of abnormal enhancement.3. Normal brain MR angiogram."}
{"instruction": "Generate impression based on findings.", "input": " There is restricted diffusion involving the left posterior frontal corona radiata with corresponding flair hyperintensity consistent with acute infarct. Additionally, there are foci of mild hyperintensity on the diffusion sequence with iso-to high ADC values and FLAIR hyperintensity compatible with subacute infarcts. There is moderate degree of flair hyperintensity within the periventricular and subcortical white matter, and to a lesser degree involving the pons,, findings which are nonspecific but most suggestive of chronic small vessel ischemic disease. There two tiny foci of susceptibility in the right posterior frontal lobe which are nonspecific but compatible with chronic microhemorrhages.No intracranial mass or mass-effect is seen. No hydrocephalus. No extra-axial collections. Paranasal sinuses are clear. Partial opacification of the mastoid air cells. Calvarium and extracranial soft tissues are unremarkable.MRA HEAD", "output": "1. Acute infarct involving the left posterior frontal corona radiata with additional subacute infarcts in the left frontoparietal corona radiata and centrum semi-ovale.2. Mild to moderate chronic small vessel ischemic disease.3. No evidence of high-grade stenosis involving the intracranial vasculature."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Transsphenoidal surgery with persistent subcentimeter lesion within the right pituitary gland. Signs and symptoms: Yearly follow-up. Pre- and post enhanced pituitary MRI:Examination redemonstrates a partially cystic mass in the right side of sella with suggestion of subtle extension into the right cavernous sinus. Compared to prior exam there is no convincing evidence of any change in the signal intensity or size of this lesion.All the measurements of pituitary gland remain nearly identical to prior study. Associated mass effect with this finding evident by leftward deviation of the pituitary stalk remains also identical to prior study. The largest craniocephalad measurement of dictated at 8.8 mm is identical to prior exam.There is no detectable mass within the basal cistern and no evidence of mass effect on the suprasellar visual complex.Pre and post enhanced brain MRI:Negative diffusion weighted images.FLAIR images demonstrate a few punctate nonspecific hyperintensities in the subcortical and periventricular white matter without change since prior exam and without evidence of enhancement. Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise and stable since prior exam. No detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable calvarium and orbits without abnormal enhancement.", "output": "1.Pituitary MRI demonstrate stable right-sided pituitary lesion in size, signal intensity and extend since prior study.2.Brain MRI demonstrate no acute intracranial process, stable few nonspecific nonenhancing punctate FLAIR hyperintensity in the subcortical and periventricular white matter and stable unremarkable exam otherwise."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old woman with history of ulcerative colitis status post proctocolectomy with ileal pouch anal anastomosis 23 years ago, left ischiorectal fossa abscess status post drainage and seton placement in December 2015, please evaluate for fistulous tracts. PELVIS:UTERUS, ADNEXA: C-section scar noted. Nabothian cysts present. A simple 3.7 cm right ovarian cyst is noted, physiologic for a menstruating patient.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent inguinal lymph nodes noted, likely reactive.BOWEL, MESENTERY: There is a perianal seton within a transsphincteric fistulous tract extending from the 12:00 position of the rectum to the left gluteal cleft in the left ischioanal fossa. The surrounding soft tissues are indurated with increased T2 signal.Within this region (6/39) there is a questionable T2 hyperintense tract extending from the 1:00 position of the rectum to a 23 x 8 mm collection of fluid in the left labia majora (7/29) which demonstrates minimal peripheral enhancement. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Enhancing fluid collection in the left labia majora which, could represent a small abscess, but likely communicates with the rectum via a suspected (but not clearly visualized) fistulous tract.2.Seton within the left transsphincteric fistulous tract."}
{"instruction": "Generate impression based on findings.", "input": "31 year old male with a history of NF1 and plexiform behind the right knee but extensive tumor beyond. ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities identified.SOFT TISSUES: Note is made of an extensive plexiform appearing masses within the soft tissues about the posterior aspect of the right knee extending inferiorly along the anterior and lateral aspect of the calf as well as along the posterior aspect of the distal femur with associated T2 prolongation peripherally with central low intensity, consistent with the patient's history of neurofibromatosis, although these are incompletely characterized due to the lack of intravenous contrast. The largest lesion along the lateral aspect of the popliteal fossa measures approximately 8.3 x 5.0 cm (image 97; series 1701) and demonstrates heterogeneous internal signal intensity, previously measuring 7.4 x 4.7 cm. Further characterization of these lesions is limited due to the lack of intravenous contrast and dedifferentiation cannot be excluded by this examination. Additional foci of intramuscular fluid signal intensity are identified within the adductors, hamstring, sartorius and quadriceps musculature of the right thigh which appear most consistent with neurofibromas. Additional masses are identified within the left thigh musculature which are also most consistent with neurofibromas. Additional foci of fluid signal intensity are identified within the incompletely imaged pelvis which also may represent neurofibromas, incompletely characterized. There are also multiple foci of increased signal intensity on fluid sensitive sequences within the subcutaneous tissue about the anterior and lateral aspect of the calf and anterior aspect of the thigh which may represent cutaneous neurofibromas.There is mild to moderate muscle atrophy.The severe atrophy of the tibialis posterior, flexor digitorum longus musculature.ADDITIONAL", "output": "Findings consistent with the patient's history of neurofibromatosis with associated large plexiform neurofibroma along the posterior aspect of the knee. There is interval increase in size of a 8.3 cm lesion along the lateral aspect of the popliteal fossa, which is incompletely characterized on this noncontrast examination, as described above. "}
{"instruction": "Generate impression based on findings.", "input": "42-year-old male with palpable loose body in the left knee MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Focal marrow signal abnormality at the posterior aspect of the lateral femoral condyle with focal area of loss of articular cartilage measuring approximately 2.4 cm in AP dimension. Moderate joint space narrowing. LIGAMENTS: The anterior cruciate ligament is intact. The posterior cruciate ligament is intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL", "output": "1.Lesion in the suprapatellar fat pad. This may represent unusual synovitis such as PVNS. Cartilage also be considered although the lesion is unusual signal pattern for cartilage. Examination with intravenous contrast would be helpful.2.Focal loss of articular cartilage of the posterior aspect of the lateral femoral condyle with underlying marrow edema."}
{"instruction": "Generate impression based on findings.", "input": "Strong family history of pancreatic cancer. EUS June 2015 was normal. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal morphology, size, and enhancement. Hepatic steatosis. No focal lesion biliary ductal dilatation or vascular abnormality. Partially contracted gallbladder.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: The pancreas is normal in morphology and signal intensity without pancreatic ductal dilatation or focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing right renal cyst. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: Duplicated IVC.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lobular cystic lesion adjacent to a right mid lumbar facet joint extending into the paraspinal musculature, compatible with a synovial cyst measuring 2.3 x 2.2 cm.OTHER: No significant abnormality noted.", "output": "1.No discrete pancreatic lesion.2.Hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old male with a history of testicular carcinoma. Evaluate for recurrance. ABDOMEN: Lack of intravenous contrast limits evaluation for lymphadenopathy and of solid organs.LIVER, BILIARY TRACT: There is decreased T2 signal abnormality with associated loss of signal on in phase sequences throughout the liver and spleen, consistent with hemosiderosis.SPLEEN: There is decreased T2 signal abnormality with associated loss of signal on in phase sequences throughout the liver and spleen, consistent with hemosiderosis.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney. Focus of fluid signal intensity with peripheral decreased T1 and T2 signal abnormality likely represents a failed transplanted left iliac fossa kidney.Right iliac fossa transplant kidney in place. There is a small collection along the posterior margin of the superior pole of the transplant measuring 2.4 x 1.0 cm, consistent with the known history of hematoma, appearing decreased in size when compared to the prior study. Note is made of multiple linear and wedge-shaped foci of decreased T2 signal abnormality along the superior and inferior poles of the transplant kidney. Differential considerations include scarring, small infarcts and pyelonephritis. This is incompletely evaluated on this noncontrast examination. The ureter of the transplant kidney is difficult to evaluate secondary to extensive metallic susceptibility artifact from the surgical clips in the surrounding area, however, it appears to insert on the bladder.RETROPERITONEUM, LYMPH NODES: Prominent inguinal lymph nodes are nonspecific, but may be reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive collaterals are identified in the soft tissues overlying the abdomen and pelvis. Heterogeneous bone marrow signal abnormality.OTHER: No significant abnormality.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent inguinal lymph nodes are nonspecific, but may be reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The left testicle is not visualized and may be surgically absent.OTHER: Right iliac fossa transplant kidney in place. There is a small collection along the posterior margin of the superior pole of the transplant measuring 2.4 x 1.0 cm, consistent with the known history of hematoma, appearing decreased in size when compared to the prior study. Note is made of multiple linear and wedge-shaped foci of decreased T2 signal abnormality along the superior and inferior poles of the transplant kidney. Differential considerations include scarring, small infarcts and pyelonephritis. This is incompletely evaluated on this noncontrast examination. The ureter of the transplant kidney is difficult to evaluate secondary to extensive metallic susceptibility artifact from the surgical clips in the surrounding area, however, it appears to insert on the bladder.", "output": "1.No convincing evidence of residual or recurrent disease on this noncontrast examination. Prominent inguinal lymph nodes are nonspecific but may be reactive in etiology.2.Scattered areas of signal abnormality in the right iliac fossa transplanted kidney are incompletely characterized on this noncontrast examination. Differential considerations include scarring and infarct. Pyelonephritis cannot be excluded and clinical correlation is indicated. 3.Small perinephric hematoma along the superior aspect of the right iliac fossa transplant kidney which appears similar to slightly decreased in size when compared to previous examinations."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate growth of secondary GBM. Patient on Avastin. Signs and symptoms: Secondary GBM. Pre and postcontrast enhanced brain MRI:Postoperative changes of a right frontal tumor resection and with resultant ex vacuo dilatation of the adjacent right lateral ventricle remains similar to prior study.Large focus of FLAIR hyperintensity anterior to the surgical cavity and along the right frontal cingulate gyrus measures nearly identical to prior exam and without convincing evidence of abnormal enhancement.Flair and T2 hyperintensity surrounding and within the right frontal horn demonstrate subtle interval increased size and with new evidence of enhancement since prior exam. Finding is highly suggestive of tumor.A second well demarcated masslike lesion with FLAIR hyperintensity along the posterior superior aspect of the resected cavity measures slightly larger in size since prior exam and with evidence of subtle mass effect. The largest AP axis of this lesion measures almost 27 mm compared to prior study measurement of 23. This change however could be secondary to slice positioning. This finding however demonstrate enhancement which is new since prior and best appreciated on axial post enhanced series 11 images 4 and 5. Constellation of findings are suggestive of tumor. Focus of hemorrhagic FLAIR hyperintensity along the interhemispheric aspect of the left hemisphere demonstrate evidence of mineralization and without change since prior exam. It however demonstrate subtle enhancement on post infused images which is more conspicuous on current study however not significantly changed when compared with earlier exams.", "output": "1.FLAIR and T2 hyperintensity surrounding and within the right frontal horn of lateral ventricle demonstrates subtle interval increased size and with evidence of new enhancement as detailed. Finding is suspected of tumor.2.Well-demarcated focus of FLAIR hyperintensity with restricted diffusion along the posterior superior aspect of the surgical cavity in the right frontal demonstrate evidence of new enhancement and suspected for tumor.3.Stable focus of FLAIR hyperintensity with mineralization and subtle enhancement along the interhemispheric aspect of the left frontal parietal lobe as detailed above. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: C2 lesion, colon cancer with metastases to spine. 6 months follow-up. Signs and symptoms: Evaluate for change, six-month follow-up. Pre- and post enhanced cervical MRI:Examination demonstrates uniform T1 hyperintense, T2 hyperintense and T2 STIR hyperintense vertebral bodies and the posterior elements of C1, C2 and C3 representing prior radiation change and without evidence of enhancement or interval change.There is revisualization of multiple foci of intraosseous enhancement in the vertebral bodies of C4, C5, C6, C7, T1, T2 and its posterior elements, posterior elements of T3 and posterior body of T4 on consistent with metastatic lesions. There is no extraosseous spread of tumor. There is minimal interval increase size of metastatic lesion in the vertebral body of C4 since prior exam measuring 11 mm in length compared to 9 mm on prior study (sagittal postcontrast enhanced series). No significant change in the size of the large C5 vertebral body metastatic lesion. There is interval size of metastatic lesion in dorsal aspect of the body of C6 vertebrae measuring approximately 11 mm in height compared to prior study measurement of 5 mm. Minimal increased size of metastatic lesion in the dorsal body of C7 measuring approximately 6 mm on current exam. Previously noted metastatic lesion in the posterior element of T3 also demonstrate interval noticeable increased size measuring at 16.5 mm in cranial cephalad axis compared to prior study measurement of 6 mm.Degenerative changes and resultant moderate central spinal stenosis at C3-C4 and with resultant focal myelomalacia remains stable since prior exam. There is no detectable enhancement of the cord or the leptomeninges.", "output": "1.Stable post radiation changes of C1, C2 and C3 without evidence of metastasis.2.Extensive additional metastatic lesions involving vertebral bodies and posterior elements from C4 through T2 which most demonstrate interval increased size as detailed/measured above.3.No detectable epidural spread of tumor. No abnormal meningeal enhancement.4.Moderate Central spinal stenosis at C3-C4 and associated cord myelopathy without change since prior exam. Degenerative changes at C7-T1 also results in mild central spinal stenosis which has remained stable since prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Lesion. Signs and symptoms: Headaches No evidence of hemorrhage, mass effect, midline shift or hydrocephalus. There is subtle low-density surrounding the trigone of right lateral ventricle and extending into the right temporal lobe is again identified as was noted on MRI of brain from 12 -- 16 -- 2008. There is a slight ex vacuo dilatation of the trigone of right lateral ventricle. These findings all remain stable since prior CT examination dated 7 -- 8 -- 2008. Limited view of paranasal sinuses and mastoid air cells are unremarkable. Calvarium is intact.", "output": "Stable examination since prior CT and with no acute findings."}
{"instruction": "Generate impression based on findings.", "input": " The spinal cord signal appears unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. At C7-T1, there is a small left paracentral disc protrusion. There is no significant spinal canal stenosis. There are subcentimeter perineural cysts at the bilateral T8-9, right T9-10, bilateral T10-11, and right T11-12 levels. The largest measures 7 x 9 mm in the T11-12 right neural foramen with possible impingement of the T11 exiting nerve root. The spinal cord displays normal signal and morphology. Bilateral thyroid nodules are partially imaged.", "output": "1. No significant spinal canal stenosis or evidence of spinal cord lesions. 2. Multilevel subcentimeter perineural cysts in the lower thoracic spine, the largest of which is in the right T11-12 neural foramen with possible impingement on the T11 exiting nerve root. 3. Bilateral thyroid nodules. A thyroid ultrasound may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Disturbance of skin sensation [782.0], Reason for Study: ^Reason: paresthesia to left arm and left face new onset History: see above. Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.There is about 12.6 mm x 4 mm sized extra-axial well marginated lesion attached on the inner table of the skull on the right hemisphere indicating possible calcified meningioma without showing any evidence of mass effect toward the adjacent brain structure.C-spine MRIThere is evidence of external fixation using plate and screws between C4-C5.Comparing to prior scan performed on March 4, 2015, kyphotic angulation of upper cervical spine from C2 to C6 appears to be slightly lessened.Previously recognized extensive degenerative changes as well as spinal cord syrinx at the level of C5 and C6-7 do not show any significant interval change.Spinal canal narrowing especially at the level of C4-5 appears to use to be lessened than prior scan.Neuroforaminal stenosis especially on the left side C45 appears to be slightly lessened, however, still shows mild to moderate stenosis.Otherwise no significant interval change in terms of degenerative changes of intervertebral discs of cervical spine since prior scan.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. Postoperative status of cervical spine in particular anterior fixation between C4-C5 with interval improvement of 1) upper cervical lordotic angle 2) the degree of spinal stenosis at the level of C45 and 3) the degree of neuroforaminal stenosis at the level of C45 left side."}
{"instruction": "Generate impression based on findings.", "input": "Benign neoplasm of brain, unspecified [D33.2], Reason for Study: ^Reason: Inflammatory pseudotumor; f/u progression History: headaches Redemonstration of left frontoparietal craniotomy with parasaggital dural based mass resection status, unchanged since prior scan.Previously seen left cerebral convexity dural thickening and enhancement lesion is again seen, unchanged since prior scan. Associated encephalomalacia with minimal susceptibility lesions indicate postoperative changes also do not show any interval change since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. About 6-7mm downward placement of cerebellar tonsils are again seen, unchanged since prior scan.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Bilateral mastoids show post-mastoidectomy changes with fluid collections on the left side indicating interval left mastoidectomy. No postoperative unusual finding.", "output": "1. Post left fronto parietal craniotomy status. Underlying dural thickening and enhancement on the left cerebral convexity as well as associated left frontoparietal encephalomalacia, unchanged since prior scan.2.No evidence of new abnormal enhancement. No acute ischemic or hemorrhagic lesion.3. Unchanged right mastoidectomy changes since prior scan. 4. Left side postmastoidectomy status, no postoperative unusual finding.5. Unchanged downward herniation of bilateral cerebellar tonsils."}
{"instruction": "Generate impression based on findings.", "input": "History of hysterectomy and right hepatectomy. Abdominal mass noted on prior CT. ABDOMEN:LIVER, BILIARY TRACT: Postoperative changes from right hepatectomy of known large hemangioma. There is associated edema and postsurgical changes adjacent to the resection bed without a suspicious lesion or drainable fluid collection. The remaining liver parenchyma has normal signal without a focal lesion.No intrahepatic or extrahepatic biliary ductal dilatation. Status post cholecystectomy.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 upper abdominal lymphadenopathy.BOWEL, MESENTERY: Note is made of a duodenal diverticulum. Colonic diverticulosis.BONES, SOFT TISSUES: Postsurgical ventral abdominal wall changes.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The previously described incompletely imaged soft tissue mass seen on CT 2/9/2016 anterior to the right psoas muscle corresponds to the right ovary with a punctate follicle. The ovary is normal in size and morphology. The patient is status post hysterectomy and left-sided salpingo-oophorectomy. Status post right salpingectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disc disease affects the lumbar spine most severe at L5-S1.OTHER: No significant abnormality noted.", "output": "1.Residual right ovary corresponds to the mass lesion described on the prior CT. The ovary is normal in morphology and size. No hydroureteronephrosis.2.Status post right hepatectomy with postsurgical changes in the hepatectomy bed."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate GBM, patient TMZ, Avestin, NovoTTF. Signs and symptoms: GBM. BMD. Pre and post enhanced brain MRI:Examination demonstrates mild interval decreased size of a large necrotic right hemispheric frontal GBM since prior exam and with decreased surrounding vasogenic edema since prior study. The largest transaxial dimensions of this necrotic tumor with thick irregular rim of enhancement are at 44 x 33 mm compared to prior study the measurements of 56 x 41 mm. Changes results in better visualization of right hemispheric cortical sulci and without evidence of midline shift.Several additional remote foci of FLAIR/T2 hyperintensity and enhancement in the corpus callosum and extensively in the left hemisphere demonstrate varying degrees of interval improvement and progression since prior study. For example a previously noted focus of enhancement in the posterior left occipital lobe which measured at 9 x 10 mm on prior exam has increased to 17 x 18 mm. A smaller additional focus of enhancement in the left occipital lobe which measured at 3.8 mm on prior exam has increased to approximately 9 mm current study. Focus of enhancement in the left anterior temporal lobe which measures 11 x 7 mm on prior exam demonstrates significant interval decreased size and measuring at approximately 8 x 5 mm on current study. Focus of enhancement in the immediate periventricular white matter of the left temporal lobe which measured at 6 mm in thickness has decreased and measuring 2.3 mm on current exam.Few of the additional remote foci of enhancement demonstrate interval improvement since prior study. Multiple transversely oriented rim-enhancing lesions in the corpus callosum demonstrate interval decreased size. The largest lesion in the anterior body of corpus callosum measuring approximately at 34 x 14 mm on prior exam has decreased to 33 x 7 mm in size.The ventricular system remains within normal size and midline is maintained. The CSF spaces/cisterns remain patent.There is no detectable new foci of FLAIR/T2 hyperintensity or new foci of abnormal enhancement since prior exam.", "output": "1.Interval decreased size and surrounding vasogenic edema and regional mass effect of a large right frontal GBM as detailed/measured about.2.Interval progression as well as interval improvement of multiple additional foci of enhancement consistent with multifocal focal GBM as detailed/measured above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: posterior reversible encephalopathy syndrome History: seizure MRI of the brainNo diffusion weighted abnormalities are appreciated.There is T2 and flair signal hyperintensity present along the right occipital lobe at the cuneus and along the right parietal lobe at the precuneus and to a much lesser degree scattered along the left precuneus are areas of serpiginous flair signal hyperintensity present within the sulci of the right posterior temporal lobe.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening of the sphenoid sinuses. The visualized portions of the mastoid air cells are opacified. The patient is intubated. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm. There is mild narrowing of the mid basilar artery between the anterior/inferior cerebellar arteries and the superior cerebellar arteries . The right posterior cerebral artery is smaller than the left posterior cerebral artery. There is narrowing and dilations of the basilar artery associated with what appears to be attenuation of the distal posterior cerebral artery branches right more than left To a lesser degree there is suspicion for attenuation of the distal ACA and MCA vasculature. The A2 segment of the anterior cerebral arteries azygos. New right orbitofrontal artery comes off the right A1 segment. The posterior communicating arteries are not readily identified. The left vertebral artery is larger than the right vertebral artery.", "output": "1.Findings are suspicious for cerebral infarction involving the right cuneus and precuneus. 2.There is narrowing and dilations of the basilar artery associated with what appears to be attenuation of the distal posterior cerebral artery branches right more than left. To a lesser degree there is suspicion for attenuation of the distal ACA and MCA vasculature. Vasculitis or vasculopathy cannot be excluded.3.Patchy signal changes in the left precuneus are suggestive of a subacute infarction."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old male with decreased range of motion following direct trauma. Some of the images are limited by patient motion artifact.ROTATOR CUFF: The musculature and tendons the rotator cuff appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a linear band of intermediate-to-high signal which traverses the posterosuperior labrum indicating a tear. Lower-intermediate signal intensity extends down the posterior labrum, which may reflect scarring of an old posterior labral tear. The anterior labrum appears intact. There is a mild focal depression of the posterolateral aspect of the humeral head, which may represent an old Hill-Sach deformity. Poorly defined foci of intermediate to low signal intensity within the subscapular recess may reflect focal synovitis.BICEPS TENDON: The tendon of the long head of the biceps appears normal.ADDITIONAL", "output": "Findings compatible with a posterosuperior labral tear as described above."}
{"instruction": "Generate impression based on findings.", "input": "Female 80 years old Reason: 79 yo F with HCC, please evaluate for interval change compared to outside MRI dated 12/2/14. History: none Study is significantly limited due to motion artifact and lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. The liver parenchyma is diffusely heterogeneous and there is a nodular contour, caudate lobe hypertrophy and prominence of the hepatic fissures, consistent with cirrhosis. There is signal dropout on in phase images suggestive of iron deposition. T2 iso-/hypo-intense hepatic lesion measures 4.6 x 3.8 cm (series 8, image 10). The lesion is remeasured on prior study at 5.7 x 4.6 cm. Central T2 hyperintense signal /diffusion signal within the lesion is nonspecific and not significantly changed compared to prior study. Evaluation of this lesion is significantly limited in the absence of contrast.Evaluation for hepatocellular carcinoma is significantly limited in the absence of intravenous contrast however there are no additional areas of T2 signal hyperintensity or diffusion restriction to suggest new lesions.SPLEEN: Splenomegaly measuring 14.6 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace abdominal ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Stable position of a cholecystotomy tube. Left upper quadrant collateral vessels are noted.", "output": "1.Limited study due to motion and the absence of intravenous contrast. Comparison with outside images demonstrates decrease in size of treated hepatic lesion. No new lesions are identified given the limitations.2.Cirrhotic liver morphology with splenomegaly and splenic varices."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic lung cancer status post treatment. There is interval increase in size of the left inferior frontal gyrus and left lateral orbitofrontal gyrus peripherally enhancing lesions, measuring up to 13 mm and 18 mm, previously 10 and 16 mm, respectively. There is also interval increase in the degree of associated vasogenic edema. Furthermore, there appears to be a new 5 mm diameter lesion in the right posterior middle temporal gyrus. There is no evidence of acute infarct. There is a background of mild scattered cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemia. 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": "Interval increase in size of the left frontal lobe metastases and associated edema. New lesion in the right posterior temporal lobe."}
{"instruction": "Generate impression based on findings.", "input": " Thoracic spine:There is mild anterior wedge deformity of T7 due to superior endplate compression, containing material which is hypointense on all sequences, consistent with the provided history of prior kyphoplasty.Marrow edema is noted involving the facet joints at T6/7, T7/8, and T8/9 bilaterally, extending into adjacent pedicles, due to facet degenerative hypertrophy. Facet hypertrophy is also noted more inferiorly, however without associated edematous marrow change.Modic type I discogenic reactive endplate change is noted at T6/7, T9/T10, T10/11, T11/12, and T12/L1.Other than the aforementioned T7 wedge deformity, the remaining vertebral body heights are maintained. The spinal cord is without focal atrophy, edema, or myelomalacia. There are no masses.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 diffuse annular disc bulge encroaching the anterior CSF space however without significant cord abutment or resulting stenosis. T7/8 demonstrates diffuse annular disc bulge with a superimposed small paramedian disc protrusion causing minimal anterior left hemicord flattening without intrinsic cord signal abnormality or resulting stenosis. T8/9 demonstrates diffuse annular disc bulge encroaching the anterior CSF space however without significant cord abutment or resulting stenosis. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates trace retrolisthesis T12 on L1, diffuse annular disc bulge encroaching the anterior CSF space however without significant cord abutment or resulting stenosis. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation is present throughout somewhat sparing the L5/S1 disc level. Mixed Modic discogenic reactive endplate changes are present at L3/4 and L4/5.L1/2: Mild disc bulge without stenosisL2/3: Mild disc bulge and mild bilateral facet hypertrophy without stenosisL3/4: Diffuse annular disc bulge, ligamentum flavum thickening, moderate bilateral facet hypertrophy, and tiny bilateral facet effusions. There is minimal bilateral neural foraminal stenosis.L4/5: Diffuse annular disc bulge, ligamentum flavum thickening, moderate left facet hypertrophy, and moderate to severe right facet hypertrophy. There is mild central, mild left lateral recess, moderate right lateral recess, and moderate bilateral neural foraminal stenosis.L5/S1:Mild disc bulge, mild left facet hypertrophy, and moderate right facet hypertrophy. There are no stenoses.SI Joints: Bridging marginal osteophytes are consistent with mild osteoarthritic degenerative change", "output": "1.There is mild anterior wedge deformity of T7 due to superior endplate compression, containing material which is hypointense on all sequences, consistent with the provided history of prior kyphoplasty.2.L3/4: Minimal bilateral neural foraminal stenosis.3.L4/5: Mild central, mild left lateral recess, moderate right lateral recess, and moderate bilateral neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.7 x 5.5 x 4.4 cmPeripheral Zone: In the left mid gland to apex there is a wedge-shaped region of T2 weighted hypointensity measuring 1.4 x 1.2 cm (series 901/12) which is associated with restricted diffusion (series 704/184) and arterial enhancement.Central Gland: 5 mm well-defined focus of restricted diffusion (series 704/284) with associated T2-weighted hypointensity in the left mid-gland transition zone may represent a BPH nodule and less likely a small focus of prostatic adenocarcinoma. Benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion. Left seminal vesicle T2-weighted hypointensity may be post-treatment related.Extracapsular Extension: No evidence of extraprostatic 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": "1.4 cm lesion in the left mid gland to apex may reflect a site of prostatic adenocarcinoma. Additional non-specific left mid-gland 5 mm focus may represent a small focus of carcinoma verus a BPH nodule.No evidence of seminal vesicle invasion, extraprostatic extension or pelvic lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Outside Request: anterior instability left shoulder spastic quadriplegia; labral tear Evaluation is limited by metallic susceptibility artifact due to orthopedic hardware overlying the posterior aspect of the glenoid.ROTATOR CUFF: The supraspinatus and infraspinatus tendons appear intact. The teres minor and subscapularis tendons appear intact.SUPRASPINATUS OUTLET: There is trace fluid within the subacromial/subdeltoid bursa of doubtful clinical significance. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the glenoid and glenoid labrum is limited as described above. The anterior third of the glenoid appears deformed with slight angular depression of the articular surface, however, we are not certain to what degree this represents a true anatomic deformity or deformity related to the aforementioned metallic susceptibility artifact. The anterior inferior labrum appears enlarged which may represent a compensatory phenomenon. Although no gadolinium is seen separating the labrum from the underlying glenoid, the margins of the hypertrophied labrum are slightly irregular perhaps reflecting chronic degeneration. Furthermore, the articular cartilage of the anterior inferior glenoid is abnormally thickened and irregular with low signal intensity which also may represent a combination of degeneration and labral overgrowth. The posterior inferior labrum is difficult to evaluate due to metallic susceptibility artifact. The superior labrum appears intact. The glenohumeral joint capsule is patulous.BICEPS TENDON: The tendon of the long head of the biceps appears intact.", "output": "1. Limited study due to metallic susceptibility artifact from the patient's orthopedic hardware as described above.2. Deformity of the anterior inferior glenoid as described above which may reflect a peculiar dysplasia or the sequela of prior trauma/surgery. Although we see no fluid-filled tear of the labrum, the anterior inferior labrum appears thickened and irregular which may reflect a combination of chronic degeneration and scarring. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "37 years Female (DOB:12/14/1978)Reason: Evaluate for lumbar epidural steroid injection, eval for herniated disc/ osseus mets History: lumbar painPROVIDER/ATTENDING NAME: MAGDALENA ANITESCU BENJAMIN DOMB Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is some loss of vertebral body height present at L1 and L2 associated with some T2 signal hyperintensity within the L1 and L2 vertebral bodies.. The conus medullaris on sagittal imaging is grossly intact. There is diffuse marrow replacement presentAt L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate reactive changes which are bright on T2 and dark on T1. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.There is diffuse marrow replacement present which could be related to patient's known lymphoma.2.There are compression fractures present at L1 and L2 which appear to be subacute.3.There are degenerative changes present in the lumbar spine worse at L5-S1 where there is some narrowing of the neural foramina. There is no significant compromise to the spinal canal or exiting nerve roots as a result of degenerative changes.4.The examination is incomplete due to patient's inability to complete the exam as a result of anxiety. This may result in a lower detection rate of underlying abnormalities within the lumbar spine."}
{"instruction": "Generate impression based on findings.", "input": "60 years Male (DOB:7/27/1955)Reason: multifocal infarctions, suspect septic embolization History: as abovePROVIDER/ATTENDING NAME: RICHARD KRAIG RICHARD KRAIG A small focus of gyriform T2 and FLAIR hyperintensity is present along the right occipital lobe posteriorly at the inferior aspect of the right cuneus. There is associated gyriform T1 signal hyperintensity. There is no diffusion restriction associated with this. There is associated susceptibility effect. Small focus of susceptibility effect is present in the left occipital lobe along the left cuneus.A punctate foci of susceptibility effect and small foci of susceptibility effect scattered in the cerebellar hemispheres bilaterally.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There are hemorrhagic lesions present in the occipital lobes bilaterally but more on the right occipital lobe and the left. There is gyriform pattern suggests these are related to a vascular event. I suspect the related to subacute embolic events.2.Multiple small foci of hemorrhage are present in the cerebellar hemispheres. It is possible these are related to embolic events with some hemorrhagic conversion.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: MRI liver to r/o HCC History: post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Ablation cavity in the right lobe of the liver measures 3.1 x 1.6 cm (series 10 image 47), unchanged.New ablation cavity from interval ablation of previous HCC inferiorly measures 3.8 x 2.5 cm. No nodular arterial enhancement or washout to suggest residual disease. Intrinsic T1 signal compatible with blood products.No new lesions.Cirrhotic morphology. Patent hepatic vasculature. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in the pancreatic head is unchanged, measuring 1.3 x 0.9 cm (series 9 image 22), likely a side branch IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Prominent periportal and gastric hepatic lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.New RFA ablation cavity with no specific evidence of residual disease.2.Stable additional RFA patient cavity with no specific evidence of recurrence.3.Stable probable IPMN. "}
{"instruction": "Generate impression based on findings.", "input": "20 years Male (DOB:2/2/1996)Reason: history of rhabdomyosarcoma s/p radiation therapy History: new onset memory loss; history of rhabdomyosarcoma s/p radiation therapyPROVIDER/ATTENDING NAME: ELISE OBERMAN TARA O HENDERSON The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cysts. The visualized portions of the right mastoid air cells are clear. The patient is status post left mastoidectomy .The left parotid gland is absent. The visualized portions of the orbits are intact.", "output": "There is no evidence for brain metastases."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: possible stroke. Signs and Symptoms: as above. Nonenhanced brain MRI:There is no evidence of an acute ischemic stroke.Examination demonstrate diffuse left hemispheric periventricular and subcortical FLAIR hyperintensity of brain parenchyma and to a lesser degree of the left basal ganglia associated with mild ex vacuo dilatation of left lateral ventricle suggesting chronic ischemic changes in the microvascular distribution. Compared to prior exam there is significant interval progression of finding in the left hemisphere.Very minimal similar finding on the right side is also noted. Significant discrepancy of the findings on the left suggest possibility of proximal large vessel vascular stenosis. There is mild left-sided medullary and degeneration.Cortical sulci are prominent for patient's stated age however without detectable signal abnormality.Images through posterior fossa demonstrate focus of encephalomalacia in the right middle cerebellar peduncle without significant change since prior exam. Also similar to prior exam there is prominence of cerebellar and vermian folia for patient's stated age of 49.The signal void of major intracranial arterial branches are identified. There is persistent low signal changes in the left vertebral and basilar artery with decreased caliber as was noted on prior MRI and CTA examinations.", "output": "1.No acute intracranial process and negative diffusion weighted series.2.Extensive left hemispheric periventricular / subcortical and to a lesser degree left basal ganglia FLAIR hyperintensity with volume loss suggesting progression of small vessel distribution ischemic strokes since prior MRI exam. Minimal similar changes in the right hemisphere is also noted. Stable focus of encephalomalacia/chronic stroke in the right middle cerebellar peduncle.3.Asymmetrical (L>R) extent of left hemispheric findings is suggestive of a larger proximal vessel stenosis or occlusion.4.Prominence of cortical sulci and cerebellar-vermian folia for patient of stated age and consistent with underlying parenchymal volume loss.5.Redemonstration of signal changes in the left vertebral artery and proximal basilar with decreased caliber consistent with findings on prior CTA examination."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old pregnant female. Evaluate for fetal abdominal wall defect. PELVIS:UTERUS, ADNEXA: Gravid uterus with fetus in cephalic presentation. Anterior placenta. Cervical cerclage is present. There is a 4 mm T2 hyperintense focus seen at or very close to the skin surface of the anterior upper abdominal wall near the midline (series 1101/27). This finding likely correlates with the reported cystic focus seen on 18 week fetal survey ultrasound. No liver or bowel herniation. Normal fetal cord insertion. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 10 mm left perineal T2 hyperintense, most likely a Bartholin's gland cyst (series 601/9)OTHER: No significant abnormality noted.", "output": "Small, nonspecific anterior abdominal wall cystic lesion without any significant anterior abdominal wall defect.. No liver or bowel herniation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: screen for HCC, presence of hemangioma History: Hep B, hx of hemangioma, RUQ pain. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal morphology, parenchymal signal intensity, and enhancement. There is redemonstration of a T2 hyperintense structure within segment 5 (series 3, image 24) which measures 10 mm, not significantly changed. This structure demonstrates peripheral nodular enhancement and likely represents a hemangioma. No suspicious hepatic lesions are identified.The hepatic vasculature appears patent.The gallbladder appears within normal limits. No biliary ductal dilatation.SPLEEN: A splenule is 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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable right hepatic lobe lesion with imaging features suggestive of a hemangioma. No new hepatic lesions are identified."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Tendonitis after trauma; left elbow pain History: left elbow pain LIGAMENTS: Although this examination was not optimized for detailed evaluation of the intrinsic ligaments of the elbow, the ulnar collateral ligament appears intact. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact.TENDONS: There is thickening and intermediate signal abnormality within the common extensor tendon at the level of the lateral epicondyle indicating mild tendinosis. No fluid-filled tear is evident. The flexor tendons appear intact. The biceps and brachialis muscles and tendons appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. There is osteophyte formation indicating mild osteoarthritis. There is a small amount of increased signal abnormality within the capitellum on fluid sensitive sequences which may reflect degenerative change (19; series 1401)SURROUNDING STRUCTURES: The ulnar nerve is normal in appearance.ADDITIONAL", "output": "Tendinosis of the common extensor tendon and osteoarthritis of the elbow as described above."}
{"instruction": "Generate impression based on findings.", "input": "Rule-out progression of spondylosis after decompressive surgery. History of C5-C6 ACDF in 2000 and C3-C4, C4-C5, C5-C6 laminotomy with C3-C4 diskectomy and July 2013. Residual myelopathy. Intermittent neck pain radiating to bilateral upper extremities. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height with evidence of osseous fusion involving the C5 and C6 vertebral bodies. There is minimal retrolisthesis of C4 and C5. Alignment is otherwise maintained. There is T2 hyperintensity involving the C4 and C5 vertebral bodies which are likely on a degenerative basis.Again seen is abnormal T2 hyperintensity within the cervical cord at C3-C4, C4-C5, and C5-C6 levels with associated volume loss consistent with myelomalacia. Compared to 6/20/2013, interval decompression of the spinal canal is seen from C3 to C5. Diskectomy at C3-C4 is also seen. No significant residual spinal canal stenosis is demonstrated.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Interval discectomy. No significant compromise to the spinal canal. There is mild to moderate bilateral neural foraminal narrowing worse on the left.C4-5: Small disc osteophyte complex again seen. No significant compromise to the spinal canal. Moderate to severe right and moderate left neural foraminal narrowing related to uncovertebral hypertrophy. C5-6: No significant compromise to the spinal canal. Minimal left foraminal narrowing. Dorsal ligamentum flavum thickening effaces the dorsal thecal sac. C6-7: No significant compromise to the spinal canal. There is mild to moderate bilateral neural foraminal narrowing.C7-T1: Mild disc osteophyte complex and uncovertebral hypertrophy. No significant compromise to the spinal canal. Mild left neural foraminal narrowing.Small disc bulges in the upper thoracic spine again seen. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "1. Compared to 6/28/2013, interval discectomy at C3-4 and decompression of the spinal canal from C3 to C5 is seen. No significant residual spinal canal stenosis is appreciated.2. Again seen is abnormal T2 hyperintensity at C3-C4, C4-C5, and C5-C6 and consistent with myelomalacia.3. Multilevel neural foraminal narrowing again seen as detailed above, worst at C4-5 and similar to prior."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are breast MRI (10/6/2016), images from MRI guided biopsy of right breast and postprocedural right mammographic images (11/8/2016) performed at outside institution. BREAST MRI (10/6/2016):Per outside radiology report, breast MRI was performed as screening for high risk woman.The breast MRI was performed per a protocol, outlined in the outside radiology report.There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a lobulated mass measuring 8 x 8 x 10 mm (AP x LR x CC) at retroareolar region in the right breast. Distance between nipple and the mass is approximately 2 mm. There are no other abnormal enhancing lesions elsewhere in the right breast or in the left breast. No abnormal lymph nodes are identified in either axillary region.IMAGES FROM MRI GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/8/2016):Images from MRI guided biopsy right breast have been submitted. However there are no actual biopsy images. Post procedural right mammographic images show a marker clip placed at retroareolar region. The mass is not identified on the mammogram.Per outside pathology report, the result was malignant, invasive mammary carcinoma grade 3.", "output": "Biopsy proven unifocal carcinoma in the right breast at retroareolar region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": " The left frontal sinus is completely opacified with a peripheral rind of T1 isointensity to brain which enhances, with central T1 hyperintensity, likely representing obstructive inspissated secretions.There is a T1 isointense to brain and T2 hyperintense lesion in the left frontoethmoidal recess and the left anterior ethmoid, which is diffusely enhancing. There is dehiscence of the lateral wall of the frontoethmoidal recess at this level and there is an extraconal enhancing component along the medial aspect of the left orbit. There is mass effect on the extraconal left orbit, although the muscles remain discrete. There is also dehiscence of the left ethmoid roof. There is adjacent dural thickening of the left inferior frontal lobe.There is mucosal thickening of both maxillary sinuses, left more than the right.There are extensive paranasal sinus post-operative changes, including bilateral antrostomies which are patent.", "output": "1. There is a stable enhancing mass in the left frontoethmoidal recess, extending into the left anterior ethmoid sinus. Extra conal left orbital component with dehiscence of the lateral wall of the frontoethmoidal recess and left ethmoid roof. This mass is likely to represent recurrence of squamous cell carcinoma. MRI of the brain is recommended to assess for brain parenchymal involvement.2. Probable mucosal thickening of the left frontal sinus with associated obstructive inspissated secretions.3. Mucosal thickening of the maxillary sinuses bilaterally, left greater than right."}
{"instruction": "Generate impression based on findings.", "input": "53 year old male with prior cervical spine injury. Evaluate for cervical spine injury. MRI C-Spine:The craniovertebral junction appears within normal limits. There are postsurgical changes of an anterior cervical discectomy and fusion spanning C4-C6. There is also evidence of a prior open door left-sided laminoplasty procedure from C4 through C6. There is straightening of the cervical spine and no evidence of subluxation. There is significant volume loss involving the cervical spinal cord particularly in its mid and lower cervical aspects. Abnormal T2 signal is evident in the cervical cord bilaterally at the C3-C4 level and more pronounced at the C4-C5, C5-C6, and C6-C7 levels. Findings are most consistent with myelomalacia and similar to prior study from 9/21/2010 which was prior to posterior decompression. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.Interspace observations in the cervical spine:C2-3: Right greater than left uncovertebral hypertrophy which contributes to right greater than left mild to moderate bilateral neural foraminal narrowing. No significant spinal canal stenosis.C3-4: Prominent disc osteophyte complex and prominent uncovertebral spurring. Moderate to severe bilateral neuroforaminal narrowing. Mild to moderate degree of spinal canal stenosis which is slightly less pronounced than priorC4-5: Significant uncovertebral spurring which contributes to severe left and moderate to severe right neural foraminal narrowing. No significant spinal canal stenosis.C5-6: Prominent uncovertebral and facet arthropathy. Moderate bilateral neural foraminal narrowing. No significant spinal canal stenosis.C6-7: Prominent disc osteophyte complex and facet arthropathy. Moderate to severe, right greater than left, bilateral neuroforaminal narrowing. Mild to moderate spinal canal stenosis which is slightly less pronounced than prior.C7-T1: No significant compromise to the spinal canal or neural foramina.MRI Cord compression protocol:Elsewhere within the spine involving the thoracic and lumbar levels, the vertebral bodies are appropriate in the overall alignment and height aside from straightening of the spinal curvature and mild L5 on S1 retrolisthesis The thoracic spinal cord has gross normal signal characteristics and overall morphology. Within the thoracic spine there are scattered degenerative changes including relatively more prominent disc bulges at the T1-T2 and T9-T10 level but without high-grade spinal canal stenosis or evidence of acute cord compression. These thoracic disc bulges are progressed since prior. Disc height loss at the T9-T10 level is also progressed since prior.There are multiple disc bulges involving the lower lumbar spine as well as prominence of the dorsal epidural fat at the L4-L5 level. There is moderate spinal canal stenoses suspected at the L3-L4, L4-L5, and L5-S1 levels based on the sagittal sequences. There is mild retrolisthesis of L5 on S1. Edematous marrow signal changes are noted at the L5-S1 level which are progressed since prior study from 2010. There is also moderate degree of neural foraminal stenoses from the L3-L4 to L5-S1 levels which appears worse.", "output": "1.Extensive myelomalacia involving the cervical cord which was present on prior MRI from 9/21/2010. No clear evidence of cord edema.2.Post-surgical changes of prior anterior instrumentation/fusion and posterior decompression with laminoplasties extending from C4 through C6. There is mild to moderate degree of spinal canal stenosis at the C3-C4 and C6-C7 levels which is slightly less pronounced than on prior.3.Limited cord compression protocol sequences obtained of the remainder of the thoracic and lumbar spine demonstrate no findings to suggest acute cord or acute cauda equina compression. There are however degenerative changes as described above with at least moderate spinal canal stenoses at L3-L4 to L5-S1 which appear worse since prior MRI from 9/21/2010. Dedicated thoracic and lumbar spine images can be obtained for more detailed evaluation as clinically indicated.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, 38 years old, with history of grade 2 oligodendroglioma status post radiation and chemotherapy. A region of T2 hypoerintensity involving the left frontal white matter and cortex with some cortical thickening is again seen. As on prior exams, the lesion shows central cystic degeneration. There has been no significant interval change in size or morphology. No pathologic enhancement is seen. Separate from the above described lesion, ill defined T2 hyperintensity in the periventricular white matter is unchanged and likely treatment related. No new areas of signal abnormality are seen. No significant mass effect or edema is detected. The ventricles maintain normal size and configuration. Thick enhancement along the right orbital roof is unchanged.", "output": "1.No change in the size or morphology of the treated left frontal lesion.2.Stable findings along the right orbital roof likely representing fibrous dysplasia."}
{"instruction": "Generate impression based on findings.", "input": "Back pain and fever. Lower extremity weakness. History of lung transplant. CERVICAL:There is sagittal straightening, which may reflect patient positioning. Vertebral body heights are preserved. There are fat-containing marrow lesions, most compatible with hemangiomas. There is mild multilevel disc desiccation in addition to height loss at C6-C7. Degenerative endplate changes are seen, most pronounced at C4-C5, where there is mild spinal canal stenosis. Even milder canal stenosis is present at the levels C3-C4 through C6-C7. The spinal cord shows normal signal. There is moderate-to-severe bilateral C3-C4 and bilateral C4-C5 neural foraminal stenosis with mild or mild-to-moderate bilateral C5-C6 and C6-C7 neural foraminal stenoses.THORACIC:Sagittal alignment is anatomic. The vertebral bodies are preserved in height and there is no suspicious marrow signal abnormality. There is mild upper thoracic disc desiccation and height loss. There is also mild right facet proliferative change at T10-T11 indenting the thecal sac. There is no significant disc protrusion. The spinal canal is preserved and the spinal cord is normal signal and morphology. Bilateral pleural effusion/thickening and pulmonary opacification are better assessed on the companion CT scan.LUMBAR:Sagittal alignment is anatomic. The vertebral bodies are preserved in height and there is no suspicious marrow signal abnormality. There is disc desiccation at L2-L3 through L4-L5 associated with mild disc height loss and a small bulge at L2-L3 and minimal height loss without significant bulge at the other 2 levels. Otherwise, the thecal sac is preserved. The conus medullaris tip is at L1-L2 level. The conus shows normal shape and signal.T12-L1 and L1-L2: No significant disc herniation. No spinal canal or neuroforaminal stenosis.L2-L3: There is a left paracentral disc extrusion which posteriorly displaces the traversing left L3 nerve root and causes mild left neural foraminal stenosis. There is mild-to-moderate facet arthropathy but no significant central spinal canal stenosis.L3-L4: There is a small disc bulge that is eccentric to the left along with bilateral facet arthropathy resulting in mild bilateral neural foraminal stenosis but no significant spinal canal stenosis.L4-L5: Severe right and mild-to-moderate left facet arthropathy along with a small disc bulge causing no significant central spinal canal stenosis and only mild left subarticular recess stenosis. There is also mild bilateral foraminal stenosis.L5-S1: There is no significant spinal canal or neural foraminal stenosis.", "output": "1.Multilevel cervical spondylosis causes mild spinal canal stenosis at C4-C5 and multilevel neural foraminal stenoses as described above.2.Thoracic spine shows minimal multilevel spondylosis but no spinal canal or neuroforaminal stenosis. 3.Relatively mild multilevel degenerative disease in the lumbar spine is most pronounced at L2-L3, where there is a left paracentral disc extrusion posteriorly displacing the traversing left L3 nerve root. Please correlate with left L3 radiculopathy.4.There is no abnormal spinal cord signal or compression. There is also no gross signs of spinal infection.5.Bilateral pleural effusion/thickening and pulmonary opacification are better assessed on the companion CT scan."}
{"instruction": "Generate impression based on findings.", "input": "40 year-old female with family history of breast carcinoma in her mother at age 69 and a paternal aunt. History of bilateral breast implants. Known left breast fibroadenoma. Heterogeneous fibroglandular tissue with marked background parenchymal enhancement is noted bilaterally. Bilateral retropectoral saline implants are identified. The implants demonstrate normal contour with no evidence for rupture. At the approximate 1:00 position of the left breast, posterior depth, there is a 1.0 cm intermediate signal intensity nonenhancing mass best seen on the T2 weighted sequence, corresponding to the benign morphology mass on recent ultrasound, likely the patient's known fibroadenoma. A nonenhancing cyst is present at the 6 o'clock position of the left breast.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "Benign morphology left breast mass, corresponding to the known left breast fibroadenoma. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with pain in left knee. Evaluate for medial meniscus tear. MENISCI: There is a complex tear of the posterior horn of the medial meniscus consisting of a large radial component as well as additional longitudinal tearing through the periphery of the posterior horn near its root. There is additional globular increased signal intensity within the body of the medial meniscus indicating intrasubstance degeneration and possible undersurface fraying. The anterior horn appears intact. There is slight medial extrusion of the body of the medial meniscus. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patella particularly involving the medial facet and median eminence with focal full-thickness degeneration centrally along the median eminence associated with underlying subchondral cyst formation. There is also moderate degeneration of the articular cartilage of the medial tibiofemoral compartment with a small full-thickness defects in the weightbearing cartilage. There is minimal edema in the underlying medial tibial plateau which we suspect is degenerative in etiology. The articular cartilage of the lateral compartment appears intact.LIGAMENTS: The cruciate and collateral ligaments are intact. There is mild edema along the superior band of the medial collateral ligament which could represent a mild sprain in the appropriate clinical context.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL", "output": "1. Complex tear of the medial meniscus.2. Osteoarthritic changes and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: brain metastasis, status post whole brain radiotherapy. There are several subcentimeter foci of abnormal supratentorial and infratentorial enhancement, which appear to be leptomeningeal in nature, perhaps with associated intraparenchymal extension with at least some of the lesions. The largest is located along the right prefrontal gyrus measuring approximately up to 9 mm. Additional subcentimeter foci of abnormal enhancement are present along the inferior right temporal lobe, anterior left temporal lobe, posterior left parietal lobe, and bilateral cerebellar hemispheres. There is no evidence of intracranial hemorrhage or acute infarct. There is confluent abnormal increased T2 signal within the periventricular white matter with additional focal areas of abnormal high T2 signal within the right frontal subcortical white matter, as well as the right posterior capsular region and corona radiata. There is also patchy high T2 signal within the pons, greater on the right. There are nonspecific punctate foci of susceptibility effect along the left sylvian fissure. There is mild cerebral parenchymal volume loss. The major cerebral flow voids are intact. There appears to be a small right sigmoid diverticulum. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "Multiple intracranial enhancing lesions suspicious for leptomeningeal metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Right hip pain Note that the examination is markedly limited by motion artifact as well as by the patient's body habitus.ACETABULAR LABRUM: There is a linear focus of increased signal intensity overlying the anterior labrum which is best seen on series 9 image 15. This is favored to represent artifact versus a true tear although given the extensive motion, this is unclear.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL", "output": "Focus of increased signal intensity within the anterior labrum which is favored to be artifactual in nature given the extensive motion artifact and poor signal of the study although a small tear in this area cannot entirely be excluded. There is no evidence of gross labral detachment."}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of brain, unspecified [C71.9] / Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: further eval of hemorrhagic mets History: metastatic cancer, worsened LE weakness Evolving multifocal bihemispheric mainly hemorrhagic lesions are seen on today's scan.Right thalamic and right hippocampal lesions' maximum measured diameter of each lesion appear to be decreased and there are evidence of peripheral hemosiderin deposition indicate evolving ICH.However, the right posterior temporal lesion shows development of cystic cavity adjacent to enhancing area the left superior temporal lesion appear to be increased in size since prior scan.There is interval development of right frontal burr hole with ventriculostomy tube inserted into the right lateral ventricle.There is no evidence of acute ischemic lesion.The ventricles, sulci and cisterns are unremarkable. 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. Some hemorrhagic lesions show MR characteristics of evolving ICH with interval decrease in size but some (right posterior temporal and left superior temporal lesions) demonstrate interval increase in size.2. No acute ischemic lesion.3. Stable ventricle size."}
{"instruction": "Generate impression based on findings.", "input": "Left forehead nodule: band like headaches. There is a lentiform fat signal lesion in the left lateral frontal scalp that measures up to 4 mm in thickness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is a partially empty sella. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and mastoid air cells are grossly unremarkable. There is a left maxillary sinus retention cyst.", "output": "1. Small left frontal scalp lipoma.2. Nonspecific partially empty sella, which may represent pseudotumor cerebri."}
{"instruction": "Generate impression based on findings.", "input": " There are multiple foci of restricted diffusion throughout the right cerebral hemisphere predominantly in the deep white matter but also including the right basal ganglia as well as the right precentral gyrus. Foci of restricted diffusion along the corpus callosum are also noted. Mild diffusion restriction is also seen in the left posterior frontal and left parietal lobes. There has been evolution of the previously seen infarcts from MRI from 1/27/2016 involving the left frontal lobe.There is FLAIR hyperintensity associated with the above-mentioned infarcts. There are scattered foci of susceptibility effect compatible with chronic blood products which are similar to prior, particularly along the right lateral ventricle margin with additional areas including the left subinsular region, right lateral thalamus, and few foci involving the right pons and cerebellum. There is also a background of moderate degree of periventricular and subcortical FLAIR hyperintensity which is nonspecific but compatible with chronic small vessel ischemic disease. There is no intracranial mass or mass effect. No hydrocephalus. There is diffuse opacification involving the sphenoid sinus with frothy secretions and fluid levels as well as bilateral mastoid air cell opacification, which may be related to intubation. Mild paranasal sinus opacification elsewhere.MRA HEAD", "output": "1. Multiple acute infarcts in the bilateral, but predominantly right, cerebral hemispheres as described above. There has also been evolution of previously seen left posterior frontal infarct. Background of moderate chronic small vessel ischemic disease also noted.2. There is high-grade stenosis or near occlusion involving the right internal carotid artery, new since prior CT angiogram 1/26/2016. Extent of residual flow can be better assessed with CTA if clinically indicated. There is also significant attenuation/decreased flow involving the right middle cerebral artery and its branches compared to the left.3. Scattered foci of chronic hemorrhage appear similar to prior, relatively more prominent in the right periventricular white matter."}
{"instruction": "Generate impression based on findings.", "input": " There is a small focus of increased diffusion signal on series 3 image 18 in the right hemipons with focally decreased ADC signal. This area shows very subtle abnormal T2 signal abnormality. There is mild nonspecific T2 hyperintense signal abnormality in the periventricular and subcortical white matter, as well as the brainstem likely representing chronic microvascular ischemic changes. There is mild global volume loss commensurate with patient age with bilateral hippocampal volume loss (right greater than left), and slightly greater volume loss in the right temporal lobe. There is no hydrocephalus. There is no midline shift or herniation. The left V3 vertebral artery flow void is diminutive suggesting stenosis vs hypoplasia. There is a small left maxillary sinus air-fluid level with trace bilateral mastoid mucosal thickening. The skull and extracranial soft tissues are unremarkable.", "output": "1.Small recent (acute/subacute) right hemipontine infarct.2.Mild global parenchymal volume loss with slightly greater involvement of the right temporal lobe and right hippocampus. 3.Mild chronic microvascular ischemic changes.The finding regarding infarct was discussed with Dr. Emma Daisy over the telephone at 3:19 p.m. today."}
{"instruction": "Generate impression based on findings.", "input": " Redemonstrated is a right parietal lobe enhancing nodule again measuring 10 x 11 mm. No other enhancing lesions are present.Postsurgical findings consistent with right parietal craniotomy and tumor resection are redemonstrated. Minimal curvilinear enhancement in the surgical bed appears similar to prior examination. Edema involving the parietal lobe is stable.No intra-axial or extra-axial fluid collections are visualized. The ventricles are normal in size. The basal cisterns are visualized. Small retention cysts are visualized in the left maxilla sinus. Partial opacification of the left mastoid air cells is redemonstrated.", "output": "Redemonstrated is a right parietal lobe enhancing nodule again measuring 10 x 11 mm. No other enhancing lesions are present."}
{"instruction": "Generate impression based on findings.", "input": " Limited exam due to patient inability to cooperate. Severe motion artifact.Scattered acute diffusion abnormality abnormality is seen in the right caudate and bilateral internal capsule, left greater than right. There is possible blood product adjacent to the right temporal lobe. Poor quality axial T2 images suggestive of suprasellar hemorrhage within the tumor, and less likely clots in the subarachnoid space.", "output": "Limited study. 1.Ischemic changes of the right caudate and bilateral internal capsule, left greater than right.2.Poor quality axial T2 images suggestive of suprasellar hemorrhage within the tumor."}
{"instruction": "Generate impression based on findings.", "input": "48 years, Male, new right posterior headaches since one week. There is extensive susceptibility artifact and distortion obscuring much of the right parietal, temporal, and occipital lobes, as well as the right posterior fossa. Visualized portions of the brain demonstrate no significant signal abnormality, intracranial mass, or mass effect. No midline shift or herniation. No hydrocephalus or extra-axial collections. Visualized calvarium and extracranial soft tissues are unremarkable.", "output": "Limited MRI of the brain as described above which was terminated due to extensive artifact. Visualized brain parenchyma demonstrates no evidence of intracranial mass effect or signal abnormality. If the hearing implant cannot be removed, CT may be helpful for visualizing the currently obscured areas in the brain. "}
{"instruction": "Generate impression based on findings.", "input": "Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: NSCLC brain mets hx. History: hx brain mets. Previously seen left anterior mesial temporal lobe nodular enhancing lesions with the susceptibility artifacts are seen and appear to be stable. However, due to different imaging of adjacent technique (currently 4 mm thickness on fat saturation T1 axial scan and 2 mm thickness on 3-D T1 postcontrast acquisition; the 3-D acquisition was acquired in 1 mm thickness on prior scan), precise interval evaluation is impossible.There is no other abnormal enhancement on this scan.Encephalomalacia with ex vacuo changes of left lateral ventricle of the left parietal lobe especially inferior parietal lobule are again seen, unchanged since prior scan.Left caudate nucleus and bilateral cerebellar hemispheric tissue losses indicate prior ischemic infarct are again seen, unchanged.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "1. Stable looking left mesial temporal lobe punctate enhancing foci since prior scan. However, the examination can be repeated without additional charge for precise evaluation.2. No new abnormal enhancing lesion on this scan.3. Unchanged postoperative changes of the left parietal lobe lesion and chronic ischemic infarctions on the left caudate and bilateral cerebellar hemispheres.4. No acute ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: pain History: pain ROTATOR CUFF: There is a full-thickness tear of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 18 mm in the AP dimension. There is minimal retraction. There is extension of this tear posteriorly to involve the anterior fibers of the infraspinatus. There is mild fatty atrophy of the supraspinatus. The infraspinatus muscle appears intact. There is thickening and intermediate signal intensity of the supraspinatus indicating mild tendinosis. There is increased intermediate signal intensity within the articular surface fibers of the subscapularis at the level of its insertion which may represent focal tendinosis or undersurface fraying. No full-thickness tear is evident. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Additionally note is made multiple round foci of decreased signal abnormality within the bursa on both T1 and T2-weighted images corresponding to the foci of ossification seen in recent radiographs. These findings likely represent loose bodies, with the largest measuring 14 mm in its largest diameter, situated along the anterior aspect of greater tuberosity. Mild osteoarthritis affects the acromioclavicular jointGLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Mild osteoarthritis affects the glenohumeral joint.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the joint versus a very mild tenosynovitis. ADDITIONAL", "output": "Full-thickness tear of the rotator cuff with minimal retraction. Multiple loose bodies within the subacromial subdeltoid bursa as described above. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Prostate cancer. Abnormal bone scan findings. The images and the official report of the whole body bone scan performed at outside hospital are not available. The clinical note indicates bone scan shows questionable abnormalities in the lower spine and also a pelvic node measuring 2cm in size.The study quality is mildly degraded by motion.CERVICAL SPINE:Alignment is anatomic accounting for straightening. Vertebral bodies are preserved in height. Marrow signal is notable for mild degenerative change subjacent to the endplates, most pronounced at C5-C6 through C7-T1 which is also associated with mild-to-moderate disc height loss. There is also edema like marrow signal involving the left sided articulating pillars at L2-L3 which is probably related to facet arthropathy. There is no suspicious marrow lesion. The cervical spinal cord shows normal signal and only very minimal ventral flattening by the C4-C5 degenerative disc-osteophyte complex. There is hyperostosis/enthesopathy at the occipital attachment of the ligamentum nuchae.C2-C3: Minimal disc-osteophyte complex and moderate left and mild right facet arthropathy, causing minimal left neuroforaminal stenosis. Left facet arthropathy is associated with marrow edema in the corresponding left articulating pillars. No significant spinal canal or right foraminal stenosis.C3-C4: Minimal disc-osteophyte complex and mild uncovertebral and facet arthropathy. No significant spinal canal or foraminal stenosis.C4-C5: Disc-osteophyte complexes associated with a narrow based central disc protrusion/spurring minimally indenting the ventral aspect of the spinal cord without abnormal cord signal. Mild facet arthropathy with no significant foraminal stenosis.C5-C6 and C6-C7: Disc-osteophyte complex is eccentric to the right but no significant spinal canal stenosis. Mild-to-moderate facet and uncovertebral arthropathy contribute to mild bilateral foraminal stenosis.T7-T1: No significant spinal canal or foraminal stenosis.THORACIC SPINE:Alignment is anatomic. Vertebral bodies are preserved in height and there is no suspicious marrow abnormality. Areas mild disc height loss in the mid thoracic spine associated with a small disc-osteophyte complexes as described below. The spinal canal is otherwise fairly preserved. The thoracic spinal cord shows normal signal and shape. Focal T2-hyperintensity and contrast enhancement just adjacent to the left spinolaminar junction at T3-T4 level on sagittal imaging (image #18) is related to a vessel. A 9 mm well-circumscribed, T2-hyperintense, mildly T1-hyperintense lesion within the skin and T8-T9 level to the left of midline is most likely a sebaceous cyst.T1-T2: Minimal disc-osteophyte but no spinal canal or foraminal stenosis.T2-T3: No spinal canal or foraminal stenosis.T3-T4 and T4-T5: Minimal disc-osteophyte but no spinal canal or foraminal stenosis.T5-T6: Broad-based left paracentral disc protrusion but no significant spinal canal or foraminal stenosis.T6-T7: No spinal canal or foraminal stenosis.T7-T8: Narrow based central disc protrusion mildly narrows the spinal canal. No foraminal stenosis.T8-T9, T9-T10, T10-T11 and T11-T12: No significant disc herniation. No spinal canal or foraminal stenosis.LUMBAR SPINE:Alignment is notable for 7 mm of anterior subluxation of L5 relative to S1 associated with bilateral chronic appearing pars interarticularis defects. There is also lumbar straightening which may relate to patient positioning. The vertebral bodies are preserved in height. Marrow signal shows no suspicious focality. Mild degenerative marrow change is present subjacent to the L2-L3 and, to a lesser extent, L1-L2 endplates anteriorly. There is also edema like signal involving the marrow of the left L4 articulating pillar, which is probably reactive to facet arthropathy. Small Schmorl node is present along the inferior endplate of L2 also with minimal associated subjacent marrow change. Moderate size anterior osteophytes are present at L2-L3. The tip of the conus medullaris is at the upper most L2 level. The conus medullaris and included coronal part of the spinal cord show normal signal and shape.T12-L1: No disc herniation. Mild facet arthropathy. No spinal canal or foraminal stenosis.L1-L2 and L2-L3: Minimal disc bulge but no spinal canal or foraminal stenosis.L3-L4: Disc bulge flattens the ventral aspect of the thecal sac. Moderate facet arthropathy and mild ligamenta flava thickening. There is mild narrowing of the subarticular recesses but no nerve displacement and no central spinal canal stenosis. No significant foraminal stenosis.L4-L5: Disc bulge and severe bilateral facet arthropathy (with a small synovial cyst arising from the dorsal aspect of the left facet) cause no significant spinal canal stenosis but mild-to-moderate left and mild right foraminal stenoses. Edema like signal involving the marrow of the left articulating pillar is probably reactive to facet arthropathy. L5-S1: Spondylolisthesis and anterior subluxation are associated with anteroposterior elongation of the spinal canal. Severe facet arthropathy, associated with minimal effusion, results in moderate transverse spinal canal stenosis and moderate biforaminal stenosis. In addition to disc and covering by the subluxation, there is a tiny right paracentral disc protrusion with coronal migration which abuts the traversing right S1 nerve root.", "output": "1.The study is mildly motion degraded.2.There is no definite, destructive spinal osseous metastasis. Foci of edema-like marrow signal abnormality subjacent to the endplates, as described above, are most likely degenerative in nature. Also, similar signal abnormality involving the left L4 as well as the left C2-C3 articulating pillars is probably reactive to facet arthropathy.3.L5-S1 spondylosis and anterior subluxation along with severe facet arthropathy are associated with moderate transverse spinal canal and biforaminal stenoses. Tiny right paracentral L5-S1 disc protrusion abuts the right S1 nerve root. Please correlate with right S1 radiculopathy.4.There is no spinal cord signal abnormality."}
{"instruction": "Generate impression based on findings.", "input": "31 years Female (DOB:9/6/1985)Reason: history of optic chiasm glioma History: history of glioma very subtle right inferior homonymous with no change when compared to fields from 2001. Optometrist noted pallor in the left optic disc.PROVIDER/ATTENDING NAME: JEFFREY W. NICHOLS JEFFREY W. NICHOLS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There is no evidence for recurrence of the chiasmatic or optic nerve glioma."}
{"instruction": "Generate impression based on findings.", "input": "History of pancreatitis and pseudocyst in the past. Recently noted fluid collection status post IR drain. Evaluate for pancreatic duct leak. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity without a focal suspicious lesion. Status post cholecystectomy. The common bile duct measures 8 mm, likely related to postcholecystectomy state. It tapers smoothly distally. There is suboptimal contrast opacification limiting evaluation of the vasculature.SPLEEN: Perisplenic high T2-weighted signal intensity fluid collection measuring approximately 2.8 x 2.5 cm, not significantly changed in size from recent CT. Note is made of the gastro-cystostomy tract (series 601/26) which appears to communicate with the collection.PANCREAS: There are peripancreatic inflammatory changes. Long segment stricture of the main pancreatic duct extending from the body to the tail with mild upstream dilatation at the distal tail measuring 4 mm, similar in appearance to the prior. This dilated duct may communicate with the perisplenic pseudocyst although this is not definitively demonstrated. Note is made of the gastrocystostomy tract (series 601/24). There is a very small peripancreatic pseudocyst measuring 9 x 8 mm at the level of the pancreatic body (series 701/26), unchanged.Due to suboptimal contrast opacification evaluation for pancreatic necrosis is suboptimal.Following secretin administration there is a mild excretory response of the pancreas with fluid filling the proximal duodenum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: In the anterior pararenal space abutting the lateral chest wall there is a 2.9 x 1.4 cm fluid collection, slightly decreased from the prior study with drainage catheter noted extending to the subcutaneous soft tissues where there is mild induration.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Compared to the recent CT the perisplenic fluid collection is essentially unchanged and the left anterolateral pararenal space fluid collection is slightly decreased in size with drainage catheter in place.2.Persistent main pancreatic duct stricture with distal ductal dilatation. The pancreatic duct at the level of the tail may communicate with the perisplenic fluid collection but this is not definitive. The perisplenic collection does appear to communicate with the gastrocystostomy tract."}
{"instruction": "Generate impression based on findings.", "input": "Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: r/o stroke History: left side arm heaviness, left side hearing loss There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is focal tissue loss on the left frontal periventricular white matter with T2/FLAIR high signal intensity.There is no evidence of abnormal enhancement.Scattered couple FLAIR high signal intensity lesions on bilateral white matter are non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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.2. No abnormal enhancement.3. Focal tissue loss on the left frontal periventricular white matter."}
{"instruction": "Generate impression based on findings.", "input": "14-year-old male with trisomy 16 and hypoplastic dislocated shoulder.IMAGE ACQUISITIONS: CT of both shoulders without contrast enhancement processed in transverse, sagittal, and coronal planes. Left shoulder: As seen on prior radiographs, there is a deformed, angulated scapula with a dysplastic, shallow, and retroverted glenoid. The articular surface of the glenoid is essentially parallel to the axis of the medial aspect of the scapular body. The humeral head articulates with the glenoid, but appears slightly anteriorly subluxed. The coracoid process extends directly anteriorly from the dysmorphic neck of the scapula, resulting in a coracohumeral interval of over 2cm As seen on radiographs, the acromion is elongated and courses anterosuperiorly in relation to the humeral head. There is a linear lucency that partially traverses the acromion and has adjacent sclerosis; we are uncertain if this is an additional developmental defect or a stress fracture. The distal end of the clavicle is located superior to the ossification center of the acromion process.Right shoulder: There is a similar abnormal morphology to the right shoulder with a shallow, dysplastic, and retroverted glenoid that articulates with the humeral head. There is a small bone fragment along the posterior lip of the glenoid that may be posttraumatic in etiology. As with the left shoulder, the coracoid extends directly anterior from the scapular neck. The distal clavicle lies superior to the ossification center of the acromion.The spine is incompletely visualized, however, there is levoscoliosis of the cervicothoracic spine. Please refer to spine MRI for further spine report.", "output": "Bilateral shoulder abnormalities as described above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of seizures with fever, please eval for structural abnormality History: complex febrile seizure vs partial seizure with fever No abnormal signal is seen on the diffusion weighted images. Increased periventricular white matter T2 hyperintensity is noted. Small focus of T2 hyperdensity is also noted left parietal lobe subcortical white matter. There is a linear FLAIR signal extending from the white matter to the cortex of the right cerebellar hemisphere not seen on any other MRI sequence. This is nonspecific but a developmental venous anomaly is suspected. This may be better detected on enhanced imaging.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. The ventricles are slightly large. The basal cisterns are normal in size and configuration. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.", "output": "1.Abnormal periventricular T2 signal and mild ventriculomegaly is nonspecific and may represent periventricular leukomalacia and less likely an underlying metabolic disease. Correlation with the patient's history is recommended.2.Linear FLAIR signal extending from the white matter to the cortex of the right cerebellar hemisphere is nonspecific but a developmental venous anomaly is suspected. This may be better detected on enhanced imaging.Findings paged to Dr. Cook at 1119 on 3/21/15. "}
{"instruction": "Generate impression based on findings.", "input": "Female 8 months old with hypotonia and global developmental delay, rule out structural anatomical abnormality Exam is mildly motion degraded. There is mildly diminished volume of the supratentorial white matter, which is particularly more prominent in the bilateral periatrial regions. There is mild associated prominence of the ventricles without hydrocephalus. There is normal myelination and sulcation. There is no evidence of intracranial hemorrhage, mass, acute infarct, or other focal signal abnormalities. There is no midline shift or herniation. The major cerebral flow voids are intact. Orbits, sella, and extracranial soft tissue structures are grossly unremarkable.", "output": "Mildly diminished supratentorial white matter volume. Otherwise, no focal structural abnormalities are appreciated."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with chronic abdominal pain, diarrhea, elevation of inflammatory markers 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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.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": "No specific findings to account for the patient's symptoms. Small and large bowel appear within normal limits."}
{"instruction": "Generate impression based on findings.", "input": " Limited evaluation of the cervical spine with sagittal T1 and STIR sequences per cord compression protocol demonstrates evidence of diffuse metastatic disease. No compression fractures. No obvious epidural tumor. No evidence of cord compression.THORACIC SPINE", "output": "1. Diffuse osseous metastatic disease in the cervical, thoracic, and lumbar spine. 2. There are multiple compression fractures throughout the thoracic and lumbar spine with osseous retropulsion and epidural tumor as detailed above. Findings are worst at the T6 level where there is impression and deformity of the thoracic cord related to retropulsion and epidural tumor. No associated cord signal abnormality. Mild spinal canal narrowing is seen at T8, T9, T12 and L3. Allowing for differences in technique, osseous retropulsion and spinal canal narrowing appears similar to prior CT from 10/29/2014.3. Epidural tumor extending into the neural foramina is seen at multiple levels, relatively more prominent at the T6-T7, T12-L1 levels as well as the left L3-L4 level."}
{"instruction": "Generate impression based on findings.", "input": "14-year-old female with history of embryonal rhabdomyosarcoma of the cervix, 8 months off therapy. Evaluate for signs of recurrent disease. The uterus is normal. The ovaries are not visualized similar to prior exam. Again seen are 2 tiny round areas of low signal intensity within the vagina unchanged. Nonspecific T2 hyperintensity of the vaginal introitus and labia persists and appears unchanged. There is persistent enhancement of the vaginal mucosa. Small amount of free pelvic fluid unchanged.Slightly increased T2 signal in the symphysis pubis is unchanged.", "output": "No evidence of disease recurrence. Otherwise no significant interval change from prior exam."}
{"instruction": "Generate impression based on findings.", "input": "76 year old man with bioprosthetic AVR and CABG. Referred to assess for change in ascending aorta dilation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 166 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19), the LV mass index is 31 g/m2 (normal range 85+/-15), and the LV mass is 60 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a transmural area of late gadolinium enhancement in the basal inferior and inferolateral walls. The pattern is consistent with prior myocardial infarction. These segments are not likely to be viable. There is no evidence of other late gadolinium enhancement and the remainder of the myocardium is viable. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 72 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveA bioprosthetic valve is noted in the aortic position. Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta is aneurysmal (fusiform). The dimensions are:Ascending aorta: 46x41mmProximal Arch: 34x34mmMid Arch: 30x33mmDescending Aorta: 29x27mmPulmonary 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 FindingsSternal wires are noted, surgical bypass clips are noted. Elevated right hemi-diaphragm with colonic interposition between the diaphragm and liver as an anatomic variant. 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. Normal left size with normal systolic function (LVEF 55%) with evidence of a transmural myocardial infarction involving the basal inferior and inferolateral walls.2. Normal right ventricular size and systolic function (RVEF 53%).3. Ascending aortic aneurysm with a maximum diameter of 46mm, which is slightly larger when compared to the CMR study from 1/14/2015. 4. Bioprosthetic aortic valve noted. 5. See extra-cardiac findings. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Soft tissue mass fifth digit left foot History: left foot pain Severely limited examination secondary to extensive patient motion artifact. The examination was terminated early due to the patient's inability to further tolerate the examination per the technologist note. A skin marker was placed over the dorsal aspect of the proximal phalanx of the fifth digit of the left foot. Note is made of multiple foci of decreased signal abnormality along the dorsal and lateral aspect of the proximal phalanx of the fifth digit of the left foot which correspond to the foci of calcification seen on recent radiographs. There is also diffuse bone marrow signal abnormality within the proximal phalanx of the fifth digit and head of the fifth metatarsal which is nonspecific. There is fluid within the fifth MTP joint indicating a mild synovitis. No definite erosions are identified. There is a small amount of fluid within the first MTP joint. There is deformity of the proximal phalanx of the fourth toe likely reflecting prior remote trauma.", "output": "Limited examination demonstrating nonspecific bone marrow signal abnormality within the fifth metatarsal head and proximal phalanx of the fifth digit with foci of calcification in the overlying soft tissues. These findings are incompletely characterized and nonspecific but may represent the sequela of gouty arthropathy, avascular necrosis, prior trauma, or infection/osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": " Brain MRI:The left AICA is visualized coursing in close proximity to and may be in contact with the cisternal portion of the left facial nerve but evaluation is limited by motion. The left AICA does not appear to enter the left porus acusticus. There is no gross evidence of a mass or abnormal enhancement of the visualized cranial nerves, including the trigeminal or facial nerves.The ventricles and sulci are normal in size. There are no mass effect or midline shift. No DWI abnormalities are identified. There are no extraaxial fluid collections. Scattered mild periventricular and subcortical T2/FLAIR hyperintensities are noted likely from the sequelae of mild chronic small vessel ischemic disease.Brain MRA:There is antegrade flow within the distal bilateral vertebral arteries, the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. Note is made of a normal variant dominant left vertebral artery, Hypoplastic right ACA, small right PComA and nonvisualized left PComA. No arterial stenoses, occlusions or aneurysms are identified.", "output": "The left AICA incidentally courses in close proximity to and may contact the cisternal portion of the left facial nerve but full evaluation is limited by motion. No mass or abnormal enhancement is noted along the trigeminal or facial nerve distribution, within significant limitations of patient motion. Unremarkable MRA head."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status, AIDS (CD4 6), evaluate for mass or stroke or signs of CNS infection. Please note lack of contrast limits the evaluation for infection. However, there is no evidence of intracranial mass, abscess or empyema. There are patchy and scattered bilateral cerebral white matter T2/FLAIR hyperintensity which are nonspecific, likely relating to small vessel ischemic changes. There is a small focus of T2/FLAIR signal in the right middle cerebellar peduncle abutting the fourth ventricle, which is not well evaluated without intravenous gadolinium, which is nonspecific and may also be related to prior ischemia. There are small foci of susceptibility in the left frontal lobe as well as along the wall of the left lateral ventricle compatible with chronic microhemorrhages and are nonspecific in distribution. 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. There is aerated secretion in the sphenoid sinuses, as well as mucus retention cysts in the bilateral maxillary sinuses. There is trace fluid in the bilateral mastoid air cells. The bone marrow signal is diffusely heterogeneous which is nonspecific.", "output": "1. Lack of contrast limits evaluation for intracranial infection. There is however no evidence of mass, abscess, or empyema.2. Scattered nonspecific cerebral T2/FLAIR white matter lesions are nonspecific, but most compatible with mild chronic small vessel ischemic disease. Small focus of T2/FLAIR hyperintensity along the right middle cerebellar peduncle abutting the fourth ventricle may also be related to the same but not well evaluated without contrast and remains nonspecific. If there remains suspicion for intracranial infection, consider post gadolinium sequences if renal function improves or lumbar puncture for further evaluation.3. Diffuse heterogeneity of the bone marrow signal is nonspecific. No frank osseous destructive lesions are seen."}
{"instruction": "Generate impression based on findings.", "input": "Other disorders of psychological development [F88] / Other symptoms and signs involving the musculoskeletal system [R29.898], Reason for Study: ^Reason: Please evaluate for abnormality to explain hypotonia, or for Chiari History: Global developmental delay. No evidence of acute ischemic or hemorrhagic lesion.No evidence of intra-axial or extra-axial mass lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "No evidence of acute ischemic or hemorrhagic lesion.No mass lesion.No evidence of Chiari malformation."}
{"instruction": "Generate impression based on findings.", "input": "Elevated PSA. Negative prior biopsies. PELVIS:PROSTATE:Prostate Size: 6.1 x 6.5 x 7.9 cm.Peripheral Zone: The peripheral zone is diffusely thinned. In the medial mid gland there is a 5 x 5 mm round focus of subtle T2-weighted hypointensity without associated restricted diffusion or enhancement, low suspicion. No suspicious focal lesion in the peripheral zone. Central Gland: Marked benign prostatic hyperplasia without a discrete suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No dominant suspicious lesion evident. 2.Marked BPH."}
{"instruction": "Generate impression based on findings.", "input": "Pain. Suspect medial meniscus injury. MENISCI: There is a small undersurface tear at the posterior horn of the medial meniscus. The lateral meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: There is mild chondral softening at the medial facet of the patella, without full-thickness defect or underlying bone marrow reactive changes. There is a full thickness defect with underlying bone marrow reactive changes at the deep flexion portion of the medial femoral condyle. The remainder of the cartilage and bone marrow is unremarkable.LIGAMENTS: The cruciate and collateral ligaments are intact and unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Small undersurface tear of the posterior horn of the medial meniscus.2. Focal areas of chondromalacia, as above."}
{"instruction": "Generate impression based on findings.", "input": " Redemonstrated is near-complete compression deformity of T12 centrally and anteriorly with retropulsion of fragments posteriorly abutting the distal thoracic cord causing anterior flattening, however without cord compression. These findings are unchanged when compared to the 2008 MRI.There are no acute fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: Unremarkable and unchangedL2/3: Mild disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy which appears similar although there is new mild right lateral recess stenosis.L3/4: Mild disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There are no stenoses. These findings are unchanged.L4/5: Grade 1 anterolisthesis L4 on L5, asymmetric bulge to the right with disc uncovering, ligamentum flavum thickening, severe bilateral facet hypertrophy, and small bilateral facet effusions. There is severe central, severe bilateral lateral recess, and moderate bilateral neural foraminal stenosis which have progressed.L5/S1:Unremarkable and unchanged", "output": "1.L2/3: New mild right lateral recess stenosis.2.L4/5: Severe central, severe bilateral lateral recess, and moderate bilateral neural foraminal stenosis, which have progressed."}
{"instruction": "Generate impression based on findings.", "input": " There is a large right-sided chest wall mass just anterior to the manubrium and sternum which is incompletely imaged, and seen on prior PET/CT to represent metastasis. Additionally, there is partial visualization of a larger right lateral chest wall mass.There is moderate to severe motion artifact which significantly limits evaluation. While there are are multiple enlarged lymph nodes in the right subpectoral region and axilla, with the largest lymph node in the right infraclavicular fossa measuring 16 x 10 mm. There is no significant mass-effect or compression of the brachial plexus/neurovascular bundle suspected however the branches of the right brachial plexus appear to course into the large lateral right chest wall mass.There is mild cervical spondylosis.", "output": "1.Moderate to severe motion artifact limited examination with no evidence for right brachial plexus compression. However the right brachial plexus branches appear to course into the area of the large right lateral chest wall mass.2.Large right-sided chest wall masses partly imaged, consistent with metastases. Also lytic left manubrial metastasis."}
{"instruction": "Generate impression based on findings.", "input": " Dedicated images through the sella demonstrate a slightly enlarged bony sella which is CSF density filled consistent with partially empty sella as there is minimal enhancing pituitary tissue along the floor identified. This appearance is stable since prior MRI from August 2015. No focal abnormal signal intensity or mass is seen within the pituitary gland. The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.Left Meckel's cave is slightly larger than the right, likely normal variant. Minimal fluid is also seen along the left inferior meatus.There is mild mucosal thickening in the visualized left maxillary sinus.", "output": "Stable appearance of slightly enlarged bony sella (which may been referenced on the outside sinus CT), with partially empty appearance and therefore no enlargement of the pituitary gland itself, as questioned. This appearance is stable since August 2015 and is most often an incidental finding especially in the setting of other prominent subarachnoid spaces as noted in this patient, although the finding can be associated with pseudotumor cerebri. "}
{"instruction": "Generate impression based on findings.", "input": "Female 24 years old Reason: 24 y/o with recent diagnosis grade II endometrial cancer History: vaginal bleeding PELVIS:UTERUS, ADNEXA: The uterus measures 8.0 x 4.3 x 5.6 cm. The endometrial thickness is 2.1 cm. On the early postcontrast phase of imaging, there is subtle post contrast heterogeneous perfusion involving the right anterolateral aspect of the myometrium adjacent to the tumor. This normalizes on the more delayed phase of imaging. There is some heterogeneous loss of the junctional zone involving the posterior fundal aspect of the uterus likely representing areas of focal myometrial lesion.Tumor also extends into the lower uterus to the level of the internal cervical os.. No evidence of parametrial extension.Right ovary is normal. Left ovary has a fat containing mass measuring 5.4 x 5.1 cm on image 85/series 1103. Imaging features are compatible with dermoid cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Endometrial tumor as detailed above.2.5.4 cm left ovarian dermoid."}
{"instruction": "Generate impression based on findings.", "input": "Developmental delay and lack of expected normal physiological development in childhood. The cortical sulci are in proportion to the cerebral ventricles. Prominent perivascular spaces are demonstrated in the bilateral parietal lobes, right greater than left. No midline shift or mass effect is appreciated. The gray-white matter junction is preserved. There is no diffusion restriction to suggest acute ischemia. No abnormal gradient susceptibility is demonstrated. No intra-axial or extra axial fluid collections are visualized. Myelination appears appropriate for age.", "output": "Prominent perivascular spaces in the bilateral parietal lobes, right greater than left, are nonspecific and may be an incidental finding. However rounded appearance of some especially can be associated with mucopolysaccharidosis. Please correlate clinically."}
{"instruction": "Generate impression based on findings.", "input": "Female 54 years old Reason: Left shoulder rotator cuff tear History: Left shoulder pain ROTATOR CUFF: Supraspinatus tendinopathy, with no discrete rotator cuff tear identified.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "Supraspinatus tendinopathy with no discrete rotator cuff tear. Large joint effusion."}
{"instruction": "Generate impression based on findings.", "input": "A 55 male with paroxysmal atrial fibrillation s/p ablation, family history of premature coronary artery disease. In 2010 because of atypical symptoms the patient was catheterized and found to have non-obstructive coronary artery disease. In 6/2015 he had another catheterization because of similar symptoms and was found to have an ostial left main stenosis of 40-50% with non significant FFR and minimal lumen area of 8mm2. The patient was referred to cardiac MRI for follow up.MEDICATIONS: rivaroxaban, Lipitor, lisinopril First Pass PerfusionDuring hyperemia, no perfusion defects were present. A mild dark rim artifact is noted.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 208 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 87 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 106 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 82 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 trace pericardial effusion.Extracardiac FindingsMild thyroid enlargement. 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. No perfusion defects/ \"ischemia\" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 58%).4. Normal RV size and systolic function (RVEF 60%).5. Mild 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": "18 years old patient. Assess for postop bleed craniotomy in 11/19. The patient is status post left frontal craniotomy appeared and there is an extra-axial hemorrhagic fluid collection of present underneath the craniotomy flap with a fluid fluid level associated some air bubbles. It is adjacent to the high convexities and measures approximately 9 mm in thickness comparedA 1 cm hyperdense focus is present adjacent to the right chest appear frontal gyrus which has an extra-axial location. It was present on the MRI of 11/17/09.There is vasogenic edema present where the patient's known mass was paired this is edema pattern is stable since 11/19/09 MRI. There is some mass effect associated.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Status post left frontal craniotomy for tumor surgery.2.There is a left-sided subdural hemorrhagic fluid collection present with some mild mass effect apparent3.A 7mm extra-axial hyperdense focus is present adjacent to the right superior frontal gyrus. This could represent a small meningioma."}
{"instruction": "Generate impression based on findings.", "input": "Primary CNS lymphoma. Status post chemotherapy and stem cell transplant. Worsening right ocular ptosis. There is no acute infarct or acute intracranial hemorrhage. The confluent and patchy T2-hyperintense signal involving the periventricular and deep cerebral white-matter is not significantly changed since the previous examination. Similar involvement is present in the lateral aspect of the left cerebellar hemisphere. The frontal horn of the right lateral ventricle remains small while the remainder of the ventricular system as well as the other CSF-containing spaces remain enlarged reflecting underlying brain volume loss. There is no contrast-enhancing or space-occupying brain lesion. The cavernous sinuses are symmetric and the Meckel's caves are preserved. There is no abnormal leptomeningeal enhancement.There is mild anterior ethmoid sinus mucosal thickening. There are changes of previous bilateral cataract surgery but the orbits are otherwise unremarkable. There is no definite destructive skull lesion.", "output": "1.There is no new intracranial contrast enhancement or mass to suggest tumor recurrence.2.There is no acute infarct or intracranial hemorrhage.3.Unchanged brain white-matter abnormality perhaps representing a combination of sites of prior lymphomatous disease and some superimposed posttreatment change or chronic microvascular ischemia."}
{"instruction": "Generate impression based on findings.", "input": "63 years Male (DOB:3/25/1953)Reason: metastatic hnc History: metastatic hncPROVIDER/ATTENDING NAME: VASSILIKI SALOURA VASSILIKI SALOURA There is an extra-axial mass which involves the superior sagittal sinus posteriorly measuring approximately 68 x 15 x 24 mm. Inferiorly the torcula appears to be patent.There is a 4 mm enhancing focus present in the right cerebellar hemisphere. There is a 5 mm enhancing focus present in the right temporal lobe adjacent to the temporal horn of the left lateral ventricle. There is a 7 mm enhancing focus present in the left medial occipital lobe contiguous with the above described lesion. There is a punctate enhancing focus present in the left parietal lobe subcortical white matter. There is a punctate focus of enhancement along the right occipital lobe cortex. There is enhancing tissue behind the adjacent occipital calvarium associated with intervening loss of marrow signal suggesting that this mass extends through the occipital bone into the adjacent subcutaneous tissues.The cerebellum appears to be somewhat atrophic in appearance.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There is a mass involving the distal aspect of the superior sagittal sinus which has enlarged relative to prior exams. It appears to be associated with occlusion of the superior sagittal sinus. The lesion appears to extend through the adjacent occipital bone and infiltration into the adjacent subcutaneous tissues behind the occipital bone. MR or CT venography would help confirm the occlusion of the superior sagittal sinus. It appears not to have been present in October 2015 to the extent of visualization possible. Differential considerations include metastases, meningioma, lymphoma, granulomatous lesion as well as other neoplasms potential involving superior sagittal sinus. Given findings suspicious for brain metastases metastasis would be high on the differential.2.There are multiple lesions scattered in the cerebellum and supratentorial brain which are suspicious for metastatic disease. These are not readily appreciated on the prior CT exams.3.Cerebellar atrophy4.Examination is degraded due to patient motion artifact which may obscure more subtle abnormalities.5.An email was sent to Dr Saloura at the time of this dictation."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with family history of HCC and liver lesion seen on outside hospital imaging. ABDOMEN:LIVER, BILIARY TRACT: Small right hepatic lobe cysts. No suspicious hepatic lesions. Status post cholecystectomy. No biliary ductal dilation.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Macro clinical ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is a mildly T2 hyperintense mass at the Klatskin point that measures 7.2 x 5.5 cm. This obstructs the biliary tree causing severe intrahepatic biliary ductal dilatation. At the periphery of the liver especially in the left lobe there are multiple T2 hyperintense cystic foci that show restricted diffusion and are suspicious for hepatic abscesses. There are other lesions in the liver that are mildly T2 hyperintense and is suspicious for metastatic disease.Patent vessel flow voids are present within the main portal vein indicating patency.Gallbladder contains multiple gallstones and is mildly distended. The gallbladder neck is obstructed by the Klatskin mass. There are trapped gallstones in the gallbladder neck.Distal common bile duct is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology without pancreatic ductal dilatation. No focal pancreatic mass is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Upper abdominal small bowel is not distended.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild upper abdominal ascites.", "output": "1.Findings of a large mass at the Klatskin point with severe intrahepatic biliary ductal dilatation suspicious for a cholangiocarcinoma.2.Multiple cystic foci in the periphery of the liver near the dilated bile ducts most suspicious for hepatic abscesses.3.Scattered other lesions in the liver suspicious for metastatic disease.4.Cholelithiasis with gallbladder distention.5.Findings discussed with Dr. Wali at 11:40am by the radiology resident on call "}
{"instruction": "Generate impression based on findings.", "input": "Acute mental status changes x 1 week There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Areas of subcortical and periventricular white matter hypodensity indicate small vessel ischemic disease of indeterminate age. If there is concern for an acute stroke, an MRI may be considered for further evaluation.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": "Small vessel ischemic disease of indeterminate age. No acute intracranial findings."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with abnormal LFTs. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Severe cirrhotic morphology is again noted. No evidence of arterially enhancing and washing out lesions. The common hepatic artery, hepatic veins, main portal vein, left and right portal veins are patent.SPLEEN: Splenomegaly.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: Large-volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right and moderate left pleural effusions.", "output": "1.Severe cirrhosis without any suspicious arterially enhancing and washing out lesions to suggest hepatocellular carcinoma.2.Large volume ascites.3.Small right and moderate-sized left pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Female, 73 years old, with history of recurrent ovarian cancer and worsening right low back pain. Assess for spinal metastases, osseous abnormality, or disc abnormality. Spinal alignment is anatomic. Vertebral body heights are preserved. Uniform fatty marrow replacement from L2 down is likely related to radiation therapy.Schmorl's nodes are seen along the L3-4 endplates. More anteriorly along the L3 inferior endplate, there is a T1 hypointense, T2 heterogeneous mildly enhancing lesion which is nonspecific. Mild associated sclerosis is seen on prior CTs dating back at least to 2/19/2014.Aside from these findings, no other concerning areas of marrow signal abnormality are detected.The visualized spinal cord, conus and cauda equina are unremarkable. No pathologic intraspinal enhancement is suspected.Mild loss of disc height affects L3-4 and L4-5. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild bulging disc with a superimposed right foraminal protrusion. No significant generalized spinal canal stenosis. Moderate right foraminal narrowing. L3-4: Mild bulging disc. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Marked right facet hypertrophy. Mild left facet hypertrophy. Ligamentum flavum thickening. Mild laterally bulging disc. No significant spinal canal stenosis. No significant neuroforaminal narrowing. A right retrocrural pathologic lymph node is identified. Left renal pelvocaliectasis is also redemonstrated.", "output": "1.No definite evidence of spinal metastatic is seen. A nonspecific lesion within the anterior aspect of the L3 vertebral body showing heterogeneous T2 signal characteristics and mild enhancement seems to have been present at least as far back as early 2014. This could represent a benign lesion such as a hemangioma. Given the history of malignancy, though, at least one follow-up exam demonstrating stability would be reassuring.2.A disc herniation at L2-3 on the right causes a moderate narrowing of the right neural foramen.3.Marked right facet arthropathy is seen at L5-S1.4.No areas of high-grade spinal canal or foraminal stenosis are seen."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for spinal cord infarct. Signs and symptoms: 9-year-old male with history of epidural lipomatosis, status post T3 -- T8 laminectomies now with bilateral leg paralysis. Pre-and post-enhanced cervical and thoracic MRI:Examination demonstrates increased T2 signal intensity and caliber of the cord extending from C5 inferiorly through the entire thoracic cord and reaching the conus consistent with extensive cord edema. The signal abnormality of the cord is more centrally located which is suggestive of an ischemic process. There is subtle inhomogeneity of the signal intensity of the cord. Although there is no distinct signal changes of acute bleed, possibility of minimal petechial hemorrhage however cannot be entirely excluded.Post-infused images demonstrate very faint patchy foci of suspected enhancement within the cervical and lower thoracic cord. This finding likely reactive and may represent leakage of contrast from the vasculature rather than a mass or vascular lesion.The overall appearance of this finding is highly suspected of a cord infarct. Less likely possibility of transverse myelitis cannot be entirely excluded.Diffusion-weighted images are suboptimal however demonstrate increased signal intensity of the thoracic cord which does not appear to extend to the cervical cord. This appearance may suggest presence of a cord infarct and vasogenic edema.Postoperative changes of multi-level laminectomy and with expected epidural enhancement at the surgical site and enhancement of posterior soft tissues of the upper is noted.", "output": "1.New since prior exam is diffuse cord increased T2 signal intensity and caliber extending from C5 through the conus and highly suggestive of ischemic stroke. Ill-defined faint foci of inhomogeneity of the cord raises the remote possibility of minimal associated hemorrhage. There are also very faint ill-defined patchy foci of high density on post infused images in the cervical and lower thoracic cord which is history of present enhancement or leakage of contrast from the vasculature."}
{"instruction": "Generate impression based on findings.", "input": "Infant born at 30 weeks with concern for genetic anomaly; microcephaly, single nare, cannot open eyes: microcephaly, midface hypoplasia. There is fusion of the frontal lobes and thalami with a monoventricle, absence of the falx cerebri, no discernible corpus callosum or olfactory apparatus, and prominent posterior intracranial prominent cerebrospinal fluid space. There is diffuse absence of cerebral gyri and sulci, yielding a lissencephalic appearance. There is deficiency of myelination. The cerebellum is relatively intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. There is an azygous anterior cerebral artery. There is severe microcephaly and hypotelorism. There is a single blind-ended nostril associated with a tubular, proboscis-like appendage, just inferior to the level of the orbits. There is bilateral otomastoid fluid signal.", "output": "Findings compatible with alobar holoprosencephaly and cebocephaly."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for structural abnormality, evaluate Chiari. Signs and symptoms: Headache, Chiari malformation on CT measuring 6 to 7 mm. Pre and post enhanced brain MRI:Examination demonstrates 13 mm herniation of cerebellar tonsil through the foramen magnum with flattening deformity of the tonsil consistent with Chiari malformation.Diffusion-weighted images are unremarkable.Examination otherwise demonstrate normal anatomic cord morphology and signal intensity of brain parenchymal on all MRI sequences.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is unremarkable.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses and their pattern of enhancement is unremarkable.There is a multi branch vascular enhancement in the left posterior frontal lobe highly suggestive of a congenital developmental venous anomaly. This finding is not associated with any susceptibility signal changes to suggest a cavernoma. Unremarkable enhanced images otherwise for any detectable abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern. Minute mucosal thickening of bilateral ethmoid sinuses however is noted.Nonenhanced complete spine MRI:Examination of cervical spine demonstrate above described Chiari malformation with flattening deformity of the tonsils. The signal intensity and caliber of cervical cord remains within normal and in particular no evidence of syrinx is detected. There is normal anatomical developmental vertebral column and without evidence of spinal canal or neural foraminal compromise.CSF flow study demonstrate presence of biphasic flow through the foramen of magnum anteriorly. There is significantly diminished flow posteriorly through the foramen magnum and no convincing flow through the fourth ventricle or the aqueduct. MRI of thoracic spine demonstrate normal anatomical development of vertebral column without spinal canal or neural foraminal compromise.There is normal signal intensity and caliber of the thoracic cord and without evidence of syrinx.MRI of the lumbar spine demonstrate normal anatomical developmental vertebral column without spinal canal or neural foraminal compromise. There is normal termination of the cord at lower L1 level. There is normal signal intensity of the cauda equina and in particular without evidence of fatty filum.Incidental note is made of significantly dilated bladder without detectable abnormality of the bladder wall.", "output": "1.Pre- and post enhanced demonstrate Chiari malformation with 13 mm herniation of cerebellar tonsils with resultant flattening deformity. A small left frontal lobe developmental venous anomaly is detected and unremarkable exam otherwise. Paranasal sinuses, mastoid air cells and middle ear cavities are well pneumatized.2.Nonenhanced MRI of spine redemonstrate Chiari malformation as detailed above. Unremarkable total spine MRI otherwise as detailed above. CSF flow study demonstrate biphasic flow anteriorly through the foramen magnum and significantly diminished flow posteriorly without detectable flow through the fourth ventricle or the aqueduct."}
{"instruction": "Generate impression based on findings.", "input": "Treated low grade neuroglial tumor: surveillance. There are postoperative findings related to left frontal craniotomy for tumor resection. There is an unchanged area of enhancement associated with an ovoid area that contains susceptibility effect along the anterior margin of the right frontal horn. There is also no significant interval change in the surrounding confluent areas of T2 hyperintensity in the bilateral frontal lobes, adjacent to the surgical cavity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.", "output": "Unchanged post-treatment findings in the frontal lobes without evidence of tumor progression."}
{"instruction": "Generate impression based on findings.", "input": "27 year old female complaining of abdominal pain with history of Crohn's disease status post two bowel resections and planned placement of Seton tube for drainage treatment of multiply recurring high-spreading extrasphincteric perianal fistula. Evaluate for perianal abscess. ABDOMEN:LUNG BASES: No pleural effusions. LIVER, BILIARY TRACT: Periportal low attenuation compatible with periportal edema was seen on the prior exam, but this has resolved. No focal liver lesions. SPLEEN: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypodense lesions are too small to characterize.ADRENAL GLANDS: There is a 0.8 x 1.7 cm cystic lesion associated with the left postero-lateral adrenal limb on axial image 19/145. This was present on the prior examination and appears unchanged. If indicated, further evaluation with dedicated adrenal CT or preferably, MRI examination would be helpful to characterize this lesion.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild wall thickening of the terminal ileum and cecum identified. This is near the anastomosis. No surrounding fluid collections.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:UTERUS, ADNEXA: An IUD is in place. Minimal free fluid identified within the pelvis.There is a relatively hypodense object in the right vagina / adnexa on coronal image 53/109 measuring 1.7 x 5 cm which may be a tampon or other foreign object. This appears unchanged in position and size since the prior exam. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Minimal wall thickening of the descending colon seen on the prior exam has resolved without evidence of abscess formation. No free air or pneumatosis.In the interval since the prior examination, multiple air collections which extend posteriorly towards the sacrum and extend to the left lateral aspect of the rectum have developed. These are seen best on axial image 128/145 and coronal image 41/109. No abscess was found.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "New air collections in in presacral and left lateral aspect of the rectum have developed since the prior examination. No abscess was found. Exam is stable otherwise. Probable tampon in vagina - see above. "}
{"instruction": "Generate impression based on findings.", "input": "Metastatic esophageal cancer: please assess for CNS involvement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are numerous scattered T2 hyperintense foci within the cerebral white matter. There is no abnormal intracranial enhancement. There is mild 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 is a small right sphenoid sinus retention cyst.", "output": "Numerous nonspecific scattered T2 hyperintense foci within the cerebral white matter, but no evidence of intracranial metastases."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female. Right lateral hip pain. Evaluate for possible greater trochanter tendinitis. There is mild fatty atrophy of the right gluteus minimus muscle relative to that on the left but the gluteus medius and minimus tendons appear normal. The musculature of the hip otherwise appears normal. The bone marrow signal intensity is within normal limits. Moderate osteoarthritis affects the right hip with cartilage loss particularly noticeable along the posterior superior aspect of the hip. The edge of the anterior labrum is poorly defined and has increased signal intensity likely reflecting degenerative fraying/tearing. On the large field of view images, mild osteoarthritis affects the left hip. The pubic symphysis and sacroiliac joints are normal for patient age. Degenerative disk disease affects the visualized lower lumbar spine with narrowing of the spinal canal at L4-L5.", "output": "1. Mild fatty atrophy of the right gluteus minimus muscle but no evidence of tendon pathology or peritrochanteric bursitis. 2. Degenerative arthritic changes, as described above."}
{"instruction": "Generate impression based on findings.", "input": "evaluate for c-spine injury after trauma The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature.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.Minor opacity is present in the sphenoid sinus which is better seen on the recent CT of the maxillofacial bones.", "output": "1.Straightening of the normal cervical curvature could be related to muscle spasm or patient positioning. It is nonspecific.2.There is no evidence for spinal cord injury."}
{"instruction": "Generate impression based on findings.", "input": "Headaches. Childhood history of craniosynostosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, and there are no areas of abnormal signal. There is no abnormal parenchymal or leptomeningeal enhancement. The midline structures and craniocervical junction are within normal limits. The ventricles and basal cisterns are normal in size and configuration. There is a cavum septum pellucidum. There is no midline shift or herniation. The major cerebral flow voids are intact. There is slight cranial asymmetry, related to a history of craniosynostosis and reconstructive surgery. The orbits and scalp soft tissues are grossly unremarkable. There are small right maxillary sinus mucus retention cysts.", "output": "1. Slight cranial asymmetry, related to a history of craniosynostosis and associated reconstructive surgery.2. No evidence of intracranial hemorrhage, mass, or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "39 year-old female with painless jaundice. Rule out pancreatic mass. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without cholecystitis. Several small gallstones are present in the neck of the gallbladder. Infiltrative changes in the periportal fat and lymphadenopathy in the hepatic hilum. There is extensive periportal edema. These infiltrative findings surround the superior mesenteric artery and vein, confluence and main portal vein, possibly representing infiltrative neoplasm. The hepatic vasculature is patent. No biliary duct dilatation.SPLEEN: No significant abnormality notedPANCREAS: There is an area of ill-defined hypoenhancement in the pancreatic head seen on axial image 40/161 of series 4, which could represent a primary pancreatic neoplasm. For further evaluation with contrast-enhanced MRI and M.R.C.P. may be helpful, if indicated.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large right upper pole simple benign cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Ill-defined hypodensity in pancreatic head with associated fat infiltration and lymphadenopathy in the hepatic hilum. Periportal edema. Findings may be due to pancreatic neoplasm. Cholelithiasis without cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Numbness, pain, burning, fasciculations in the lower extremities. Evaluate for infiltrating pachymeningitis. Five lumbar type vertebral bodies are presumed to be present. Again seen is levoscoliosis of the lumbar spine with apex at the L2-L3 level. Vertebral body heights are within normal limits. Bone marrow signal is benign with T1 hyperintense focus at the T11 vertebral body compatible with focal fat or hemangioma. The conus medullaris is normal in position.Minimal degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: There is a disc bulge without significant spinal canal or neural foraminal stenosis. Facet arthropathy on the right.L3-L4: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy and ligamentum flavum thickening.L5-S1: Minimal disc bulge eccentric to the left with mild left neural foraminal stenosis. No spinal canal or right neural foraminal stenosis. There is facet arthropathy particularly on the left and ligamentum flavum thickening.Cauda equina nerve roots in the upper lumbar spine are rightward deviated due to the levoscoliosis. No abnormal enhancement is seen involving the cauda equina nerve roots or the epidural space. Paraspinous soft tissues are within normal limits.", "output": "1. No abnormal mass or enhancement to suggest pachymeningitis as questioned.2. Moderate levoscoliosis of the lumbar spine with apex at the L2-L3 level as seen previously.3. Mild degenerative changes with mild left L5-S1 neural foraminal narrowing. No significant spinal canal or foraminal stenosis in the remainder of the lumbar spine."}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval interval changes History: weakness Nonenhanced CT of brain:Examination again demonstrate large area of left frontal -- temporal craniectomy with resultant slight bulge of brain parenchyma through the bony defect. The entire left anterior temporal lobe, left inferior frontal lobe has uniformly high density compared to the rest of brain parenchyma which remains stable and is concerning for petechial hemorrhage. A follow-up with an MRI is recommended. This finding remains stable since prior exam. Subtle encephalomalacia/edema in the left basal ganglia is again noted with no change. Extra-axial fluid density at the site of craniectomy and extension posterior to the posterior edge of craniectomy is again noted. There is slight increase in the fluid collection at this site since prior exam.", "output": "1.No definitive evidence of new intracranial findings since prior study. Please see above comments.2.Slight interval increase in the extra-axial fluid collection at the craniectomy site with extension posterior to the dorsal edge of craniectomy."}
{"instruction": "Generate impression based on findings.", "input": "patient with posterior epidural fluid collection. Please aspirate sample. 61 yo female Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the fluid collection. Following needle removal images obtained demonstrate no complications . Air was present in the remaining cavity.", "output": "Epidural fluid collection aspiration under CT guidance."}
{"instruction": "Generate impression based on findings.", "input": "47 year-old female with strong family history of breast cancer, personal history of breast reduction surgery There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.A few benign appearing foci are present in both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. Annual breast MRI is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": " Exam is limited by significant motion artifact. Within these limitations there is no definite evidence of cord compression. The vertebral body heights are maintained. There is disc space narrowing with posterior disc bulge and hypertrophy of the ligamentum flavum at C5-6. There is no definite cord signal abnormality. There is no significant spinal canal narrowing in the thoracic or lumbar spine. There is mild edema in the paraspinal soft tissues in the left lower lumbar region, of uncertain etiology.", "output": "Limited study due to motion artifact. Multilevel spondylosis, with moderate spinal canal narrowing at C5-6. No definite evidence of cord compression or cord signal abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Other headache syndrome [G44.89], Reason for Study: ^Reason: evaluation for worsening frontal headache x 9 months History: constant frontal headache No evidence of acute ischemic or hemorrhagic lesionThere are nonspecific T2/FLAIR high signal intensity lesions on white matter, one on the left frontal lobe superior frontal gyrus and another on the right inferior lobule of parietal lobe. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "No evidence of acute ischemic or hemorrhagic lesion.Nonspecific T2/flair high signal intensity lesions as described above."}
{"instruction": "Generate impression based on findings.", "input": "Per EPIC, Cushing's disease secondary to ACTH-secreting microadenoma status post transsphenoidal hypophysectomy on 6/1. Fever and elevated white count. Evaluate for abscess in the sella. There are postoperative findings related to transsphenoidal hypophysectomy. There is a small rim-enhancing fluid collection at the left aspect of the sella measuring approximately 4 x 7 x 5 mm (AP x TR x CC) with prominent surrounding enhancement in the sella. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. There is no evidence of parenchymal abscess or empyema. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There are acute on chronic changes with diffuse mucosal thickening of the paranasal sinuses.", "output": "1.Please note examination was performed as a brain MRI and suboptimal for evaluation of the sella. There is however a discrete 4 x 7 x 5 mm fluid collection in the left aspect of the sella with prominent surrounding enhancement. Although some of these changes can be seen postoperatively, the possibility of abscess can not be excluded. 2.No evidence of parenchymal edema, parenchymal abscess, or extra-axial collection to suggest empyema."}
{"instruction": "Generate impression based on findings.", "input": "59 yo male with VT Left VentricleThe left ventricle is mildly enlarged. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 113 ml/m2 (normal range: 74+/-15), the LVEDV is 228 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 100 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. . There is patchy late gadolinium enhancement in the mid and basal lateral wall and basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. THis pattern is not suggestive of ischemic heart disease (MI).Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 162 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated .Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root at the level of the SOV is 4.3 cm.. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings . 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. Lower normal LV systolic function without evidence of infarct. 2. Patchy delayed enhancement in the lateral and info lateral wall.3. Normal RV size and function without evidence for ARVD.4. Aortic SOV 4.3 cm with mild AR"}
{"instruction": "Generate impression based on findings.", "input": " There has been interval further partial glossectomy. There are unchanged post-treatment findings related to neck dissection and radiation therapy. The previously demonstrated T2 hyperintense enhancing lesion along the left dorsum of the tongue is no longer evident. Scattered small cervical lymph nodes are identified, but there is no lymphadenopathy. There is mild degenerative changes involving the lower cervical spine with disc osteophyte complexes. The remaining salivary glands and thyroid are unchanged. The orbits and imaged intracranial structures are unremarkable. There is fluid in the left mastoid air cells.", "output": "1. No definite evidence of residual locoregional tumor or significant cervical lymphadenopathy.2. Left mastoid effusion.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 42 years old Reason: Right knee pain History: Right knee pain Normal appearance of the right knee. The left knee also appears normal as seen on the frontal view.", "output": "Normal appearance of the right knee. Please refer to MRI report 04/11/15 for additional findings."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Cyrus is a 40-year-old female with a family history of breast cancer in sister (diagnosed at the age of 40) and a maternal aunt. Personal history of benign left breast MRI guided biopsy in 2014 for fibroadenomatoid change. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Scattered T2 intense nonenhancing cysts are identified bilaterally. Scattered foci of enhancement are seen in both breasts, including at site of benign left breast biopsy, all of which are stable compared to prior examinations. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Stable T2 hyperintense hepatic lesion.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with pain ROTATOR CUFF: There is mild increased intermediate signal within the supraspinatus tendon suggesting tendinosis although we see no tear. Mild increased intermediate signal intensity distally in the infraspinatus suggesting tendinosis with cyst formation in the underlying bone at its insertion. There is increased signal intensity more proximally at the myotendinous junction that may represent a strain. No discrete tear is evident. The teres minor muscle and tendon appear normal.Although some fibers of the subscapularis tendon can be traced to the lesser tuberosity, there is thinning of the tendon likely reflecting chronic attritional tearing as well as what appears to be frank detachment of the inferior fibers of the tendon from the lesser tuberosity suggesting a full-thickness but incomplete tear. The subscapularis muscle is within normal limits.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. There is a trace amount of fluid within the anterior aspect of the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is within normal limits. Although no fluid signal intensity is seen entering the labrum, branching intermediate signal intensity is noted in the superior labrum suggestive of a tear that probably extends into the superior fibers of the anterior labrum.BICEPS TENDON: Signal intensity of the tendon of the long head of the biceps is within normal limits. Small amount of fluid within the sheath may simply represent extension of the glenohumeral joint.ADDITIONAL", "output": "1.Findings compatible with attritional tearing of the subscapularis tendon with a full-thickness defect of the tendon inferiorly.2.Mild tendinosis affects the supraspinatus and infraspinous tendons. Mild signal at the myotendinous junction of the infraspinatus may represent a strain.3.Findings suggestive of a superior labral tear as described above of questionable clinical significance."}
{"instruction": "Generate impression based on findings.", "input": "40 year old man with tetralogy of Fallot referred for evaluation of RV size/ function and severity of pulmonic regurgitation. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 110 ml/m2 (normal range: 74+/-15), the LVEDV is 206 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 89 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 136 g (normal range 164+/-36). There is mild hypokinesis of the mid inferior and inferolateral walls. There is a large patch repair of the membranous interventricular septum without evidence of residual ventricular septal defect. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with mild to moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 224 ml/m2 (normal range 82+/-16), the RVEDV is 423 ml (normal range 142+/-31), the RV end systolic volume index is 135 ml/m2 (normal range 31+/-9), and the RVESV is 254 ml (normal range 54+/-17). The RVOT is aneurysmal consistent with outflow tract patch.Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve is trileaflet opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is severe pulmonic valve regurgitation. The regurgitant fraction is 52% and the regurgitant volume is 80ml. Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a right sided aortic arch with a mirror image 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 moderately dilated 36mm. The RPA is mild to moderately dilated (25mm) with 21ml of forward flow. The LPA is mildly narrowed (16mm) with forward flow of 23ml.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. The innominate vein travels inferior to the aortic arch before entering the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is evidence of ascites. Additionally, there is low signal of the liver on SSFP imaging which would suggest the presence of hepatic iron overload; however, dedicated T2-star iron imaging was not performed. 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. Mild LV dilation with normal systolic function (LVEF 57%) with evidence of VSD repair. There is mild hypokinesis of the mid inferior and inferolateral walls.2. Severe RV dilation with mild to moderately reduced systolic function (RVEF 40%). The RVOT is aneurysmal consistent with outflow tract repair.3. Severe right atrial dilation.4. Severe pulmonic valve regurgitation.5. The main pulmonary artery is moderately dilated. The RPA is moderately dilated and the LPA is mildly stenosed. There is equal flow to both lungs.6. Right sided aortic arch with mirror imaging and variant venous anatomy, as described above. 7. See extra-cardiac findings."}
{"instruction": "Generate impression based on findings.", "input": "History of C6-C7 disk replacement with residual left upper extremity pain There is artifact from disc prosthesis at the C6-C7 levels limiting the exam in this area. Vertebral body heights are preserved. Alignment is grossly within normal limits. Bone marrow signal is within normal limits. The visualized spinal cord is normal in signal and morphology.Level by level findings are as follows:C2-C3: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.C3-C4: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.C4-C5: Minimal disc bulge. No spinal canal or neural foraminal stenosis.C5-C6: Minimal disc bulge and mild uncovertebral joint hypertrophy. This creates minimal left neural foraminal stenosis, better seen on the oblique sequence. Right neural foramen is patent. No spinal canal stenosis.C6-C7: Evaluation significantly limited by artifact from disc prosthesis. The lateral aspect of the bilateral neural foramen are patent. No high-grade central canal stenosis.C7-T1: Small central disc protrusion. No significant neural foraminal or spinal canal stenosis.", "output": "1. Postoperative changes from placement of C6-7 disc prosthesis. Resulting susceptibility artifact markedly limits evaluation of the C6-7 level. No high-grade neural foraminal or spinal canal stenosis at this level. CT may be helpful to assess the neural foramen if clinically indicated.2. Minimal C5-6 left neural foraminal narrowing. "}
{"instruction": "Generate impression based on findings.", "input": "16-year-old male with transverse myelitis. Evaluate for cord compression. There is increased T2 signal intensity within the ventral spinal cord from C3 to C6, which appears similar in distribution when compared to the prior outside examination from 9/17/2015. The spine is otherwise unremarkable. Alignment is within normal limits. Vertebral body heights and intervertebral disc spaces are preserved. No evidence of cord compression or significant spinal canal stenosis in the cervical, thoracic and lumbar spine.", "output": "1. No evidence of acute cord compression.2. Redemonstration of ventral spinal cord signal abnormality from C3 to C6, appearing similar in distribution when compared to the prior outside examination. "}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with PSC. Evaluate for new strictures. ABDOMEN:LIVER, BILIARY TRACT: No significant intrahepatic or extrahepatic biliary duct dilation. Narrowing of the bile ducts at the confluence of the right and left hepatic ducts is similar to prior study. Mild irregularity of the mid common bile duct is also similar to prior study. No new dominant stricture. No new focal hepatic lesions.Stable nonspecific subcentimeter T2 hyperintense lesion in the anterior left hepatic lobe without suspicious enhancement, too small to characterize and possibly due to a cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "1.Stable abnormal appearance of the biliary tree, consistent with stated history of PSC. No new dominant stricture.2.No new suspicious hepatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "Left ankle pain. Evaluate for AVN of the talar dome. TENDONS: The tendons are intact.LIGAMENTS: The ligaments are intact.ARTICULAR SURFACES AND BONE: Bone marrow signal is within normal limits. ADDITIONAL", "output": "1. No evidence of avascular necrosis.2. Small ankle joint effusion."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old male with left knee pain. Evaluate left knee patellar tendinitis/pain. MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: The articular cartilage is normal. Bone marrow signal intensity is normal.LIGAMENTS: The anterior and posterior cruciate ligaments as well as the medial and lateral collateral ligaments are morphologically normal.EXTENSOR MECHANISM: The extensor mechanism is intact and morphologically normal.ADDITIONAL", "output": "Unremarkable MRI examination of the knee."}
{"instruction": "Generate impression based on findings.", "input": "Female 62 years old Reason: Evaluate for HCC History: Recent TACE/RFA for residual tumor ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates cirrhotic morphology. Posttreatment changes of interval TACE/RFA with a larger cavity in segment 5 which measures approximately 3.7 x 1.2 cm (series 10, image 62). Intrinsic T1 hyperintense signal within the cavity suggests hemorrhage. There is no focal enhancement to suggest residual tumor. Previously described area of enhancement in segment 7 appears stable and again, may represent fibrosis. Patent hepatic vasculature.No new lesions are identified.SPLEEN: The spleen is measured at upper limits of normal.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.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "1.Cirrhotic liver morphology. Status post TACE/ RFA of a segment 5 lesion without residual enhancement to suggest residual or recurrent tumor. No new lesions are identified."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain ABDOMEN:LUNG BASES: Dependent atelectasis.LIVER, BILIARY TRACT: 8mm nonspecific hypodensity in the liver, most likely benign.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild hydronephrosis of the left kidney with associated perinephric fluid. Left ureter is also dilated throughout its course. Two punctate stones in the left UVJ largest measuring 4-mmRight kidney and right ureter are unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Left UVJ stones causing left-sided hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Non-small cell lung cancer with brain metastasis. Presurgery (biopsy) planning. Limited exam, for stereotactic guidance. The numerous areas of poorly defined T1 shortening predominantly, previously proved to be partly hemorrhagic and partly contrast enhancing, involving the cortex but also the deep brain structures have not significantly changed since the previous examination, accounting for technique differences. Some areas of associated heterogeneous T2 signal are seen with the parenchymal lesions, consistent with blood products. Scattered subtle contrast enhancement on the surface of the cerebellum in the interfolial spaces represents leptomeningeal metastatic involvement and is again unchanged. They are not associated with mass effect, midline shift or herniation. There has been no other significant changes since the previous examination on this limited.", "output": "This study was obtained for surgical planning and shows no significant change when compared to the recent August 21, 2015 examination regarding the numerous parenchymal and leptomeningeal metastatic lesions."}
{"instruction": "Generate impression based on findings.", "input": " There are no abnormal masses or evidence of pathologic enhancement. The parotid and submandibular glands are normal in size and symmetric bilaterally. There are small bilateral intraparotid, submental and cervical lymph nodes, normal in morphology. The thyroid gland is unremarkable. No pathologically enlarged or necrotic lymph nodes are seen. The airway remains patent. The major cervical vessels are patent. The left vertebral artery is hypoplastic. No suspicion osseous lesions are seen. The temporomandibular joints are unremarkable within limitations of neck MRI acquisition.The imaged intracranial structures are unremarkable. There are varying degrees of central stenosis due to disc herniations at C2-3, C3-4, C4-5, and C6-7, and disc osteophyte complex at C5-6.", "output": "1.Unremarkable soft tissue neck MRI. 2.The temporomandibular joints are unremarkable within limitations of neck MRI acquisition.3.Varying degrees of central canal stenosis due to disc herniations and disc osteophyte complex."}
{"instruction": "Generate impression based on findings.", "input": "Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: brain met. Preop planning for tumor resection. #6876 for fiducials History: preop planning The scan was performed with multiple fiducial markers attached. There is about 17 mm sized well but inhomogeneously enhancing intra-axial mass at the right precentral gyrus with the surrounding edema.The ventricles, sulci and cisterns are symmetric and unremarkable. 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": "Inhomogeneously enhancing intra-axial mass with the surrounding edema on the right frontal lobe precentral gyrus. Differential diagnosis including metastasis or primary high grade glioma."}
{"instruction": "Generate impression based on findings.", "input": "Female, 73 years old, with dull bilateral high pain and pressure, not typical for optic neuritis. Assess for retro-orbital mass or optic neuritis. Numerous scattered periventricular and subcortical white matter T2 hyperintensities are redemonstrated. Allowing for technical differences, there has been no significant interval change in the appearance of these lesions since the prior MRI.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is seen.There is no evidence of any significant intracranial hemorrhage. No abnormal extra-axial fluid collections are detected. Ventricles are normal in size and morphology.Dedicated orbital imaging reveals no intraorbital mass, inflammation or pathologic enhancement. The globes are round and symmetric and demonstrate normal signal characteristics. The extraocular muscles are normal and symmetric in size. The optic nerves are likewise symmetric in size morphology and free of pathologic signal abnormality and enhancement. The remainder the optic pathway is also unremarkable. Limited views of the pituitary are unremarkable in the suprasellar cistern is patent.", "output": "1.Stable examination of the brain. No acute intracranial abnormalities are detected.2.Unremarkable evaluation of the orbits with no specific findings seen to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": " There is transitional lumbosacral anatomy with 6 lumbar vertebral bodies. For the purposes of this exam the last fully formed disc is L6-S1.The conus medullaris ends at the level of lower L2. The cord is of normal caliber and signal. Normal alignment of the vertebral bodies. There is no abnormal enhancement.There is a tiny dorsally projecting synovial cyst in the right L4-L5 facet. There are mild facet degenerative changes in the lower lumbar spine.In the visualized right lower lobe, there is a 4 mm nodule along the posterior pleural surface. Recommend follow-up.", "output": "1. Transitional lumbosacral anatomy with 6 lumbar vertebral bodies. For the purpose of this exam the last fully formed disc is at least L6-S1. If surgery is to be contemplated, please correlate with imaging of the entire spine.2. No evidence of intrathecal metastases.3. Nonspecific subcentimeter nodule is seen in the right lower lobe along the posterior pleural surface. Recommend follow-up CT chest for a complete evaluation."}
{"instruction": "Generate impression based on findings.", "input": "3-year-old female with retrognathia and oligoarticular JIA with knee and ankle swelling Right temporomandibular joint: Limited study with the patient under sedation limiting ability to obtain dedicated open and closed mouth views. The meniscus of the right TMJ is appropriately situated between the mandibular condyle and the articular eminence on the closed mouth view. The meniscus remains appropriately situated between the condyle and articular eminence on the limited open mouth view. Minimal enhancement of the synovium of the TMJ may reflect a very mild synovitis although this is equivocal. No erosions or abnormal marrow signal is evident. Partial opacification of right mastoid air cells with enhancement indicating inflammation.Left temporomandibular joint: Limited study with the patient under sedation limiting ability to obtain dedicated open and closed mouth views. The meniscus of the right TMJ is appropriately situated between the mandibular condyle and the articular eminence on the closed mouth view. The meniscus remains appropriately situated between the condyle and articular eminence on the limited open mouth view. Minimal enhancement of the synovium of the TMJ may reflect a very mild synovitis although this is equivocal. No erosions or abnormal marrow signal is evident.", "output": "1.Limited examination as described above.2.Minimal enhancement of the TMJs bilaterally may reflect a very mild synovitis, but this is equivocal. No erosions or bone marrow enhancement.3.Opacification/inflammation of the right mastoid air cells."}
{"instruction": "Generate impression based on findings.", "input": "Reason: rule out renal recurrence History: hx of renal cell carcinoma sp nephrectomy 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: Status post left nephrectomy. No evidence of recurrent disease in the operative bed.Stable small right renal lower pole cyst. No right hydronephrosis or suspicious lesion.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": "Status post left nephrectomy without evidence of recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Acute posttraumatic headache, not intractable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity. There may also be a posterior insular cortex punctate focus of high T2 signal versus artifact. 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 acute intracranial hemorrhage, mass, or acute infarct. Scattered cerebral white matter T2 hyperintensity is nonspecific and may represent chronic small vessel ischemic disease among other possibilities. A posterior insular cortex punctate focus of high T2 signal may represent prior ischemia versus artifact."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Right shoulder pain with concern for SLAP tear; History: recent football injury ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor tendons are intact. There is no muscular atrophy.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. There is no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although we see no fluid signal intensity within the superior labrum, there is intermediate signal intensity within the anterior portion of the superior labrum that likely represents a SLAP tear. Supporting this diagnosis are small cysts adjacent to the anterior superior labrum (see image #16 of series 9). Furthermore, the superior half of the anterior labrum is separated from the underlying glenoid which we expect represents an extension of the SLAP tear but could represent a normal variant sublabral foramen. The labrum appears intact inferiorly. We see no joint effusion. The glenohumeral joint alignment is normal.BICEPS TENDON: The biceps tendon appears intact. ADDITIONAL", "output": "SLAP tear and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "47 years Male (DOB:5/31/1968)Reason: eval for tumor History: eval for tumorPROVIDER/ATTENDING NAME: FERNANDO D GOLDENBERG FERNANDO D GOLDENBERG There is a 36x60mm axial dimension heterogeneously enhancing mass centered in the right thalamus protruding into the right lateral ventricle present. There is a central hemorrhage within the mass. There is associated mild ventriculomegaly with dilation of the temporal horns. The mass displaces the third ventricle to the left and creates midline shift with shift of the septum pellucidum 12 mm left of midline. It appears to encase the right thalamostriate vein. The body of the choroid is visually contiguous with this mass.There is gyral signal hyperintensity along the right inferior parietal lobule on FLAIR imaging associated with some minor leptomeningeal enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Large hemorrhagic mass centered in the right thalamus exophytic into the right lateral ventricle associated with ventriculomegaly. It appears to encase the right thalamostriate vein and involves right choroid plexus.2.Gyral signal abnormality centered along the right inferior parietal lobule is non-specific. It could be paraneoplastic or related to encephalitis."}
{"instruction": "Generate impression based on findings.", "input": " The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. The bilateral posterior communicating arteries are diminutive, a normal variant. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK", "output": "1.No evidence of diffusion abnormality, intracranial hemorrhage, or mass effect.2.Mild chronic small vessel ischemic disease.3.No evidence of flow-limiting stenosis or occlusion in the head or neck."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old female with pain, swelling, and decreased range of motion. MENISCI: There is a complete radial tear through the posterior horn of the medial meniscus near its root. There is minimal medial extrusion of the body of the medial meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the articular cartilage of the patella, particularly along the medial facet, with areas of near full-thickness cartilage degeneration. There is also partial thickness degeneration of the articular cartilage of the femoral trochlea. There is moderate diffuse thinning of the articular cartilage of the medial compartment with foci of near full thickness degeneration. The articular cartilage of the lateral compartment is relatively spared. The bone marrow signal intensity is within normal limits.LIGAMENTS: The MCL is perhaps slightly thickened, proximally, which may represent an old injury, but the ligament otherwise appears normal. The ACL appears intact. The PCL appears intact. The LCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Complete radial tear of the posterior horn of the medial meniscus.2. Osteoarthritis, joint effusion, and Baker's cyst.3. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Stroke. Signs and symptoms: Right-sided weakness. Nonenhanced CT of brain:Subacute nonhemorrhagic right cerebellar and right medullary region in the distribution of right pica stroke is again identified. There is only subtle mass effect with effacement of sulci and no evidence of mass effect on the fourth ventricle.Well demarcated nonhemorrhagic lacunar infarct of right thalamus as was noted on prior MRI exam.Small vessel disease of indeterminate age is subcortical white matter of bilateral cerebral hemispheres (left greater than right). Overall this appearance also is similar to prior MRI examination. No evidence of hemorrhage.CTA of the cervical region:Right carotid, circumferential plaque at the origin of right internal carotid artery with no hemodynamically significant stenosis is noted. The right common carotid artery including its origin and the rest of the cervical portion of right internal carotid artery is unremarkable.Left carotid, circumferential complex plaque at the origin of left internal right artery with no minimal calcification is noted. This results in significant high-grade stenosis of left internal carotid artery at this site. The left common carotid artery and including its origin and the rest of the cervical portion of the left internal carotid artery is unremarkable and widely patent.Right vertebral artery is small in caliber and is believed to represent a non-dominant vertebral (and normal anatomical variation). There is no evidence of a stenotic lesion.Left vertebral artery, there is a non-calcific circumferential plaque at the origin of the dominant the left vertebral artery is noted. There appears to be more than 50% stenosis at this site. The rest of left vertebral artery is unremarkable.Limited view of lower tic origin the origin of major vessels are essentially unremarkable.CTA of intracranial circulation:Carotid system, patent bilateral supraclinoid internal carotid arteries. Minimal atherosclerotic irregularities noted.Middle cerebral arteries and their branches demonstrate mild atherosclerotic disease however but no evidence of any large vessel vascular occlusion or high-grade stenosis.Bilateral anterior cerebral arteries demonstrate multiple foci of high-grade stenosis and ectatic changes. Findings are secondary to atherosclerotic disease. Vertebral basilar system, diffuse atherosclerotic disease of the basilar artery with multi-level areas of mild vascular lumen compromise. Similar findings are noted in the intracranial component of dominant left vertebral artery in particular in its distal component.The right vertebral artery is the nondominant vessel. There is discontinuity of the distal component of the right vertebral artery. This represents occlusion of this vessel proximal to its junction with the basilar artery. The very distal portion of right vertebral artery is visualized and shows significant decrease in its caliber to its patent more proximal component.", "output": "1.Revisualization of multiple small vessel strokes, lacunar strokes and a right cerebellar -- medullary stroke in the distribution of right pica branch. No evidence of hemorrhagic transformation.2.Atherosclerotic plaque with minimal calcification however no hemodynamically significant stenosis at the origin of right internal carotid origin.3.Significant atherosclerotic disease of the left internal carotid artery origin with very high-grade stenoses.4.More than 50% stenosis at the origin of the dominant left vertebral artery and otherwise unremarkable vertebral arteries bilaterally in the neck.5.Atherosclerotic disease of supraclinoid internal carotid arteries, bilateral middle cerebral arteries with areas of mild to moderate vascular compromise. Atherosclerotic disease results in high-grade stenosis and ectatic changes of bilateral anterior cerebral arteries.6.Patent dominant left vertebral artery intracranially with minimal atherosclerotic disease.7.Patent basilar artery however but extensive atherosclerotic disease and mild vascular lumen compromise.8.Complete occlusion of the mid section of the intracranial component of the nondominant right vertebral artery. There is significant decrease in the caliber of visualized very distal right vertebral artery compared to patent a proximal component. If further evaluation is required for management a conventional angiogram would improve detection and the cause of occlusion and morphology of this vessel evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Left arm weakness, chronic basilar invagination with dens extending through the foramen magnum seen on CT head Redemonstration of minimal dens protrusion into the foramen magnum without adjacent cervicomedullary junction signal abnormality. There is developmental narrowing of the cervical spinal canal. Diffuse T1 and T2 hyperintensity of the clivus and vertebrae, compatible with radiation changes.Spinal cord is without evidence of cord signal abnormality. No intraspinal hematoma. Alignment is anatomic. Preservation of cervical lordosis. Multilevel diffuse moderate disc height loss. Vertebral body heights are preserved.C1/2: No significant spinal canal stenosis or foraminal narrowing.C2/3: Ligamentum flavum thickening without significant spinal canal stenosis or foraminal narrowing.C3/4: Small posterior disc osteophyte complex. Uncovertebral hypertrophy, right greater than left. Endplate degenerative changes. Mild spinal canal stenosis. Moderate right and mild left foraminal narrowing. C4/5: Trace diffuse disc bulge. Ligamentum flavum thickening with right greater than uncovertebral arthropathy. Mild to moderate stenosis of the spinal canal. Moderate right foraminal narrowing. Mild left foraminal narrowing.C5/6: Trace disc bulge. Ligamentum flavum thickening with right uncovertebral arthropathy. Moderate stenosis of the spinal canal. Moderate to severe right foraminal narrowing.C6/7: Trace disc bulge with superimposed right paracentral shallow disc protrusion. Ligamentum flavum thickening with right uncovertebral arthropathy. Moderate stenosis of the spinal canal.C7/T1: Mild ligamentum flavum thickening with mild disc bulge. Mild stenosis of the spinal canal. Mild left foraminal narrowing.", "output": "1.Redemonstration of minimal dens protrusion into the foramen magnum without adjacent cervicomedullary junction signal abnormality. 2.Developmental narrowing of the spinal canal. Degenerative joint disease of the cervical spine most the thickened at C5/6 level, with moderate central spinal canal stenosis and moderate-severe right foraminal narrowing. Additional moderate central spinal canal stenosis at C4-C5 and C6-C7."}
{"instruction": "Generate impression based on findings.", "input": "Reason: ? Scaphoid fracture History: snuff box pain 3 weeks after injury LIGAMENTS: Given the limitations of a non-arthrogram study, the scapholunate and lunotriquetral ligaments are intact. TRIANGULAR FIBROCARTILAGE COMPLEX: Also given the limitations of a non-arthrogram study, there appears to be a small perforation in the articular disc of the triangle fibrocartilage complex, just medial to the radial attachment.TENDONS: There is slight increased signal intensity within the extensor carpi ulnaris tendon which suggests mild tendinosis. BONES: There is edema in the distal radius, with band-like T1 signal hypointensity contacting the articular surface, which is compatible with a comminuted, but nondisplaced fracture with intra-articular extension. There is a well-circumscribed subchondral cyst in the capitate, likely degenerative. Additional degenerative cysts are seen in the triquetrum. The scaphoid is normal.ADDITIONAL", "output": "1.Comminuted, intra-articular, but nondisplaced fracture of the distal radius.2.Small tear of the triangular fibrocartilage complex, and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old male with soft tissue infection of the right foot, ulceration of the right first toe and elevated CRP. Evaluate for osteomyelitis. There is increased bone marrow signal abnormality on fluid sensitive sequences within the distal phalanx of the great toe which is associated with decreased bone marrow signal abnormality on T1-weighted images. There is increased signal abnormality on fluid sensitive sequences within the soft tissues along the dorsal aspect of the IP joint/nailbed of the great toe which extends from the skin surface to the level of the distal phalanx, consistent with the stated history of ulceration. There is diffuse increased signal abnormality within the plantar musculature of the midfoot which enhances on post contrast sequences may represent inflammatory changes related to infection, although no definite fluid collection is identified to suggest abscess formation.", "output": "Findings consistent with osteomyelitis of the distal phalanx of the great toe. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with vaginal bleeding. Evaluate for AVM, which was suspected on recent pelvic ultrasound. PELVIS:UTERUS, ADNEXA: New 2.2 x 1.6 cm dark T2 signal lesion in the left uterine fundus with round and curvilinear morphology in a somewhat serpiginous appearance, suspicious for vascular flow voids. The lesion is centered within the myometrium with probable subendometrial extension. Lesion demonstrates avid arterial enhancement. Overall, findings are suspicious for arteriovenous malformation. Contrast opacification of the right gonadal vein on arterial phase images raises the question of venous shunting. There is a small amount of low T2, high T1 signal hemorrhage in the adjacent endometrial canal within the fundus. No suspicious adnexal masses.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": "Findings suspicious for arteriovenous malformation within the left uterine fundus, as detailed above. Additional considerations for enhancing uterine mass, such as retained products of conception, are considered less likely given the T2 appearance of the lesion. These findings should be correlated with recent pelvic ultrasound."}
{"instruction": "Generate impression based on findings.", "input": " Redemonstrated is enlargement and enhancement of a mass within the tectal plate, exerting mass effect upon the adjacent aqueduct. The lateral and third ventricles are enlarged, unchanged. A right frontal approach ventriculostomy catheter is again noted, however its tip now lies along the lateral aspect of the right frontal horn, previously medially. Fluid seen about the shunt reservoir suggests interval manipulation or revision. Pneumocephalus demonstrated on the prior exam from procedure has resolved. There is now right holohemispheric subdural fluid of CSF intensity which measures up to 11 mm in maximal depth, exerting some mild flattening of adjacent gyri. New sinuses and mastoid air cells are clear. Expected vascular flow voids are demonstrated.", "output": "1.Redemonstrated is enlargement and enhancement of a mass within the tectal plate, exerting mass effect upon the adjacent aqueduct. 2.The lateral and third ventricles are enlarged, unchanged. A right frontal approach ventriculostomy catheter is again noted, however its tip now lies along the lateral aspect of the right frontal horn, previously medially. Fluid seen about the shunt reservoir suggests interval manipulation or revision. 3.There is now right holohemispheric subdural fluid of CSF intensity which measures up to 11 mm in maximal depth, exerting some mild flattening of adjacent gyri. "}
{"instruction": "Generate impression based on findings.", "input": "No. New onset of aphasia. Rule out bleed or mass. Examination demonstrates a mass within the posterior fossa with minimal amount of hemorrhage or calcification. There is surrounding vasogenic edema and mass effect on the fourth ventricle and minimally on the quadrigeminal plate. No evidence of hydrocephalus is detected. Further follow-up with an MRI examination is recommended. The mass measures approximately 26.2 mm x 41.This examination is otherwise unremarkable.", "output": "Mass within the left cerebellum with minimal possible hemorrhage or calcification. Further follow-up with an MRI is recommended."}
{"instruction": "Generate impression based on findings.", "input": " There are postoperative findings related to L3-L4 laminectomies and posterior spinal fusion at L2-L5 utilizing bilateral pedicle screws and stabilizing rods with posterior paraspinal fluid collection. There is evidence of L2-L5 kyphoplasty. Susceptibility artifact from metallic hardware and lack of intravenous contrast limits evaluation. There is mild anterolisthesis of L4 on L5. The vertebral bone marrow signal is heterogeneous with multiple lesions throughout the imaged axial skeleton. There is mild anterior wedge deformity of the T11 vertebra without significant retropulsion. There is loss of vertebral body heights at T12 through L5 vertebral bodies with posterior retropulsion with epidural tumor extension. There is moderate loss of disc height at T11-12, with mild loss of disc height at the remaining lumbar levels. There is a left prevertebral mass anterior to L3-L5, centered at L4, measuring approximately 2.2 x 5.0 x 9.0 cm (AP x TR x CC), previously 1.4 x 4.7 x 6.8 cm. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is a mass arising from the right iliac wing, measuring up to 5.7 cm in AP dimension (5.5 cm on 3/31/2015 and 4.4 cm on 3/13/2015), which is partially imaged. Incidentally noted is mildly prominent common bile duct measuring up to 1.4 cm. Please correlate for cholecystectomy. A 5 cm wide T2 hyperintense lesion in the right kidney, likely represents a cyst, but is incompletely characterized. The bladder is distended.T12-L1: Approximately 25% loss of vertebral body height at T12 with slightly progressed retropulsion compared to 3/13/2015, but similar compared to 3/31/2015, contributing to mild spinal canal stenosis. Small central disc protrusion. No significant neural foramen stenosis. L1-L2: Approximately 25% loss of vertebral body height at L1 with progression of retropulsion compared to 3/13/2015, but similar compared to 3/31/2015, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild left neural foramen stenosis. L2-L3: Approximately 25% loss of vertebral body height at L2 with progression of retropulsion compared to 3/13/2015, but similar compared to 3/31/2015, disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to moderate spinal canal stenosis and moderate right and mild left neural foramen stenosis. L3-L4: Status post laminectomy. Approximately 25% loss of vertebral body height at L3 with retropulsion, disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis and moderate bilateral neural foramen stenosis. L4-L5: Status post laminectomy. Approximately 25% loss of vertebral body height at L4 with retropulsion, disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis and moderate bilateral neural foramen stenosis. L5-S1: Disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild to moderate bilateral neural foramen stenosis.", "output": "1. Status post posterior spinal fusion at L2-L5 with L3-L4 laminectomies.2. Extensive tumor burden involving the imaged axial skeleton with pathologic fractures and retropulsion with epidural tumor extension involving the T12 through L4 vertebral bodies, most prominent at L3-L4 and L4-5 with severe spinal canal stenosis, and variable degrees of multilevel neural foramen stenosis. The degree of retropulsion and spinal stenosis is slightly progressed compared to 3/13/2015, but similar to 3/31/2015.3. A 5.6 cm right iliac wing mass with progression in size compared to 3/13/2015 is compatible with the known leiomyosarcoma deposit.  Important findings conveyed to Dr. Zimmerman through EPIC mail on 4/9/2015 at the time of dictation. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 60 years old, with migraine. A single small focus of juxtacortical T2 hyperintensity is seen within the right parietal operculum, a nonspecific finding. No other definite or significant signal abnormality, edema or mass effect is seen. No restricted diffusion is evident. There are no enhancing lesions identified. No findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collection are observed. The dural venous sinuses and deep venous structures demonstrate normal caliber and morphology. No venous sinus thrombosis is detected.", "output": "No significant abnormality of the brain or dural venous sinuses is seen. No other specific findings are noted to account for the patient's migraines."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for stroke. Signs and symptoms: Left-sided weakness, left facial droop. Nonenhanced CT of brain:No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Paucity of cortical sulci is within normal for patient stated age. Ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Considering provided clinical data recommend further follow-up with an MRI examination since subtle findings of early acute stroke can be missed on non-infused head CT.Calvarium is intact.Visualized mastoid air cells and paranasal sinuses demonstrate extensive opacification.", "output": "1.No evidence of acute intracranial findings. Considering provided clinical data follow-up with an MRI is recommended to exclude early onset of acute stroke.2.Unremarkable CT examination of brain without contrast.3.Extensive opacification of visualized paranasal sinuses and mastoid air cells."}
{"instruction": "Generate impression based on findings.", "input": "History of Crohn's disease with indeterminate liver mass seen on prior CT. MR for further evaluation. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. No focal hepatic lesion. At the site of the questionable left lobe lesion, there is no signal abnormality and this may have represented volume averaging on the prior CT. There is mild dilatation of multiple right intrahepatic bile ducts, but no obstructing lesion is evident. There is also a questionable filling defect in the distal common bile duct (series 701 image 22) which may represent a stone or debris. The gallbladder is unremarkable.SPLEEN: The spleen is upper limit of normal in size. There are multiple focal lesions in the spleen the largest of which measures 2.7 x 2.6 cm. These have increased T2 signal, do not restricted diffusion, and do not demonstrate enhancement on the postcontrast images. The smaller lesions appear to have thin internal septations or central dots.PANCREAS: Mild parenchymal atrophy. The main pancreatic duct is nondilated.ADRENAL GLANDS: 12 mm right adrenal nodule which demonstrates dropout on the out of phase images compatible with an adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No focal hepatic lesion at the site of clinical interest in the left hepatic lobe. Appearance on prior CT may have reflected volume averaging at the porta hepatis.2.Stable mild right intrahepatic ductal dilatation without obvious obstructing lesion. There is an apparent filling defect in the distal common bile duct which may represent debris or a small stone. This can be further evaluated with MRCP or ERCP as clinically warranted.3.Right adrenal adenoma.4.Multiple splenic lesions with benign imaging features, possibly cysts. These can be followed as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Other amnesia [R41.3], Reason for Study: ^Reason: r/o mets History: problems with memory No evidence of acute ischemic or hemorrhagic lesion.Underlying brain shows multiple scattered high signal intensity lesions on bilateral periventricular white matter on FLAIR images indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or 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 are clear.Partial opacifications on bilateral mastoid air cells.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Non specific small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: ?cervical radiculopathy History: pain in axilla and shoulder. Per technologist note patient has right-sided neck pain radiating down the right shoulder and arm. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C4-5: Mild disc bulge and mild right-sided uncovertebral hypertrophy. No significant compromise to the spinal canal or neural foramina.C5-6: Small disc osteophyte complex with right greater than left uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild to moderate right neural foraminal stenosis. No significant left neural foraminal narrowing. C6-7: Small central disc extrusion without significant narrowing of the spinal canal. There is possible small amount of disc material in the right neural foramen, as seen on sagittal oblique sequence series 9 image 5 of 11. There is uncovertebral hypertrophy on the right. There is mild to moderate neural foraminal stenosis at this level. No significant left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Secretions noted within the trachea. Partial opacification of the right mastoid air cells also noted.", "output": "1. Multilevel degenerative changes in the cervical spine. There is mild to moderate right C5-C6 and right C6-C7 neural foraminal stenosis which may be affecting the C6 and C7 nerve roots. Please see details above. 2. No significant spinal canal stenosis in the cervical spine."}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old Reason: evaluate lateral meniscus History: lateral joint line pain, locking MENISCI: The lateral meniscus is intact. The anterior horn of the medial meniscus is extruded anteriorly. The remainder of the medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is marked cartilage loss about the medial femoral condyle. The remainder of the articular cartilage is intact. There is T2 hyperintense edema type signal about the lateral femoral condyle.LIGAMENTS: Cruciate ligaments are intact. MCL is intact. There is T2 hyperintense signal about the lateral collateral ligament complex which may represent mild strain, with no frank tear. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL", "output": "1.Lateral femoral condyle bone edema. 2.Small to moderate joint effusion, and inflammation in the lateral soft tissues of the knee. 3.Anterior extrusion of the anterior horn of the medial meniscus."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female status post anterior exenteration, RPLND, neobladder ABDOMEN:LIVER, BILIARY TRACT: Unchanged subcentimeter hepatic cysts. No new suspicious lesions or pathologic enhancement. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left midpole subcentimeter renal cyst is unchanged. RETROPERITONEUM, LYMPH NODES: No abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Tarlov cysts are noted in the spine.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Postsurgical appearance of cystectomy with neobladder creation.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.No specific evidence of recurrent or metastatic disease.2.Cholelithiasis without MR evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: 26-year-old female with unilateral headache, worsening and increasing photophobia/blind spots. Signs and symptoms: As above. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrate normal anatomical morphology of the brain with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and grade-white matter differentiation/brain myelination.Negative post enhanced images for any detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium or the retro-orbital spaces.Normal visualization of signal void of major intracranial arterial branches.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.", "output": "Negative pre and post enhanced brain MRI."}
{"instruction": "Generate impression based on findings.", "input": "Headaches The signal intensity of the brain parenchyma is normal. There is no evidence of acute intracranial hemorrhage, extra-axial fluid collections, or diffusion abnormality. There is no mass, mass effect, or midline shift. The midline structures are normal. The cerebellar tonsils are normal in position. The ventricles and sulci are normal in size. 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": "Unremarkable MRI brain with no specific findings to account for the patient's headaches. "}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female with pain following a fall, area in the right calcaneus concerning for lipoma on x-ray. TENDONS: The Achilles' tendon is intact. The anterior, peroneal, and medial tendons are intact. There is a small amount of fluid along the distal tibialis posterior tendon which may not be of any clinical significance.LIGAMENTS: The anterior and posterior talofibular ligaments appear intact. The calcaneofibular ligament appears slightly thickened which could conceivably represent a mild sprain but we suspect this is not of current clinical significance as there is no adjacent edema. The distal tibiofibular syndesmotic ligaments and the deltoid ligament complex appear intact.ARTICULAR SURFACES AND BONE: A heterogeneous lesion in the anterior aspect of the body of the calcaneus containing fat is consistent with an intraosseous lipoma. Additional nonadipose contents are seen within lipoma but overall this has the appearance of a benign lesion of no significance.Edema within the head, neck, and body of the talus most conspicuous in the lateral aspect of the head of the talus with there is suggestion of a linear component may represent a nondisplaced fracture, but this is equivocal. Edema is also concentrated along the medial aspect of the posterior process of the talus but we see no discrete fracture. Mild edema is also noted in the medial aspect of the tibial plafond, navicular tuberosity, medial calcaneus, cuboid, and medial aspect of the fifth metatarsal base without fracture evident.ADDITIONAL", "output": "1.Intraosseous lipoma of the calcaneus as described above.2.Multiple foci of marrow edema may reflect bone contusions with a possible nondisplaced fracture of the inferolateral head of the talus."}
{"instruction": "Generate impression based on findings.", "input": "Small paraaortic mass seen on prior chest CT. Further characterization. Again seen is a well-defined left paraortic lesion localized in the left retrocrural space at the level of T12 which is stable in size and morphology compared to the prior chest CT. Reference measurements are provided below. The lesion has well-defined countors and is in close proximity to the paravertebral neurovascular bundles. It demonstrates slightly hyperintense signal on T2-weighted imaging with mild restricted diffusion and heterogeneous, predominantly peripheral enhancement on the arterial phase which washes out on the delayed phases acquired. Preserved fat planes between the lesion and the adjacent descending thoracic aorta, left diaphragmatic crura and adjacent vertebral body. No signs of local invasion.No additional lesions are identified.The visualized portions of the mediastinum, pleura, lungs and chest wall are within normal limits, considering limitations of technique.INDEX LESION MEASUREMENTS (Current exam date/time: 11/4/2016 10:00:00)LEFT PARA-AORTIC LESION: 1.7 x 0.9 cm (Image 4, Series 401); 1.9 x 1.0 cm on prior (8/3/2016) (Image 61, Series 3).", "output": "Stable small left paraortic mass which demonstrates imaging features suggestive of a small peripheral neurogenic tumor such as schwannoma, neurofibroma or paraganglioma. No evidence of local invasion or aggressive features at this point of time. In the absence of comparison images and indeterminate nature of this lesion, consider imaging follow-up (Spine MRI) to ensure stability. "}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other disturbances of skin sensation. Other symptoms and signs involving the musculoskeletal system HyperesthesiaClinical question: Evaluate for new acute or subacute stroke.Signs and Symptoms: Sudden onset of left facial and shoulder numbness, left arm weakness and hyperesthesia left face and arm. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable since the prior examThere is a moderate degree of punctate hyperintense lesions within the brainstem, thalami, basal ganglia and deep cerebellar structures on the FLAIR and T2 images. There are a few more on this exam compared to the prior.There are multiple punctate SWI hypointense foci in the pons, thalami, basal ganglia and hippocampi which have accumulated further since the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eye lens is thin.", "output": "1.Multiple microhemorrhages within the basal ganglia, medial temporal lobes, thalami and brainstem have mildly increased since the prior exam. The pattern suggest hypertension related microhemorrhages.2.Multiple lesions in the brainstem, thalami and basal ganglia have slightly increased since the prior exam. At this age they are most likely vascular related. 3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for acute ischemic cerebral infarction."}
{"instruction": "Generate impression based on findings.", "input": "Recent partial resection of a pituitary tumor. There are recent postoperative findings related to left frontal craniotomy for debulking of a sellar and suprasellar mass, which is unchanged in size overall. There is high T2 and intermediate to high T1 signal hemorrhage surrounding and primarily within the remaining suprasellar portion of the tumor, which appears similar in extent as on the recent CT, accounting for differences in technique. There is extensive confluent vasogenic edema and up to 15 mm of midline shift to the right. Apparent restricted diffusion along the surgical margins is likely attributable to the underlying susceptibility effect from hemorrhage rather than actual ischemia. The ventricular system appears unchanged, with partial effacement of the left lateral ventricle and mild dilatation of the right lateral ventricle. The skull, with a markedly expanded sella appears unchanged. The left subgaleal fluid collection appears to be slightly larger, measuring up to 20 mm in thickness, previously 15 mm.", "output": "1. Recent postoperative findings related to left frontal craniotomy for debulking of a sellar and suprasellar mass, which is unchanged in size. Likewise, the acute hemorrhage surrounding and primarily within the remaining suprasellar portion of the tumor appears to be similar in extent as on the recent CT, accounting for differences in technique. 2. Unchanged vasogenic edema and up to 15 mm of midline shift to the right. 3. The ventricular system appears unchanged.4. The left subgaleal fluid collection appears to have increased in size."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old male with pain and giving way. Presents with meniscus injury. MENISCI: There is a bucket-handle tear or inner margin tear of the medial meniscus with an apparent meniscal fragment displaced posteriorly, near the medial femoral condyle. There is linear increased signal abnormality within the body of the lateral meniscus which extends to the tibial and femoral articular surface consistent with a complex tear. The anterior and posterior horn appear intact.ARTICULAR CARTILAGE AND BONE: There is focal full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle with underlying subchondral signal abnormality. There is also focal full-thickness articular cartilage degeneration along the posterior aspect of the lateral tibial plateau and medial tibial plateau with underlying subchondral signal abnormality. LIGAMENTS: There is complete disruption of the ACL. There is no increased signal abnormality on fluid sensitive sequences suggesting that this may be chronic in etiology. The PCL appears intact. The MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Chronic appearing disruption of the ACL. 2. Complex tear of the lateral meniscus and bucket handle tear of the medial meniscus as described above.3. Full thickness articular cartilage degeneration as described above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 62 years old, with low back pain and history of breast cancer. Evaluate for lesions. Spinal alignment is anatomic. Vertebral body height is preserved. Extensive disc degeneration is seen at L5-S1 with endplate irregularity, edema and enhancement. No associated fluid collection or paraspinal inflammation is seen. Elsewhere, no pathologic marrow replacement or enhancement is seen.The visualized distal spinal cord and conus are within normal limits. No pathologic intrathecal enhancement is seen. No epidural abnormalities are suspected.T12-L1: Disc bulging and a tiny right paracentral protrusion. No spinal canal or foraminal stenosis.L1-2: Small right foraminal disc protrusion. No significant spinal canal stenosis. Minimal right foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal stenosis. Mild right foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc. No significant spinal canal stenosis. Mild right foraminal narrowing. L5-S1: Facet arthropathy. Bulging disc. Effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. A prominent perineural root sleeve cyst is seen along the left S2 foramen.", "output": "1.Severe disc degeneration at L5-S1 with evidence of edema and inflammation. Lack of associated fluid collections and paraspinal edema suggest that this is most likely purely degenerative in nature. Correlation with clinical and laboratory findings is suggested to further exclude the possibility of infection.2.Less significant degenerative findings are seen at additional levels with no areas of high-grade spinal canal stenosis.3.No evidence to suggest osseous metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Chugai IRB- 14-0593 History: R/O PML prior to study The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and to a greater degree subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally there is a lesion present within the corpus callosum. Compared to the prior exam these remain stable.No abnormally enhancing lesions are appreciated within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There is redemonstration and no change in the subcortical, periventricular and corpus callosum white matter lesions. These are nonspecific but could be related to a demyelinating process."}
{"instruction": "Generate impression based on findings.", "input": "Female 44 years old Reason: 44yo female with evidence of quiescent Crohn's in cecum/ileocecal valve with continue diarrhea and abdominal pain. Evaluate for small bowel Crohn's disease History: diarrhea and abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Signal loss on out of phase imaging compatible with fatty infiltration.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: Small bowel is normal in caliber and course. The terminal ileum is normal in caliber. The ileocecal valve is patent. No surrounding inflammatory changes or evidence for hyperemia.There is a focal segment of narrowing involving the sigmoid colon measuring 2.5 cm.There are additional segments distal to this that are collapsed but show mucosal hyperenhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No evidence of stricture or inflammation involving the terminal ileum..2.Findings of narrowing and mucosal enhancement within the sigmoid colon."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified visual disturbance [H53.9], Reason for Study: ^Reason: s/p OLT in October, admitted with thrombocytopenia. Now with vision changes. MRI w/ recommended by neuro consult service History: as above No evidence of acute ischemic or hemorrhagic lesion.Multiple scattered high signal intensity nodular lesions on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease, slightly more prominent on today's scan but grossly no significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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": "No evidence of acute ischemic or hemorrhagic lesion.No abnormal contrast enhancing lesion.Nonspecific small vessel ischemic disease, no change since prior scan."}
{"instruction": "Generate impression based on findings.", "input": "Male, 19 years old, with history of cerebral cavernous malformation status post resection. Surveillance imaging. Evidence of a left temporal surgical resection is again seen. An obliquely oriented resection cavity traverses the anterior temporal lobe showing interval decrease in size. Encephalomalacia of the surrounding anterior temporal gyri is also seen.Thickening of the left the medulla is again seen with susceptibility effect at the uncus. Ill-defined enhancement on a background of mild intrinsic T1 hyperintensity is also seen centered on the uncus.No new intracranial lesions are detected. No areas of significant parenchymal edema or mass effect are seen. The ventricles remain normal in size and morphology.", "output": "Postoperative findings are redemonstrated within the anterior left temporal lobe. Areas of associated parenchymal signal abnormality have not significantly changed from the prior exam. No new intracranial lesions are seen."}
{"instruction": "Generate impression based on findings.", "input": "Reason: disc herniation, stenosis History: lowe back pain radiating into both legs R >L Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level. There is disk desiccation at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disk bulge and disk dessication present at this level associated with bilateral facet and ligamentum flavum hypertrophy. The fat at the lateral recesses is not effaced. The fat surrounding the exiting nerve roots within the neural foramina is not effaced. Overall there is a mild degree of spinal stenosis present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.There are degenerative changes present in the lower lumbar spine without significant compromise to the spinal canal or exiting nerve roots. There is only mild spinal stenosis at L4-5."}
{"instruction": "Generate impression based on findings.", "input": "Male, 56 years old, with testes cancer and worsening multifocal back pain associated with left leg weakness. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or edema is seen. The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No epidural abnormalities are suspected.C2-3: Unremarkable. C3-4: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis or neuroforaminal narrowing. C4-5: Unremarkable. C5-6: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis or neuroforaminal narrowing. C6-7: Unremarkable. C7-T1: Unremarkable. Thoracic:Alignment is anatomic. Vertebral body heights are preserved. A focus of T1/T2 hyperintense, STIR suppressing signal within the T7 vertebral body likely represents a benign hemangioma. Diffuse T1/T2 hyperintense, STIR suppressing signal within the T12 vertebral body likely represents treatment related fatty marrow replacement. The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected. The left kidney is atrophic.Lumbar:Anterior wedging of the L1 vertebral body is unchanged dating back at least to 2012. Diffuse fatty replacement of the lumbar vertebral marrow space is unchanged. A Schmorl's node deformity is evident along the inferior L3 endplate. The remaining vertebral bodies demonstrate preservation of height. No new or worrisome marrow signal abnormality is detected. The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Minimal disc bulging. No significant spinal canal or neuroforaminal stenosis. L4-5: Disc bulging with a central disc protrusion, unchanged from the prior examination. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. L5-S1: Mild facet arthropathy. Mild disc bulging. No significant spinal canal or foraminal stenosis.", "output": "1.Mild degenerative findings in the cervical and lumbar regions without high-grade spinal canal or foraminal stenosis.2.Presumed treatment related marrow signal changes in the lumbar region without evidence to suggest new or recurrent metastases."}
{"instruction": "Generate impression based on findings.", "input": "50 year old man with a history of ischemic cardiomyopathy, s/p heart transplant (4/30/2015) and antibody mediated rejection, hypertension and diabetes, referred for evaluation of rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). There are no regional wall motion abnormalities present. T2 edema ratio is >2 (mildly increased), which is suggestive of myocardial edema/inflammation. Global relative enhancement value is 4, which is borderline abnormal (normal <4) which may indicate an underlying inflammatory process. The myocardial native T1 time is 1206ms, which is significantly elevated, which may be indicative of an underlying infiltrative or inflammatory process. However, it is decreased from prior MRI on 2/26/16 (1282ms previously). The extracellular volume fraction is 26%, which is in the normal range. There is a small area of patchy late gadolinium enhancement in the mid inferoseptum, which is better than before. It is atypical of myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is enlarged consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 132 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 52 ml (normal range 54+/-17).Right AtriumThe right atrium is enlarged consistent with transplant.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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a \"psudeo-bovine\" brachiocephalic branching pattern (normal variant). 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 drain normally into the right atrium.PericardiumThe pericardium is essentially normal in thickness. Small portions of the pericardium is mildly bright on T2-weighted imaging suggesting that there is some subtle residual pericarditis. However, the amount of pericardium involved is less than on prior study on 2/26/16 and much less than on the initial cardiac MRI from 2015. Additionally, on the prior study on 2/26/16, the pericardium appeared bright on LGE imaging, however it does not on today's study. These findings indicate improvement of pericardial inflammation from the prior study. There is no obvious pericardial to myocardial tethering noted on the current study. On real-time cine imaging, there is no evidence of respirophasic septal shift. Extracardiac FindingsSternotomy wires are present. 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. The left ventricle is normal in size with normal systolic function (LVEF 56%). There is a small area of patchy late gadolinium enhancement in the mid inferoseptum, which is atypical of myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. It was present on prior MRI on 2/26/16 but is now less pronounced.2. The T2 ratio is mildly elevated, the global relative early enhancement is borderline elevated, and the native myocardial T1 relaxation time is significantly elevated. Together these parameters suggest that there may be some underlying myocardial inflammation present. However, the ECV fraction is normal, which would not support myocardial inflammation. When compared to the prior study, the T2 ratio and early global relative enhancement are slightly increased; where as the native myocardial T1 relaxation time is a little improved. Overall, I would conclude that there is no significant change of the myocardium. 3. There is only mild residual pericardial inflammation, which continues to decrease on his serial cardiac MRIs. 4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "73 year old man with history of heart transplant for nonischemic cardiomyopathy in 2005, PPM placement, CKD with worsening TR and RV function referred for cardiac MRI to evaluate for rejection. Of note, given the patient's renal function no contrast was administered. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 130 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 55 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is dilated consistent with previous transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 72 ml (normal range 54+/-17). There is a pacemaker lead noted within the RV.Right AtriumThe right atrium is dilated.Aortic ValveThe aortic valve is not well seen.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve is not well seenTricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation, which appears eccentrically directed but was not fully evaluated due to the abbreviated study.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. There are transvenous device leads noted in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are sternotomy wires present. There is a left chest wall pacemaker with associated artifact. 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. Normal size LV with normal systolic function (EF 58%). 2. Normal size RV with mildly reduced systolic function (EF 48%).3. Biatrial dilation consistent with history of cardiac transplant. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Headache(784.0) [784.0], Reason for Study: ^Reason: evaluate for infarct; Head CT showing possible R lacunar infarct History: Head CT with possible R lacunar infarct; persistent headaches No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Bilateral mastoid air cells are opacified.", "output": "Normal brain MRI."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Bleed. Signs and symptoms: Fall. Non-enhanced head CT conalthere is no evidence of intracranial hemorrhage, edema mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray white matter differentiation is within normal.Calvarium, limited view of paranasal sinuses, mastoid air cells and scalp demonstrate no abnormality.Nonenhanced CT of lumbar spine:There is normal alignment the vertebral column. Diffuse area of thickened bony trabeculation involving the body of L1 vertebrae is believed to represent a hemangioma. This finding is best appreciated on axial image 18. The bony density of the lumbar spine is otherwise unremarkable. No evidence of fracture is identified. There is mild to moderate degenerative disk disease and multilevel bulge of disk material. There is also moderate hypertrophic changes of posterior elements of the ligamentum flavum and facet complexes. There is no measurable central spinal stenosis however this should be further evaluated with an MRI. Hypertrophic changes of posterior elements are most noticeable and prominent at L4 -- L5 level with resultant mass effect on the thecal sac with forward displacement.Nonenhanced CT of cervical spine:Extensive degenerative disk disease more severely at C5 -- C6 is present. Very extensive and prominent anteriorly projecting osteophytes from C2 level to T1 level are noted along the anterior aspect of vertebral column. There is evidence of mass effect on the soft tissues of the neck.There is no evidence of fracture or malalignment. There is normal articulation of occipital condyles with C1 and C1 with C2.", "output": "1.Negative nonenhanced CT of brain.2.CT of the lumbosacral spine demonstrates no evidence of fracture or malalignment.3.CT of cervical spine demonstrates no evidence of fracture or malalignment. Extensive degenerative disk disease and very large hypertrophic spurs project anteriorly into the soft tissues of the neck and there is no significant spur posteriorly within the spinal canal."}
{"instruction": "Generate impression based on findings.", "input": " MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant soft-tissue swelling anterior to the tibial tuberosity or loss of the sharp inferior angle of the infrapatellar fat pad. No thickening and edema of the inferior patellar tendo. No findings to suggest an infrapatellar bursitis. Cartilage is intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Small uncomplicated baker's cysts without specific findings to support Osgood Schlatter's "}
{"instruction": "Generate impression based on findings.", "input": "CT of the head and right paracervical spine. 56-year-old male with daily headaches x 2 years. Also mass right neck, positive cervical radiculopathy. CT of brain without infusion:No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. Calvarium, limited via paranasal sinuses, mastoid air cells and middle ear cavities are also within normal limits.CT of cervical spine without the infusion:The bony density and the alignment of cervical spine remains within normal limits. Degenerative disk disease including anteriorly projected bridging osteophytes, calcification and hypertrophic changes of posterior longitudinal ligament and bulging disks throughout the cervical spine are not. Degenerative changes at C3 -- C4 causes significant left neural foramina compromise and to a lesser degree of right neural foramina. A ventral hypertrophic spur at C5 -- C6 appears to be in contact with the cord with minimal posterior displacement of the cord. Heavy calcification of hypertrophy posterior longitudinal ligament posterior to C6 is noted. There is compromise of the left neuroforamina at C6 -- C7 level.There is no evidence of any destructive bony lesions. No evidence of any sclerotic bony changes. This examination is tailored primarily for CT of cervical spine and is not the appropriate test for evaluation of soft tissue masses ending at. Bilateral coarse soft tissue mass in the neck CT of the soft tissues of the neck with infusion or an MRI of the soft tissues of the neck is recommended.", "output": "1.Normal CT brain and calvarium without infusion.2.Degenerative changes of cervical spine with resultant multilevel neural foramina compromise as detailed.3.No evidence of any acute or sclerotic bony changes.4.This examination cannot evaluate for soft tissues of the neck since its tailored primarily for evaluation of cervical spine.5.If there is history of mass in the neck a dedicated CT of the soft tissues of the neck with infusion is recommended. 6.The findings were discussed with the clinical service pager # 4146( DR. Cathleen Mulcahy). Because a stated to the clinical service that this exam is not the appropriate test for detection of soft tissue mass in the neck. CT of the soft tissues of the neck with infusion is recommended for evaluation of possible mass in neck."}
{"instruction": "Generate impression based on findings.", "input": "Male 60 years old Reason: acute lower back pain Alignment is normal. Vertebral body heights are maintained. No acute fracture. Lesion involving the sacrum seen on MRI is not well seen due to overlying bowel gas.", "output": "No fracture or malalignment."}
{"instruction": "Generate impression based on findings.", "input": "Seizure. ?Previous tumor resection. There is an anterior, interhemispheric resection bed that is CSF-filled. There is increased T2 signal, volume loss and parenchymal distortion involving the adjacent anteromedial aspect of the frontal lobes. There is an overlying bifrontal craniotomy. Frontal sinuses are opacified which may reflect postsurgical change and/or secretions. Smooth dural enhancement is present which is likely postsurgical. No suspicious nodular nodular enhancement is seen.Multiple foci of susceptibility are seen involving the bilateral cerebellar hemispheres compatible with chronic microhemorrhages. The remainder of the brain is notable for mild volume loss. No evidence of intracranial mass or mass effect. There is ex vacuo dilatation involving the bilateral frontal horns. No hydrocephalus. The major intracranial flow voids are patent (including the anterior cerebral arteries).Mastoid air cells are clear. Two well-circumscribed, T2 hyperintense lesions involving the maxillary alveolar ridge are probably related to the periodontal cysts but not well assessed.", "output": "1.Postsurgical changes of bifrontal craniotomy with resection cavity and gliosis involving the bilateral anterior inferior frontal lobes. There is smooth dural enhancement consistent with postsurgical change. No findings to suggest recurrent tumor.2.Multiple small foci of susceptibility involving the cerebellum are compatible with chronic microhemorrhages.3.No evidence of acute infarct, intracranial mass, or mass effect.4.Opacified bilateral frontal sinuses are at least in part related to postsurgical change with areas of T2 hyperintensity reflecting obstructed secretions or possibly CSF.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "L sided weakness and sensory deficit, r/o stroke MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several foci of susceptibility effect centered in the pons and lower midbrain best seen on susceptibility images..Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present and straightening of the normal cervical curvature.At C2-3 there is no significant compromise to the spinal canal. There is narrowing of the left neural foramen resulting from disc material at this level with some encroachment of the left-sided exiting nerve rootsAt C3-4 there is loss of disc space height, diffuse disc bulge, bilateral uncovertebral osteophytes and some small endplate osteophytes. There is effacement of spinal fluid ventral and posterior to spinal cord at this level with a mild to moderate degree of spinal stenosis. There is also encroachment of the exiting nerve roots within the neural foramina bilaterally due to disc material and osteophytes - worse on the left side compared to the right.At C4-5 there is no significant compromise to the spinal canal. There is a disc bulge present at this level associated with some narrowing of the neural foramina and some mild encroachment of exiting nerve roots at this level.At C5-6 there is no significant compromise to the spinal canal . There is a right lateral recess broad-based disc protrusion present at this level which encroaches on the nerve roots at the right lateral recess.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.", "output": "1.There are multiple old microhemorrhages present within the brain stem. 2.There are multilevel degenerative changes present in the cervical spine with encroachment of the right-sided exiting nerve roots at C5-6 and the left-sided exiting nerve roots at C3-3 and C3-4 and a mild to moderate degree of spinal stenosis at C3-4.3.There is no evidence for acute ischemic cerebral infarction."}
{"instruction": "Generate impression based on findings.", "input": "Prostate neoplasm. Plan to biopsy. PSA of 9.77 ng/ml. Right and left Gleason 6. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.2 x 2.9 cm.Peripheral Zone: Within the mid gland, there is a 0.8 x 0.7 cm T2 hypointense lesion with restricted diffusion (series 1001, image 50), but no definite contrast enhancement, suspicious for carcinoma. Within the right mid gland there is T1 and T2 hyperintense signal, compatible with blood products.Central Gland: The central gland is nodular in appearance, compatible with benign prostatic hyperplasia.Seminal Vesicles: There is no seminal vesicle invasion.Extracapsular Extension: Questionable extracapsular extension is present.BLADDER: No significant abnormality noted.LYMPH NODES: Few subcentimeter external iliac lymph nodes are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Left mid gland peripheral lesion suspicious for carcinoma. Questionable extracapsular extension."}
{"instruction": "Generate impression based on findings.", "input": "known brainstem lesion interval change, projectile vomiting. No evidence of acute ischemic or hemorrhagic lesion.Multifocal scattered high signal intensities on FLAIR images on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.There is ovoid shaped lesion on the left dorsal medulla (6mm x 5mm x 5mm) with subtle enhancement on Gad infusion. There is no evidence of surrounding edema. Possible diagnosis of the lesion is likely low grade glioma.There is no other abnormal enhancement on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "1. Ovoid subtle enhancing left dorsal medullar lesion without surrounding edema, comparing to out side MR scan on Nov 18 2014, the size and MR characteristics do not show any significant interval change.2. Underlying non specific small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male with history of urothelial cancer status post nephroureterectomy and cystectomy with neobladder formation. 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: Status post left nephrectomy. Exophytic T2 hyperintense cyst in the right superior pole. No hydronephrosis.T1 hyperintense focus measuring 9 mm in the right superior pole favored to represent a renal sinus cyst containing hemorrhage or proteinaceous debris. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the midline abdominal wall.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Stable index nodule in the left pelvis. 2.No new sites of disease. "}
{"instruction": "Generate impression based on findings.", "input": "38 years Female (DOB: 10/25/1978)Reason: MS, f/u progression History: pain and gait issuesPROVIDER NAME: ADIL JAVED ADIL JAVED MRI brain: There is redemonstration of multiple periventricular and subcortical white matter lesions as well as lesions in the thalami, internal capsules, brainstem and cerebellum which were also present on the previous exam. These lesions appear to be similar in size and distribution number compared to the previous exam from 1/22/2015. Many of the lesions are perpendicularly oriented to the lateral ventricles. There are some lesions extending into the corpus callosum bilaterally. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The distal spinal cord demonstrates some subtle T2 hyperintense lesions. They are not confirmed on axial imaging.. No abnormal lesions are identified in the lumbar spine. A T1 hyperintense lesion is identified in the L4 vertebral body and most likely represents a vertebral body hemangioma. It suppresses on the inversion recovery images.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. Some subchondral cysts are present at the facet joints at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.There are periventricular subcortical white matter lesions present as well as lesions in the brainstem and cerebellum and deep gray nuclei and internal capsules which are stable and compared to prior exam. These are compatible patient's diagnosis of multiple sclerosis.2.There appear to be lesions in the distal thoracic spinal cord demonstrates some subtle lesions which are compatible with demyelinating disorder. If clinically indicated additional imaging of the thoracic spinal cord may help further assess these and confirm their presence."}
{"instruction": "Generate impression based on findings.", "input": "Numbness and tingling of the right upper extremity with concern for demyelinating disease. There is no evidence of acute intracranial hemorrhage or mass effect. There is a punctate focus abnormal T2 hyperintensity within the white matter of the left inferior frontal lobe and left aspect of the cerebellar vermis, which are nonspecific. There diffusion hyperintensity associated with the left inferior frontal lobe T2 hyperintensity without clear low ADC values. There is an additional nonspecific left frontal lobe punctate T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening of the left maxillary and right sphenoid sinuses.", "output": "Punctate T2 hyperintense foci within the white matter of the left inferior frontal lobe and left aspect of the cerebellar vermis, with mild restricted diffusion associated with the left inferior frontal lobe lesion. The left inferior frontal lobe lesion may represent an acute to subacute infarct versus an active demyelinating lesion which can also show restricted diffusion. Postcontrast sequence would be helpful, but were not be obtained due to inability of gaining intravenous access. Patient will reschedule for the postcontrast sequences. Please note however there is no specific evidence of chronic demyelinating disease on this study although remains a possibility. Further evaluation with CSF analysis may be helpful.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up for multiple sclerosis. There are multiple T2 hyperintense lesions cerebral white matter and perhaps in the right superior cerebellar peduncle. There has been interval increase in size of a lesion in the right superior frontal gyrus and in the left temporal horn periventricular white matter. The other lesions have not significantly changed. Many of the lesions demonstrate T1 hypointensity. 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": "Interval increase in size of demyelinating lesions in the right superior frontal gyrus and in the left temporal horn periventricular white matter. The other lesions have not significantly changed. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " BRAIN: There is abnormal enhancement in the left posterior nasopharynx soft tissues. There is abnormal enhancement along with innumerable foci of non-enhancement representing extensive infection with innumerable abscesses extending into the clivus. There is a low marrow T1 signal with enhancement in the left occipital condyle, inferior aspect of the left occipital bone (opisthion), left lateral mass of C1. There is epidural enhancement with small central abscess and the left cervical spinal epidural space at the foramen magnum extending inferiorly to the C1-2 level. There is extensive enhancement with multiple abscesses in the left prevertebral, paravertebral and the paraspinal left postero-lateral neck soft tissues. There is involvement of the sella surrounding the pituitary gland. There are erosive changes at the posterior cortex of the clivus with extension into the right prepontine cistern as noted previously. These findings are grossly unchanged from the prior examination.There is increased signal abnormality with somewhat bulky appearance and enhancement of the bilateral cavernous sinuses with multiple small abscesses, consistent with bilateral cavernous sinus thrombophlebitis, similar to prior examination. However, there remains no abnormal superior ophthalmic vein enlargement or proptosis. There is persistent enhancement of the walls of the cavernous carotid arteries bilaterally without significant narrowing of the internal carotid arteries.There is contiguous infection extension along the right temporal leaflet from the right cavernous sinus, with a thin subdural empyema in the right tentorial leaflet which is best appreciated on the 3-D postcontrast T1 coronal images. There is asymmetric signal abnormality with heterogeneous enhancement in the left jugular tubercle and left hypoglossal canal. The left proximal internal jugular vein appears occluded and infectious process surrounds the left jugular canal as on the prior examination. These findings are also grossly unchanged from the prior examination. The dural venous sinuses appear patent. There is no acute infarct, mass effect or midline shift. There is no evidence of infection involving the brain parenchyma, or suspicious brain parenchymal enhancement. The ventricles and sulci are normal for patient's age. The flow-voids of the skull base are patent. There are mucus retention cysts in the bilateral maxillary sinuses. There is inflammatory mucosal thickening involving the right sphenoid sinus.CERVICAL: Compared to the prior exam, there is overall slightly decreased infection involvement in the neck. Representative measurements are described below:1.Abscess in the left posterior lateral neck soft tissues previously measured 28 mm compared to 25 mm today on series 21 image 4.2.Soft tissue thickening and enhancement along the left lateral neck measured up to 47 mm previously in short axis, now measuring up to 41 mm in short axis on series 23 image 1. This process extends from the skull base inferiorly to C5-6 level, unchanged in overall extent.3.There is persistent left anterolateral epidural enhancement with foci of central non-enhancement measuring up to 7 mm at the foramen magnum extending to C1-2, compared to 9 mm previously. There is effacement of the ventral CSF space with the epidural component abutting the ventral medulla/cord at C1 level without stenosis.4.There is contiguous left anterolateral epidural infection spreading inferiorly to the C3 level measuring up to 7 mm in thickness with tiny central abscess, similar to prior examination.5.There is asymmetric enhancement in the left neural foramina down to C5-6 which may be reactive to adjacent soft tissue infection, similar to prior examination.There are postoperative findings in the left neck including scattered foci of susceptibility which appear new from prior examination.There is no cord signal abnormality or suspicious enhancement within the cord. There is no restricted diffusion in the cervical cord. Aside from the skull base and C1, there is no osseous signal abnormality or suspicious osseous enhancement in the cervical spine. There is no significant disk herniation, significant spinal canal or neural foraminal stenosis in the cervical spine.", "output": "1.No evidence of infection or abscess within the brain parenchyma.2.Extensive transspatial infection with innumerable abscesses centered in the skull base with extension into the sella with findings suggesting infectious involvement of the pituitary gland. There is thrombophlebitis of the bilateral cavernous sinuses, with contiguous extension of infection into the right tentorial leaflet resulting in a small subdural empyema. These findings are similar to prior outside MRI from January 2015.3.Extensive infectious involvement of the left sided deep neck/paraspinous and prevertebral soft tissue with multiple abscesses extending inferiorly to C5-6 level. Overall, infectious findings in the neck appears slightly decreased from the prior examination, although the overall extent of involvement appears similar to the prior examination. Please see details above.4.Left anterolateral epidural phlegmon/abscess extending from the foramen magnum to C3 level, slightly decreased from prior examination. Please see details above.5.Extensive erosive changes in the clivus with extension of infection into the pre-pontine cistern on the right, similar to prior study. Infectious marrow involvement of the left sphenoid and occipital bone as well as left lateral mass of C1, similar to prior study.6.Infectious process surrounding the left jugular and hypoglossal canals, similar to prior study.7.Left proximal internal jugular vein appears occluded, similar to prior study.Findings were discussed with Neurology resident Dr. Ali Mansour in person at the time of initial interpretation."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old with known left breast cancer. There is scattered fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, with large patchy areas of marked parenchymal enhancement bilaterally, somewhat of a limitation to the study in those regions. At the site of biopsy-proven malignancy in the left breast, there is an irregularly enhancing mass with biopsy clip artifact. Correlating with the mammogram, a smaller satellite projects immediately inferior and medial to the main mass. The overall extent is 2.4 x 2.1 x 3.4 cm. No abnormal enhancement is seen in the right breast, within the limitation described above. In the left axilla, there are several lymph nodes with mildly thickened cortices. These are non-specific in appearance, with etiologies including reactive change (given the recent biopsy) and tumor involvement possible. No abnormal axillary lymph nodes are identified in the right axillary region.", "output": "1. Index lesion in the left posterior breast measures up to 3.4 cm. 2. Asymmetric, non-specific left axillary lymph nodes. Depending on planned management of the axilla, an axillary ultrasound with possible biopsy could be considered. 3. Marked background enhancement distributes in a similar pattern to her parenchyma and limits the evaluation. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Unspecified epilepsy without mention of intractable epilepsyClinical question: h/o epilepsy s/p hippocampal laser ablation The patient is status post bilateral parietal bone and right temporal bone burr hole placement. There are T2 and FLAIR hyperintense tracts extending from the burr holes into the brain parenchyma.There is redemonstration of abutting irregularly shaped ring-enhancing lesions located in the right hippocampal head together measuring 15 x 20 cm in axial dimensions. This was also present on prior exam from 6/2/2015. On T1-weighted imaging and is bright and intermediate signal. On T2-weighted imaging it is predominantly low signal. On FLAIR MRI imaging it is low signal centrally and high signal peripherally. There is no evidence for diffusion restriction associated with it.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There is a ring-enhancing lesion present in the right hippocampus. Most likely this is related to blood products at the prior treatment site. Please correlate with surgical findings."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female presents with altered mental status an lethargy. There is no evidence of acute intracranial hemorrhage or midline shift. There is redemonstration of areas of encephalomalacia involving the right insular cortex, right temporal and right frontal lobes in the distribution of the right middle cerebral artery. There is also encephalomalacia in the left posterior cerebral artery involving the left occipital lobe.The ventricles and basal cisterns are unchanged in appearance compared to prior exam, including small right frontal horn.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1.No acute intracranial hemorrhage or midline shift.2.Stable multiple areas of encephalomalacia.3.CT is insensitive for the early detection of non-hemorrhagic CVA. MRI should be considered if clinical suspicion for CVA persists. "}
{"instruction": "Generate impression based on findings.", "input": "Right knee pain and MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Again seen is a near full-thickness defect of the lateral facet of the patella which slightly progressed compared to the prior exam.. Partial-thickness defects of the medial patellar facet are also noted which appears similar to the prior exam as well. There is also heterogeneous signal within the patellar cartilage relating to degeneration. The femoral trochlea is shallow suggesting dysplasia. The articular cartilage of the lateral compartment is thinned but otherwise intact. The articular cartilage of the medial compartment is intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: Metallic susceptibility artifact is again noted along the proximal tibia relating to prior fixation and osteotomy. No significant abnormality noted.ADDITIONAL", "output": "Slightly worsening patellofemoral cartilage loss. There are no additional acute findings."}
{"instruction": "Generate impression based on findings.", "input": "Patient with pain, evaluate for fracture. Right hip:Severe degenerative changes, including joint space narrowing, subchondral cyst formation, and subchondral sclerosis affect the right hip. There is no discrete evidence of fracture or dislocation, however if there is continued clinical concern for fracture, MRI or CT could be considered.Pelvis:Mild degenerative changes affect the left hip. Severe degenerative changes of the lower lumbar spine are partially imaged. There is moderate degenerative changes of the bilateral sacroiliac joints and pubic symphysis.", "output": "Severe osteoarthritis of the right hip without evidence of fracture. However, if there is continued clinical concern for fracture, CT or MRI may be considered."}
{"instruction": "Generate impression based on findings.", "input": "2-year-old male with right knee pain and swelling, eval for osteomyelitis MENISCI AND LIGAMENTS: The menisci, cruciate and collateral ligaments are normal in appearance.BONE AND MARROW: No evidence of marrow edema or abnormal decreased T1 signal to suggest osteomyelitis. The distal femoral and proximal tibial epiphyses are normal for patient age.SYNOVIUM: No significant abnormality noted. MUSCULATURE: The extensor tendons are normal in appearance. ADDITIONAL", "output": "Normal MRI knee for patient age without evidence of osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old man with history of orthotopic liver transplant, evaluate for HCC. Please note that this study is markedly limited due to susceptibility artifact from the IVC/porta hepatis.ABDOMEN:LIVER, BILIARY TRACT: The partially visualized liver has nodular contour and widened fissures suggestive of cirrhosis. There is a geographic area of increased T2 signal in the right hepatic lobe along with delayed enhancement of this region. There is an approximately 16 x 14 mm round focus of arterial enhancement with washout on delayed phase images (series 103, image 51) in segment 6 of the liver. Restricted diffusion suggested by this focus. Additionally, there is a 10 x 10 mm focus of arterial enhancement with washout on delayed phase images (series 13, image 23) in the dome of the liver.SPLEEN: The spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The left adrenal gland appears normal. The right adrenal gland is not visualized.KIDNEYS, URETERS: The left kidney has uniformly increased T2 signal and diffusion restriction. There is no hydronephrosis. The right kidney appears normal. The kidneys enhance symmetrically with normal nephrograms bilaterally.RETROPERITONEUM, LYMPH NODES: There are two large para-aortic masses which are heterogeneous in appearance but predominantly isointense to liver on T1 and T2 sequences. The left-sided mesenteric mass (series 4, image 27) measures 102 x 94 mm. This mass appears nodular, has small areas of high T1 signal suggesting hemorrhage, nonenhancing areas suggestive of necrosis, and peripheral enhancement. The right-sided mesenteric mass (series 4, image 27) measures 117 by 102 mm. This mass also appears nodular with nonenhancing areas suggestive of necrosis and demonstrates peripheral enhancement.The superiormost intrahepatic IVC and the intrahepatic IVC are not visualized.BOWEL, MESENTERY: Loops of small bowel are displaced by the retroperitoneal masses, otherwise the partially visualized small bowel and colon appear normal. The SMV courses anterior to the right retroperitoneal mass and is attenuated in caliber.BONES, SOFT TISSUES: There are multiple small ventral hernias, most of which contain fat, although one of which contains a portion of the transverse colon without evidence of obstruction. The patient is status post median sternotomy.OTHER: Right lung base pleural nodule (series 3, image 6) measures 12 x 11 mm.", "output": "1.Examination markedly limited by susceptibility artifact as described above, patient motion artifact noted on several sequences as well. Given the findings below, a contrast-enhanced liver protocol CT should be considered.2.Cirrhotic morphology of the liver with geographic increased T2 signal and delayed enhancement of the right lobe which may represent fibrosis or may be perfusional.3.Foci of enhancement in segments 6 and 8 of the liver as described suspicious for HCC.4.Large retroperitoneal masses which may represent necrotic nodal metastatic disease or PTLD or lymphoma (however these latter conditions considered less likely given the heterogeneous appearance).5.Abnormal signal of the left kidney nonspecific but may be related to an early obstructive process. No hydronephrosis.6.Nonspecific right pleural based lung nodule."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with HCV cirrhosis. Evaluate for hepatocellular carcinoma. Due to contrast injector malfunction, no precontrast images were obtained. Initially 15 mL of MultiHance was administered obtaining a portal venous phase. After approximately 20 minutes, an additional 12 mL was injected obtaining the arterial, portal venous, and delayed phases.ABDOMEN: LIVER, BILIARY TRACT: Severely cirrhotic hepatic morphology with caudate hypertrophy. There is been progression of confluent fibrosis and retraction. There are no arterially enhancing lesions. The delayed images demonstrate heterogeneous appearance of the hepatic parenchyma consistent with delayed enhancement within the fibrous bands rather than washout. Cholelithiasis.Gastroesophageal varices are noted.SPLEEN: Splenomegaly is 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: Large volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Sequela of severe cirrhosis without evidence of arterially enhancing lesions. The delayed images demonstrate heterogeneous appearance consistent with delayed enhancement within the confluent fibrosis rather than washout."}
{"instruction": "Generate impression based on findings.", "input": "History of NF 1. New right thigh/buttock pain and twitching. Evaluate for hamartomas and neurofibromas. Brain: Examination is slightly motion degraded. No intracranial mass or mass effect is appreciated. No abnormal parenchymal signal abnormality is seen. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No extra-axial collections. Cerebellar tonsils are borderline low-lying measuring up to 3.5 mm below the foramen magnum without clear evidence of Chiari I malformation.Sella and orbits are grossly within normal limits. There is minimal mucosal thickening involving the paranasal sinuses. Bone marrow signal and extracranial soft tissues are within normal limits. There is a small cervical syrinx which is noted at the C5 level and extends inferior, outside the field-of-view, (sagittal STIR series 25 image 16).Lumbar spine:Examination is motion degraded. The lumbar spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L1level. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. Incidentally seen is a small focus of CSF intensity measuring 9 x 8 mm at the L4-L5 level which may represent a small arachnoid cyst or diverticulum, and of doubtful clinical significance. Specifically no masses within the lumbar spinal canal or neural foramina are appreciated within the limits of noncontrast study. Please refer to separate report for findings in the pelvis. Small subcutaneous nodules are noted in the posterior paraspinous soft tissues compatible with superficial neurofibromas.", "output": "1. MRI of the brain without contrast is within normal limits. Cerebellar tonsils are borderline low-lying without clear evidence of Chiari I malformation.2. Incidentally seen on the brain MRI study is a small cervical syrinx at the C5 level which extends inferiorly, outside the field-of-view. Prior cervical spine MRI from 8/24/2012 also demonstrates a small cervical syrinx. Follow-up dedicated cervical and thoracic spine MRI can be considered for further evaluation as clinically indicated.3. No masses within the lumbar spinal canal or neural foramina are appreciated within the limits of noncontrast study. Please refer to separate report for findings in the pelvis."}
{"instruction": "Generate impression based on findings.", "input": "Female 59 years old Reason: r./o hydro History: signs RIGHT KIDNEY: Mild increased echogenicity. 7.3 cm in length. Septated upper pole cyst measures 1.7 x 2 x 2.7 cm no hydronephrosis.LEFT KIDNEY: 8.5 cm length.As well seen due to body habitus. No definite lesions. Central area of irregularity felt to be vasculature.URINARY BLADDER: : No significant abnormality noted.OTHER: No significant abnormalities noted.", "output": "No hydronephrosis or hydroureter. Echogenic kidneys. Septated cyst right upper pole unchanged from MRI of 10/13. Left kidney not well seen no evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "36 years, Male, Reason: Please assess for brain AVMs, has HHT, hx of stroke related to large pulmonary AVMs. MRI BRAIN: There are at least five punctate foci of susceptibility effect which are seen on the susceptibility weighted sequence in the bilateral frontal lobes as well as the left thalamus. There may be an additional punctate focus in the left temporal lobe adjacent to the left temporal horn. No significant associated edema, gliosis, or enhancement. No restricted diffusion to suggest acute ischemia. No clear evidence of prior infarct. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Sella and orbits are grossly within normal limits. There is a right maxillary sinus mucus retention cyst and minimal bilateral maxillary sinus mucosal thickening. Bone marrow signal and extracranial soft tissues are grossly unremarkable.MRA HEAD: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. There is mild ectasia at the left A1-A2 junction without discrete aneurysm.", "output": "1. Multiple (at least 5) punctate foci of susceptibility effect involving the bilateral frontal lobes as well as the left thalamus are compatible with chronic microhemorrhages or possibly tiny cavernous malformations. 2. Mild ectasia at the left A1 A2 junction without discrete aneurysm. No findings to suggest arteriovenous malformation."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 3.8 x 3.5 x 5.1 cm.Peripheral Zone: Focus of T2 hypointensity in the right mid gland peripheral zone with corresponding restricted diffusion measuring 7 x 4 mm. Hypointensity reaches up to the capsule, suggestive of extracapsular extension.Additional focus of T2 hypointensity in the left apical peripheral zone measuring 6 x 7 mm with corresponding restricted diffusion.No definite corresponding suspicious enhancement pattern is evident.Central Gland: Moderate degree of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Findings suggestive of extracapsular extension in the right mid gland peripheral zone.BLADDER: No significant abnormality noted.LYMPH NODES: 6 mm right inguinal lymph node.BONES, SOFT TISSUES: Fat-containing patulous left inguinal canal.OTHER: No significant abnormality noted.", "output": "1.Two foci suspicious for prostate malignancy in the left apical and right mid gland peripheral zone. Findings suggestive of extracapsular extension the right mid gland peripheral zone.2.6 mm right inguinal node noted."}
{"instruction": "Generate impression based on findings.", "input": "Female, 36 years old. Reason: left knee pain History: left knee pain Views of the left knee appear normal for age without specific findings to account for the patient's pain.", "output": "No specific radiographic findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval rot cuff, extent of OA History: shoulder pain Study is limited by patient motion artifact.ROTATOR CUFF: Thickening and increased signal of the distal supraspinatus tendon consistent with moderate to marked tendinopathy. No discrete signal change to indicate tear. Fraying of the undersurface of the supraspinatus and infraspinatus tendons at the greater tubercle insertion site. No muscle atrophy.SUPRASPINATUS OUTLET: Moderate degenerative changes of the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate degenerative changes of the glenohumeral joint with multiple subchondral cysts in the humeral head. Labrum is grossly normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "1.Findings consistent with moderate to marked supraspinatus distal tendinopathy. No discrete tear is evident.2.Moderate degenerative changes of the AC joint and glenohumeral joint. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 31 years old, status post craniotomy for tumor resection. Postoperative findings are seen compatible with recent right frontal craniotomy and right frontal lobe resection. The right-sided dura is mildly thickened and enhancing. The resection cavity is roughly wedge shaped and contains fluid and air.Restricted diffusion is seen along the margins of the resection cavity. A small amount of ragged-appearing tissue is evident within the anterior aspect of the resection cavity but this is nonspecific. Most of the nodular enhancing tissue seen on the preoperative examination has been resected, especially superiorly. Along the inferior posterior aspect of the cavity, however, there remains a region of thickened tissue which contains patchy foci of enhancement appearing similar to prior.Elsewhere in the brain, periventricular T2 hyperintensity, predominantly at the level of the frontal horns, is again seen, a finding which may be related to prior therapy. No new signal abnormality or pathologic enhancement is detected. No new abnormal extra-axial fluid collections are seen. The right frontal horn remains partially effaced similar to prior, while the remainder of the ventricular system is unremarkable.", "output": "Expected findings are seen status post right frontal resection. Most of the nodular enhancing tissue evident on the preoperative examination has been resected, particularly along the superior aspect of the cavity. Along the posterior inferior aspect of the cavity, there does remain some nodular parenchymal thickening which contains patchy foci of enhancement."}
{"instruction": "Generate impression based on findings.", "input": "Female, 41 years old, with back pain. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or marrow replacement is seen.The visualized distal spinal cord and conus are within normal limits. The nerve roots of the cauda equina are generally somewhat crowded which likely reflects a congenitally slender spinal canal. Additional superimposed degenerative findings are as follows:L1-2: Unremarkable. L2-3: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. L3-4: Mild disc bulging, slightly progressed from prior. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy, ligamentum flavum thickening, and disc bulging, progressed from prior. Mild generalized spinal canal stenosis, progressed from prior. Mild bilateral foraminal narrowing. L5-S1: Facet arthropathy, ligamentum flavum thickening, and mild spinal canal stenosis, progressed from prior. Moderate bilateral foraminal narrowing.", "output": "Relatively mild but progressive disc and posterior element degeneration is seen from L3-4 through L5-S1. Superimposed upon a congenitally narrow spinal canal, these findings contribute to mild spinal canal and foraminal stenosis as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Squamous cell lung cancer. There is a linear area of high T2 signal that extends from the posterior limb of the left internal capsule into the corona radiata without associated restricted diffusion. There are also mild scattered foci of T2 hyperintensity in the cerebral white matter elsewhere without restricted diffusion. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.", "output": "Linear area of high T2 signal that extends from the posterior limb of the left internal capsule into the corona radiata without associated restricted diffusion may represent a prior lacunar infarct. Otherwise, no evidence of intracranial metastases, hemorrhage, or acute infarction."}
{"instruction": "Generate impression based on findings.", "input": " Alignment is anatomic. No loss of vertebral body height. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. L1/2: No evidence foraminal narrowing or spinal canal stenosis. L2/3: Mild hypertrophy of the ligamentum flavum and disk dessication. No evidence of neuroforamina or central canal stenosis.L3/4: Mild hypertrophy of the ligamentum flavum and disk dessication. No evidence of neuroforamina or central canal stenosis.L4/5: Mild hypertrophy of the ligamentum flavum and disk dessication. No evidence of neuroforamina or central canal stenosis. L5/S1: Ligamentum flavum hypertrophy, right greater than left. Mild disk desiccation and loss of disk height. Moderate right neural foraminal narrowing. No evidence of left neural foraminal narrowing or central canal stenosis. Sacrum: Expansion of the thecal sac with bony remodeling of the neuroforamina bilaterally, right greater than left. There is extension to the S2 neuroforamina with mild mass effect with forward displacement and flattening of the right S2 nerve root. There is lesser mass effect on the left S2 nerve root. There is no abnormal signal of the nerve roots.", "output": "1.Expansion of the thecal sac with bony remodeling of the sacral neuroforamina bilaterally, right greater left. There is mild mass effect on the S2 nerve roots bilaterally, right greater than left. The differentials include prominent Tarlov cysts, perineural cyst, or arachnoid cyst. Myelogram with delayed imaging will be helpful for further evaluation.2.Degenerative disk disease as above, without significant central canal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "67 year old female pre-vertebroplasty procedure scan There is normal lumbar spine lordosis. Examination again shows mild collapse of the L5 vertebral body with sclerotic change, more prominent on the left side. Axial images show soft tissue density intra-osseous mass on the left with posterior extension to the left hepatic lobe and transverse process, and extending into the neural foramen and adjacent paraspinal space (axial image 60/105, sagittal image 28). There is vacuum phenomenon at L5-S1 intervertebral disk space.There is no vertebral body destruction in the residual lumbar spine. No bony destruction is identified in other segments of posterior elements.Disk bulge is noticed at L2-3, L3-4 and L4-5 level. Please refer to the dedicated lumbar spine MRI examination for more details on degenerative change findings.", "output": "L5 vertebral column metastatic lesion as detailed above. "}
{"instruction": "Generate impression based on findings.", "input": "Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: ^Reason: 42 yo M with recurrent GBM enrolled on clinical trial of re-irradiation, eval extent of disease pre-treatment History: left arm weakness Previously seen right frontal lobe and corpus callosum genu mass which extended toward left frontal lobe with enhancement show more intra tumoral enhancement especially corpus callosum genu area mass on today's scan.There are also more conspicuous enhancements of the right frontal mass especially posterior aspect. However, the maximum diameter of the lesion as well as mass effects toward adjacent ventricle and extents of surrounding edema do not show any significant interval change.Therefore, these interval changes may indicate super imposed effects of Avastin therapy but cannot exclude possibility of tumor progression.Previously seen postoperative changes of the right temporal lobe, insular and the right frontal lobe inferior parietal gyrus with associated overlying dural enhancement are again seen, unchanged. The ventricles, sulci and cisterns are unremarkable.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "Interval increase of the extent of enhancing portion of postoperative tumor especially corpus callosum genu portion mass and posterior aspect of right frontal mass. However, these findings are not associated with identifiable interval tumor size increase, nor evidence of increasing mass effects. Differential diagnosis include interval tumor progression and post Avastin therapy effects."}
{"instruction": "Generate impression based on findings.", "input": "Well-controlled HIV, treated syphilis, admitted for confusion, dizziness, unsteady gait. Had a fall 1 week ago and again 1 day before admission. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is moderate diffuse cerebral volume loss. There is a developmental venous anomaly in the posterior right perisylvian region. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.", "output": "Diffuse cerebral volume loss and probable chronic mild cerebral white matter disease. No evidence of acute intracranial hemorrhage, mass, or acute infarct."}
{"instruction": "Generate impression based on findings.", "input": "Male 58 years old Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3.7 x 4.1 x 4.0 cm.Peripheral Zone: Diffuse intrinsic T1 hyperintense signal throughout the prostate, particularly the peripheral zone suggestive of hemorrhage. Multiple foci of abnormal T2 hyperintense signal within the peripheral zone. A dominant focus of signal abnormality measures 0.7 x 1.2 cm in the right posterior basal/mid gland. A second dominant focus measures 0.6 x 1.1 cm in the left posterolateral base/mid gland. Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality, in particular no evidence of seminal vesicle invasion. Extracapsular Extension: There is suspicion for bilateral extracapsular extension. This is in the region of the expected location of the neurovascular bundles.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent external iliac chain lymph nodes are nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Two dominant foci of signal abnormality in the peripheral zone suspicious for prostatic carcinoma. There is suspicion for bilateral extracapsular extension."}
{"instruction": "Generate impression based on findings.", "input": "Left optic disc swelling and vision loss. History of venous tributary occlusion of retina on the right and breast cancer. Brain: There is a homogeneously enhancing extra-axial mass overlying the left lateral temporal convexity that measures up to 15 mm in width with associated hyperostosis. 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.Orbits: There is diffuse enhancement and prominent high T2 signal along the left optic nerve sheath and protrusion of the left optic nerve disc. The left optic nerve itself displays high signal on diffusion-weighted imaging, perhaps due to pressure effects, but displays normal T2 signal and no associated enhancement. There is no discrete mass lesion in the right orbit. The left extraocular muscles and lacrimal gland are unremarkable. The right optic nerve appears to be relatively atrophic. The right orbit is otherwise unremarkable.", "output": "1. Findings suggestive of left optic perineuritis versus perhaps an infiltrative neoplastic process.2. Unchanged left lateral temporal convexity probable meningioma."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate left facial mass concerning for left sinonasal malignancy. There is a heterogeneous and infiltrative mass centered in the left sinonasal region, completely obliterating the left maxillary sinus and much of the left nasal cavity and ethmoid sinuses, with extension into the inferior and medial extraconal orbit, abutting the left inferior rectus muscle, and into the overlying left facial subcutaneous tissues with surrounding fat stranding and into the retromaxillary space. There is also compression of the left nasolacrimal duct, with dilatation of the lacrimal sac. Overall, the mass measures up to approximately 7 cm. There are secretions and mucosal thickening in the left frontal sinus and right ethmoid sinuses. The right orbit and paranasal sinuses are unremarkable. There is a mildly enlarged left level 1B lymph node that measures 10 x 17 mm in axial section. There is no significant cervical lymphadenopathy elsewhere in the neck. The salivary glands appear to be grossly intact. There is no evidence of gross intracranial tumor. There is no evidence of acute cerebral infarction, hemorrhage, or ventriculomegaly. There is minimal nonspecific periventricular T2 hyperintensity.", "output": "1. An aggressive mass centered in the left sinonasal region with extension into the extraconal orbit, the overlying left facial subcutaneous tissues, and the retromaxillary space is compatible with a malignant neoplasm. 2. A mildly enlarged left level 1 lymph node may represent metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "35 years Female (DOB:12/30/1980)Reason: Prior MRI shows lesions consistent with MS but no findings= RIS. Today has a babinski on the right so now CIS. Burden change? Activity? History: right Babinski Lhermitte's signPROVIDER/ATTENDING NAME: BARRY G. ARNASON BARRY G. ARNASON The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple periventricular white matter lesions present some which are perpendicularly oriented to the lateral ventricles as well as some lesions extending towards the orbits callosum along the colossocingulate junction. These are identified on the prior exam in have not changed to any significant degree. There is no associated contrast enhancement with these lesions current exam. Additionally there are white matter lesions present in the posterior fossa including the left middle cerebellar peduncle and medulla where there are stable lesions, however, there is a new lesion along the left superior semilunar lobule of the left cerebellar hemisphere which lesion has developed since the prior exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "Since the prior exam patient developed a new lesion along the left cerebellar hemisphere. The rest of the study appears stable. Is omental patient's known clinical history of demyelinating disorder"}
{"instruction": "Generate impression based on findings.", "input": "43-year-old male with chronic pancreatitis and new onset right lower quadrant pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Numerous calcifications are scattered throughout the pancreas, compatible with chronic pancreatitis.A 14 x 9 cm cystic lesion is seen at the junction of the body/tail of the pancreas (series 3, image 41) with possible associated calcifications, unchanged from recent MRI.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is not definitively visualized. No right lower quadrant inflammatory changes are visualized.A tubular, blind ending structure (series 3, image 114) arises off the distal ileum, compatible with a Meckel's diverticulum. No adjacent inflammatory changes are visualized.Mild diffuse haziness of the mesentery is seen, not significantly changed.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace free fluid in the pelvis, unchanged.", "output": "Meckel's diverticulum without adjacent inflammatory changes. Nonvisualized appendix without inflammatory changes in the ileocecal region to suggest appendicitis.Cystic lesion in the pancreas, unchanged from MRI from 7/15/09. In retrospect, this is compatible with a side branch IMPN. Follow-up MRI may beneficial."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate left knee for lateral meniscus tear, loose body. History: left knee pain MENISCI: We see no discrete lateral meniscal tear. There is attenuation of the posterior horn of the medial meniscus with increased signal intensity throughout its substance likely reflecting extensive degeneration and tearing. The root of the posterior horn of the meniscus is not clearly identifiable. There is poorly defined increased signal intensity within the body of the meniscus also likely representing degeneration and perhaps degenerative tearing. The body of the meniscus is extruded medially. Additionally, there is low signal intensity beneath the extruded meniscus which could represent displaced meniscal tissue or a thickened meniscotibial ligament.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the medial tibiofemoral compartment with areas along the weightbearing portion of the medial femoral condyle and medial tibial plateau essentially devoid of articular cartilage with associated degenerative subchondral signal abnormality and cyst formation. There is also heterogeneity of the articular cartilage of the lateral compartment indicating relatively mild degeneration. There is also near full-thickness to full-thickness fissuring of the articular cartilage of the femoral trochlea, centrally. There are tricompartmental osteophytes.LIGAMENTS: There is thickening and increased signal intensity of the ACL and PCL likely representing mucoid degeneration. The collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Severe osteoarthritis of the knee particularly affecting the medial tibiofemoral compartment with extensive tearing of the medial meniscus. We see no discrete lateral meniscal tear or loose body.2. Mucoid degeneration of the cruciate ligaments and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Fasciculations and vertigo. There is no evidence of intracranial hemorrhage or acute infarct. There is a fat-signal intensity lesion along the pituitary stalk that measures up to 6 mm. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are subcentimeter nasopharyngeal retention cysts.", "output": "1. Incidental subcentimeter lipoma or dermoid along the pituitary stalk.2. No evidence of intracranial hemorrhage or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female with history of hemoglobin SS with lower back pain, shooting down leg. Diffuse hypointensity of the bone marrow again seen without abnormal enhancement or evidence of bone marrow edema. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The conus medullaris is normal in signal and morphology and terminates at an appropriate level. There is no significant spinal canal or neural foraminal stenosis at any level. The paravertebral soft tissues are unremarkable. There is diffuse low signal in the partially imaged liver and also present previously.", "output": "1. No significant disc disease, spinal canal or neural foraminal stenosis at any level.2. Diffuse marrow signal hypointensity as well as low signal in the partially imaged liver consistent with known sickle cell anemia and iron overload. "}
{"instruction": "Generate impression based on findings.", "input": "Multiple myeloma and CML BONE MARROW: Subtle areas of intermediate to low signal intensity are identified within the left posterior ilium on series 501 images 34 and 35 and these demonstrate slight hyperintensity on corresponding T2 fat saturated sequences. Additional areas are identified within the right iliac wing (series 501 image 42) and the right proximal femur (series 501 image 9)SOFT TISSUES: No significant abnormality noted. JOINTS: There is mild osteoarthritis of the hips with a small amount of fluid identified within each hip joint but no sizable effusion.ADDITIONAL", "output": "Subtle areas of intermediate to low signal intensity within the pelvis particularly in the left posterior ilium suspicious for early myelomatous involvement."}
{"instruction": "Generate impression based on findings.", "input": "Reason: New pelvic mass, presumed vaginal carcinoma. Need further evaluation with MRI prior to chemoradiation. History: As above PELVIS:UTERUS, ADNEXA:Patient is status post hysterectomy.There is a circumferential mass centered at the vaginal cuff involving the mid and upper vagina, extending cranially 6.8 cm and measuring approximately 8.3 x 5.2 cm in transverse dimension (501/44, 81/25). There are multiple parametrial soft tissue nodules in the pelvis. Nodules on the left extend to within 1 to 2 mm of the adjacent sidewall (601/41). There are multiple perirectal and retrorectal soft tissue implants within the mesorectal fascia with a large mass measuring 4.5 x 3.7 cm. Perirectal soft tissue implants abut and and are intermittently associated with the rectosigmoid colon (801/34) without definite invasion. A portion of the dominant mass abuts the left aspect of the posterior bladder wall. BLADDER: No significant abnormality noted.LYMPH NODES: Multiple enlarged pelvic lymph nodes with a left external iliac iliac node measuring up to 3.3 x 3.6 cm which compresses the left external iliac vein. Para-aortic lymphadenopathy is seen on coronal views and demonstrated on recent CT (701/18).BOWEL, MESENTERY: Multiple perirectal implants abutting the rectosigmoid as above. No mass is seen within the colon to indicate a colon cancer.BONES, SOFT TISSUES: Multiple enhancing osseous lesions likely represent metastases including the bilateral sacrum, bilateral inferior pubic rami and proximal left femoral diaphysis.OTHER: Partially thrombosed aneurysmal and normal in all all dilatation of the right common iliac artery measuring 3.2 cm", "output": "1.Vaginal cuff mass involving the upper vagina and extending into the parametrial tissues with multiple soft tissue nodules within the pelvis. A gynecological malignancy is favored including endometrial or upward extension of a vaginal or possibly cervical cancer. Correlate with history, as this also could represent a recurrent tumor.2.Retroperitoneal and pelvic lymphadenopathy.3.Multiple enhancing osseous lesions, likely metastases."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for progression of lumbar disease. Signs and symptoms: Back pain. Nonenhanced lumbar MRI:The signal intensity of the vertebral column demonstrate changes secondary to degenerative disease and are unremarkable otherwise.The alignment of vertebral column remains anatomical however there is mild straightening lumbar lordosis.Normal visualized thoracic spine and thoracic cord from T10 inferiorly is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild disk disease and subtle loss of disk height and moderate bilateral (left greater than right) facet hypertrophic changes and including the left facet effusion. Mild to moderate bilateral (right greater than left) ligamentum flavum hypertrophy is also noted. There is resultant mild central spinal stenosis and no neural foraminal compromise. There is a slight progression of degenerative changes since prior exam.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophic changes. There is no spinal stenosis and no neural foraminal compromise. There is no significant change in extent of changes since prior study.L4 -- L5 demonstrate mild disk disease, moderate to severe (left greater than right) ligamentum flavum hypertrophic changes and mild bilateral facet hypertrophic changes. Constellation of changes results in moderate central spinal stenosis. There is no appreciable change in the extent of degenerative changes since prior study.L5 -- S1 demonstrate moderate disk disease and loss of disk height, mild to moderate symmetrical bilateral ligamentum flavum hypertrophy and mild bilateral facet disease and facet effusion. There is no central spinal stenosis or neural foraminal compromise. There is however mild compromise of the lateral recess of the canal bilaterally. Although there is no significant change in the extensive of degenerative changes at this level there is interval decreased size of broad-based disk protrusion far laterally on the left since prior exam.", "output": "1.Degenerative changes of disks and the posterior elements demonstrate mild progression since prior exam as detailed.2.At L2 -- L3 mild central spinal stenosis again noted without significant change.3.Moderate central spinal stenosis at L4 -- L5 without significant change.4.At L5 -- S1 there is interval decreased size of far left lateral disk protrusion since prior exam.5.No significant neural foraminal compromise at any level."}
{"instruction": "Generate impression based on findings.", "input": "Right orbitozygomatic craniotomy for orbital schwannoma resection. There has been interval evolution of postoperative findings related to orbital tumor resection with minimal residual fluid in the anterior superior extraconal right orbit. There is interval resolution of the edema in the inferior right frontal lobe gyrus along the surgical approach and resolution of dural enhancement along the floor of the right anterior cranial fossa. There is mild protrusion of the right orbitofrontal gyri into the right orbit through a defect in the superior orbital wall and mild deformity of the right superior rectus-levator complex. The right orbital contents are otherwise intact and the left orbit appears unremarkable.", "output": "Interval evolution of postoperative findings orbitozygomatic craniotomy without evidence of recurrent tumor."}
{"instruction": "Generate impression based on findings.", "input": "32 year old with history of left breast cancer on neoadjuvant chemotherapy. Extensive suspicious calcifications in the left breast. On recent MRI, asymmetry in the right inferior breast was also identified, and further evaluation was recommended. LEFT BREAST:A targeted left ultrasound was performed patient's known left upper outer quadrant cancer. In the upper outer quadrant at the 1:00 position 3 cm from nipple there is a hypoechoic mass with biopsy clip seen centrally measuring approximately 7 x 3 x 12 mm (CC x AP x LR), consistent with biopsy-proven cancer. This mass measured up to 3 cm per report from outside hospital. There is an elongated geographic mixed echogenicity area with echogenic calcifications extending from the mass along the 1:00 radian. The mass and the adjacent strip measures approximately 18 mm long, and is 6 mm thick. There is an adjacent parallel elongated hypoechoic, geographic area with calcification at the 1:00-2:00 position approximately 4 cm from nipple, inferior and lateral to the biopsy proven cancer which measures approximately 12 x 2 x 11 mm (CC by AP by TV). These likely correlate to areas of non-mass enhancement seen on recent MRI.Targeted ultrasound of the left breast outer lower quadrant from 3:00 to 6:00 was also performed. No abnormalities are identified.RIGHT BREAST:A targeted right ultrasound was performed for the area of concern in the right inferior breast identified on MRI breast 6/1/2015 spanning 3:00 through 9:00 positions. Unremarkable sonographically dense fibroglandular tissue is present throughout the inferior breast. No discrete solid or cystic masses are identified. No correlates to the MRI findings are seen.", "output": "Interval decrease in size of known left breast cancer measuring 7 x 3 x 12 mm, previously measured up to 3 cm. Adjacent mixed echogenicity areas with calcifications are noted as described and likely correlate to areas of non-mass enhancement seen on recent MRI.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old male status post anterior shoulder dislocation now with pain, evaluate for labral tear. ROTATOR CUFF: The rotator cuff is within normal limits. The acromioclavicular joint is normal and we see no fluid within the subacromial/subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is slight deformity of the anterior inferior glenoid from the three o'clock to six o'clock position that we suspect represents a thin crescentic healing Bankhart fracture. There is deformity of the anterior inferior labrum along the suspected fracture that likely represent injury to the labrum; however, we see no fluid separating the labrum from the underlying bone, even on the ABER sequence. There is a small cleft in the articular cartilage of the anterior glenoid as well as a 7 mm linear focus of intermediate signal intensity along the surface of the anterior inferior glenoid which may represent a cartilage flap or fragment. Gadolinium partially separates the anterior superior labrum from the underlying bone and we are uncertain if this represents a tear or sublabral foramen. There is a full-thickness chondral defect along the posterior superior aspect of the humeral head. Small foci of intermediate signal intensity layering dependently in the glenohumeral joint likely represent cartilage fragments. BICEPS TENDON: The long head of the biceps is intact. There is a 5 mm focus of intermediate signal intensity in the biceps tendon sheath, likely representing an additional cartilage fragment.", "output": "Findings indicating prior anterior dislocation as detailed above, including deformity of the anterior inferior glenoid and labrum likely representing a healing Bankhart fracture with additional cartilage defects and fragments as described above."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Neoplasm of unspecified nature of brainClinical question: s/p brain tumor resectionSigns and Symptoms: s/p brain tumor resection There is a 61x56mm sagittal dimension heterogenously enhancing mass in involving the deep white matter of the right frontal lobe and the adjacent subcortical white matter of the right parietal lobe . There is adjacentT2/FLAIR signal hyperintensity compatible with vasogenic edema in an area measuring 91x64 mm axial dimensions. There are satellite foci of enhancement in the adjacent brain. There is susceptibility effect within the mass. Since the prior exam there are more blood products within the mass.The patient is status post recent right sided craniotomy. There is an underlying subdural collection measuring up to 9mm thickness. There is mass effect with 10 mm right sided shift of the septum pellucidum at the level of the internal cerebral veins. This midline shift has increased compared to the prior exam. There is mild uncal herniation present and subfalcine herniation. The right lateral ventricle is compressed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Since the prior exam the patient's right hemispheric mass has developed more hemorrhage and mass effect with slightly greater midline shift. There is mild uncal herniation present.2.Since the prior exam the patient has undergone craniotomy. There is a small extra-axial fluid collection at the craniotomy site."}
{"instruction": "Generate impression based on findings.", "input": " The pituitary gland measures up to 5 mm in craniocaudal thickness. The pituitary gland displays mildly heterogeneous enhancement, although no discrete mass is apparent. The pituitary stalk lies in the midline. The suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable. There is a small retention cyst in the right sphenoid sinus. There may be a small arachnoid cyst in the medial right middle cranial fossa.", "output": "The pituitary gland measures up to 5 mm in craniocaudal thickness, which is smaller than average, but does not meet the criteria for partially empty sella.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with right frontal mass a slight soft tissue/abscess. Rule out bleed. Examination demonstrates an irregularly shaped bony defect of right frontal bone. Soft tissue density mass externally over this bony defect is present. Very minimal epidural thickening also within the intracranial space at this level is present. There is no evidence of edema, mass effect or midline shift secondary to this finding. Further evaluation with an MRI is recommended for possibility of tumor or an infectious process. No additional bony defect is detected. Paranasal sinuses and mastoid air cells are unremarkable. Images through intracranial space demonstrate no definitive evidence of any additional abnormality. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is present.", "output": "1.Irregular bony defect with large extracranial soft tissue component that is concerning for tumor or an abscess and should be further evaluated with dedicated MRI.2.Unremarkable CT examination of intracranial space."}
{"instruction": "Generate impression based on findings.", "input": "Index finger laceration. Patient unable to bend finger. The bone marrow signal of the phalanges appears within normal limits. The tendons in the index finger are normal in signal and size. The remaining soft tissues of the finger are unremarkable.", "output": "No specific findings to account for the patient's decreased function."}
{"instruction": "Generate impression based on findings.", "input": "History of breast cancer on a clinical trial. Evaluate for metastases. There is subtle heterogeneous signal abnormality within the central pons that does not demonstrate enhancement. The appearances is nonspecific and possibly vascular in etiology. There is no associated diffusion restriction.Otherwise, no abnormal signal is seen on the T2, FLAIR or diffusion weighted images. No abnormal enhancement on the postcontrast images. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.", "output": "1.No evidence of intracranial metastatic disease.2.There is a patchy lesion present within the pons which is nonspecific. One possibility is that this is vascular related."}
{"instruction": "Generate impression based on findings.", "input": " CERVICAL SPINE: There is mild kyphosis of the cervical spine, unchanged from the prior radiograph. There is no evidence of fractures or subluxations. The vertebral bone marrow signal is unremarkable. The cervical and upper thoracic spinal cord are normal in signal. The cerebellar tonsils are in normal position. There is no significant spinal canal stenosis or neural foraminal narrowing. The imaged paraspinal contents are unremarkable, including the imaged portions of the cervical arterial flow voids. LUMBER SPINE: For the purposes of numbering five lumbar type vertebral bodies are assumed. There is slight straightening of the lumbar spine in the sagittal plane. There is no evidence of fractures or subluxations. The vertebral bone marrow signal is unremarkable. The vertebral body heights and intervertebral disc spaces are preserved, although there appears to be minimal loss of fluid signal in the L5-S1 disc. The conus is normal in signal and morphology and terminates at an appropriate level. There are no significant posterior disc bulges or herniations. There is no significant spinal canal or neural foraminal stenosis. The imaged intra-abdominal and paraspinal contents are unremarkable.", "output": "1.No evidence of cervical and lumbar spine fractures or subluxations, within the limits of MRI.2. No evidence of cervical spinal cord injury.3. Nonspecific mild kyphosis of the cervical spine and slight straightening of the lumbar spine in the sagittal plane. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: S/p SRS for brain metastasis. Surveillance exam. History: S/p SRS for brain metastasis. Surveillance exam. 58 years Female (DOB:10/11/1958)Reason: S/p SRS for brain metastasis. Surveillance exam. History: S/p SRS for brain metastasis. Surveillance exam.PROVIDER/ATTENDING NAME: STEVEN J. CHMURA SERVICES ANCILLARY Interval decrease of the size of resection cavity on the right middle temporal gyrus reaching to the periventricular white matter of right lateral ventricle occipital horn. In addition, enhancing portion of the lesion is also decreased since prior scan.There is no other abnormal enhancement is seen.No evidence of acute ischemic or hemorrhagic lesion. Right temporoparietal craniotomy is seen, unchanged since prior scan.No intracranial hemorrhage is identified. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The right mastoid air cells opacified, unchanged since prior scan. The visualized portions of the orbits are intact.", "output": "1. Interval decreased size of the resection cavity as well as decreased extent of enhancing portion of the right middle temporal gyrus lesion extended toward the right lateral ventricle periventricular white matter.2. No evidence of new abnormal enhancing lesion.3. No evidence of acute ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Critical question: Evaluate for bleed or mass. Signs and symptoms: Hypertension and headaches. Non-enhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass, mass effect or midline shift or hydrocephalus.Questionable foci of low-attenuation in the subcortical white matter of both hemispheres are noted. These may represent small vessel ischemic disease. The common follow-up with an MRI exam. Cortical sulci, ventricular system and all CSF cisterns are otherwise unremarkable. Calvarium, visualized paranasal sinuses and mastoid air cells are unremarkable.", "output": "1.No evidence of acute intracranial finding.2.Questionable small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "Trauma. The ventricles and basal cisterns are normal in size and configuration. The gray-white matter differentiation is preserved. There is subtle hypoattenuation seen in the subcortical and deep white matter of the superior frontal gyri subcortical white matter and possible expansion of the gyrus. This is unusual for a patient of this age and further assessment with an MRI is advised.There is no mass-effect or midline shift, intra-extra axial fluid collection, or acute hemorrhage.The calvaria and skull base appear normal, no evidence of a skull fracture or diastases of the calvarial sutures. No pneumocephalus.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. No acute intracranial abnormality.2. Subtle low attenuation in the in the high convexity bifrontal deep white matter unlikely traumatic and may represent congenital leukomalacia, further assessment with MRI may be helpful."}
{"instruction": "Generate impression based on findings.", "input": "Pain. Sprain involving the medial collateral ligament MENISCI: No abnormality noted and are well visualized.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Normal marrow signal observed throughout. Cartilage well visualized without focal defectsLIGAMENTS: The ACL, PCL and LCL are well visualized and intact. Stranding in adjacent soft tissue inflammatory changes are observed with the MCL, however the MCL ligament demonstrates minimal thickening towards its superior aspect with fibers that are otherwise intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Moderate MCL sprain without additional abnormality"}
{"instruction": "Generate impression based on findings.", "input": "18-year-old male with right knee pain and swelling, please rule out for MCL tear or meniscal injury. MENISCI: Predominantly transverse, near complete meniscal tear of the posterior lateral meniscus. ARTICULAR CARTILAGE AND BONE: T2 hyperintense signal is visualized within the lateral aspects of the distal anterior femur and proximal posterior tibia. Further, T2 hyperintense signal is visualized medially within the posterior tibia.LIGAMENTS: The MCL and LCL complex remain intact. High T2 signal is visualized within the ACL, though some ligamentous fibers appear intact throughout the course of the ligament.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Predominantly transverse near complete meniscal tear of the lateral meniscus posteriorly.2. Partial ACL tear. No specific evidence to indicate MCL tear, as clinically queried.3. Bone contusions within the distal aspect of the femur and proximal aspect of the tibia."}
{"instruction": "Generate impression based on findings.", "input": "62 years Male (DOB:11/14/1954)Reason: evaluate for blood versus laminar necrosis History: h/x GBMPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status-post right-sided craniotomy. There is a focus of encephalomalacia centered in the right temporal lobe. There is associated T2 and flair signal change within and temporal lobe and enlargement of the trigone of the right lateral ventricle. There is some T1 hyperintensity as well as some patchy contrast enhancement in the right temporal lobe. This appearance was also present on the prior exam from March and does not appear to have changed significantly. There is relatively decreased cerebral blood volume on perfusion maps within this region. Cerebral blood volume maps do not demonstrate any foci of increased perfusion, however, susceptibility imaging demonstrates some small serpiginous signal voids.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This is likely treatment related.There are punctate foci of signal loss and susceptibility imaging involving left thalamus and right temporal lobe. These are stable compared to prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.The patient is status post right temporal lobe surgery for removal of a neoplasm.2.There is abnormal signal within the right temporal lobe and decreased perfusion to the right temporal lobe. Since the prior exam there has been no significant interval change. "}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for brainstem abnormality: Speech apraxia, frequent aspiration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brainstem, cerebellum, and brain parenchyma appear unremarkable, including patchy areas of bilateral parietal terminal zones of myelination. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a 10 mm diameter, well-defined, cystic lesion in the left sphenoid triangle. There is fluid within the bilateral mastoid air cells and scattered paranasal sinus fluid and mucosal thickening, which may be attributable to intubation. The orbits are grossly unremarkable.", "output": "1. The brainstem is unremarkable. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. A 10 mm diameter, well-defined, cystic lesion in the left sphenoid triangle likely represents an inclusion cyst."}
{"instruction": "Generate impression based on findings.", "input": "Somnolence [R40.0], Reason for Study: ^Reason: eval for mass or stroke History: diffuse weakness No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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": "No evidence of acute ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": "New onset seizures and ESRD due to renal agenesis, inflammatory myopathy, APLS, Raynaud's, HTN, and colitis. There are scattered areas of subcortical white matter T2 hyperintensity predominantly involving the left parietal and occipital lobes, and to a lesser extent portions of the right cerebral hemisphere. There are also scattered foci of T2 hyperintensity in the deep white matter. The hippocampi are unremarkable and there is no evidence of heterotopia. There is no evidence of intracranial hemorrhage, mass, 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 appear to be grossly intact. There are artifacts related to dental braces.", "output": "Scattered white mater lesions in the bilateral cerebral hemisphere predominantly involving the left parietal and occipital lobes likely represent a posterior reversible encephalopathy syndrome versus less likely a demyelinating or infectious process, although characterization is limited by the lack of intravenous contrast (acknowledging the patient's renal failure). "}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with history of CNS lymphoma. Pre-surgical planning study. Stealth infused head CT:Nonenhanced 1 mm head CT examination with 2-D reformatted images for surgical planning is obtained.There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains normal. Previously noted minimal small vessel disease on prior brain MRI examination is not identified on this study.Visualized paranasal sinuses, mastoid air cells are unremarkable. Calvarium is intact.New since prior exam is bilateral paramedian high convexity parietal subcutaneous scalp soft tissue thickening which is best appreciated on axial images 27 through 29. Please correlate with history.", "output": "1.No evidence of any intracranial abnormality. Stable exam since prior study.2.Subgaleal soft tissue thickening in high convexity paramedian parietal region is new since prior exam. 3.Unremarkable calvarium, paranasal sinuses and mastoid air cells."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old woman with history of portal vein occlusion and worsening LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver is small and cirrhotic in morphology. No focal hepatic lesion is identified. The portal vein is not visualized beyond the confluence of the SMV and splenic vein. There are numerous, large collateral vessels in the upper abdomen. The gallbladder appears normal.SPLEEN: Spleen is mildly enlarged.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: The kidneys are normal and enhancement symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a large right pleural effusion.", "output": "1.Cirrhotic liver with nonvisualization of the portal vein suggesting thrombosis with large portosystemic collaterals.2.Large right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Left shoulder pain, possible rotator cuff/biceps pathology. ROTATOR CUFF: There is thickening with increased signal intensity indicating moderate tendinosis of the supraspinatus tendon with mild undersurface fraying. There is also focal linear increased signal intensity within the tendon extending to the insertion which may represent interstitial tearing, but we see no full thickness tear. The supraspinatus muscle is normal for age. There is mild to moderate insertional tendinosis of the infraspinatus muscle and perhaps a thin interstitial tear more proximally, but we see no surface tear. There is mild fatty atrophy along the myotendinous junction of the infraspinatus muscle. The teres minor muscle and tendon is intact. There is perhaps mild tendinosis of the subscapularis tendon but otherwise the muscle and tendon appear normal for age.SUPRASPINATUS OUTLET: There is mild to moderate osteoarthritis of the acromioclavicular joint with anteroinferior spurring of the acromion process. There is trace fluid in the subacromial/subdeltoid bursa. The coracoacromial ligament appears normal. The coracohumeral ligament appears slightly thickened.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is a small glenohumeral joint effusion. There is increased signal intensity within the labrum both anteriorly and posteriorly which likely represents degeneration/tearing.BICEPS TENDON: There is increased signal intensity within the intra-articular portion of the long head of the biceps indicating mild tendinosis. Fluid within the biceps tendon sheath likely represents extension of fluid from the glenohumeral joint. ADDITIONAL", "output": "1. Edema within the greater tuberosity that is suspicious for a healing nondisplaced fracture.2. Rotator cuff tendinosis and interstitial tearing as described above without full thickness tear.3. Mild tendinosis of the long head of the biceps tendon.4. Osteoarthritis of the acromioclavicular joint and the labral degeneration/tearing as described above.5. Small glenohumeral joint effusion as well as fluid in the subcoracoid bursa suggesting bursitis."}
{"instruction": "Generate impression based on findings.", "input": "Please evaluate for basal ganglia or other focal lesion: motor and vocal tics for >1 year. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the basal ganglia, and pituitary gland appear 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, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.", "output": "The basal ganglia appear grossly unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "Female, 33 years old, with five year history of MS presenting with a suspected exacerbation with generalized weakness and burning in the left lower extremity. Brain:Multiple T2 hyperintense lesions are redemonstrated within the juxtacortical and periventricular white matter, the corpus callosum, the brainstem and cerebellum. Accounting for differences in technique, there has been no significant interval change in size or number of lesions when compared to the prior examination.No enhancing lesions are seen. No edema or mass effect is detected. Brain parenchymal volume is well-preserved. No restricted diffusion is seen. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections are demonstrated. The ventricles are normal in size and morphology.Spine:A T2 hyperintense lesion within the ventral spinal cord at the C4 level has diminished in conspicuity when compared to the prior examination.A faint T2 hyperintense lesion within the cord at the T2 level is stable or slightly reduced in conspicuity. A T2 hyperintense lesion within the central cord at T10 is unchanged.No abnormalities of the conus or cauda equina are demonstrated. No pathologic spinal cord or leptomeningeal enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow edema or enhancement is seen.Mild disc osteophyte formation is seen in the right paracentral region at C3-4. No significant spinal canal or foraminal stenosis results. Elsewhere, the spine is free of significant disc degeneration and there are no areas of high-grade spinal canal or foraminal stenosis.", "output": "1.Multiple lesions in the brain compatible with demyelinating disease are redemonstrated without significant interval change. No new or enhancing lesions are seen.2.Multiple scattered lesions in the spinal cord compatible with demyelinating disease are stable to reduced in conspicuity when compared to prior exams. No new or enhancing spinal cord lesions are detected."}
{"instruction": "Generate impression based on findings.", "input": "Secondary glioblastoma on Avastin. There are post-treatment findings in the right frontal lobe related to tumor resection. There is no significant interval change in mildly expansile nonenhancing confluent T2 hyperintensity along the anterior, medial, and posterior margins of the right frontal lobe resection cavity and in the right anterior cingulate gyrus. There is no significant interval change in size of the minimally enhancing ependymal lesion along the lateral aspect of the right frontal horn and the subcentimeter non-enhancing lesion with restricted diffusion along the posteromedial margin of the resection cavity. There is residual gyriform intrinsic T1 hyperintensity in the left cingulate gyrus and paracentral lobule, which likely represents cortical laminar necrosis. There is no evidence of acute territorial infarction. The paranasal sinuses, mastoid air cells, and orbits are unremarkable. The skull and scalp soft tissues appear unchanged.", "output": "1.No significant interval change in presumed residual tumor surrounding the right frontal lobe resection cavity and in the right anterior cingulate gyrus. 2.No significant interval change in size of an ependymal lesion along the lateral aspect of the right frontal horn and along the posteromedial margin of the resection cavity."}
{"instruction": "Generate impression based on findings.", "input": "Reason: PSC, eval for strictures History: Abdominal pain, PSC ABDOMEN:LIVER, BILIARY TRACT: There is volume loss of the right lobe, which may reflect underlying cirrhotic morphology. Areas of alternating biliary stricture and dilatation of the intrahepatic ducts appear similar to prior study in degree and distribution. Common bile duct is normal in appearance. There is stable smooth defect in the common hepatic duct, likely reflecting extrinsic compression from crossing vessel. No new areas of stricture or dilatation of the bile duct. No suspicious hepatic lesions is identified.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Alternating biliary stricture and dilation widely throughout both lobes of liver typical of PSC, appearing similar to prior study. No evidence for new strictures or worsening biliary dilatation. NO mass lesions seen."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Cerebral infarction, unspecifiedClinical question: rule out ischemic infarct, R MCA distributionSigns and Symptoms: worsening of known dysarthria, left UE, LE weakness There are no foci of diffusion restriction appreciated.There is encephalomalacia involving the right parietal lobe and to lesser degree adjacent right frontal lobe and temporal lobe as well as right insular cortex. This is all in the distribution of the right middle cerebral artery territory predominantly. There is associated loss of volume of the right cerebral peduncle. There is associated ex vacuo effect along the right lateral ventricle.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There is no evidence for acute infarction.2.Encephalomalacia involving right middle cerebral artery territory structures predominantly centered in the right parietal lobe but also involving the adjacent brain is most likely related to prior cerebrovascular event.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "History of carcinoid syndrome and left adrenal mass. Unknown primary. ABDOMEN: The study is limited by the patient's body habitus and suboptimal images on some of the imaging sequences.LIVER, BILIARY TRACT: Significant hepatic steatosis. No focal liver lesion. Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left and right adrenal gland are essentially normal in morphology size and signal intensity without a focal lesion. KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No discrete adrenal or liver lesion. Hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are MRI dated February 2, 2015, and ultrasound and mammogram dated February 4, 2014 performed at Lutheran General Hospital . For comparison, diagnostic mammogram and left breast ultrasound, images from ultrasound guided left breast biopsy and post biopsy mammogram, and images from left stereotactic biopsy and post biopsy mammogram performed at Lutheran General Hospital dated January 27, 2015 are available. DIAGNOSTIC MAMMOGRAM and LEFT BREAST ULTRASOUND (1/27/2015): Two standard views of the right breast and 3 standard views, one spot compression, and two magnification views of the left breast were obtained. The breast parenchyma is composed of scattered fibroglandular elements, distributes fairly symmetrically in both breasts. Multiple clusters of calcifications are present throughout the left breast, predominating within the central inner aspect. Notably, branching calcifications are present within the central slightly inner left retroareolar breast, mid depth. Total extent of calcifications spans approximately 7.2 cm AP x 5.6 cm transverse x 5.5 cm craniocaudal, extending to the level of the nipple. A 9 mm focal asymmetry is present within the upper inner left breast posteriorly, subjacent to a palpable marker (BB), and persists on spot compression imaging. No dominant mass, suspicious calcifications, or areas of architectural distortion are present in the right breast.Diagnostic ultrasound shows an irregular hypoechoic mass at the 11 o'clock position of the left breast, 8 cm from the nipple measuring 1.1 x 0.8 x 0.8 cm. Mild increased vascularity is present. Other images labeled left axilla show no lymph nodes. STEREOTACTIC GUIDED LEFT BREAST BIOPSY and SPECIMEN RADIOGRAPH (1/27/2015): Images from stereotactic biopsy of linear, branching calcifications within the central left breast are provided. Targeting appears appropriate. Calcifications are noted within the biopsy specimen.ULTRASOUND GUIDED LEFT BREAST BIOPSY and POST-BIOPSY MAMMOGRAM (1/27/2015): Images from ultrasound guided biopsy of the left breast mass at the 11 o'clock position, 8 cm from the nipple are provided. Targeting appears appropriate.Three standard views of the left breast were obtained post stereotactic and ultrasound guided biopsies. An X-shaped biopsy clip is present at the stereotactic biopsy site within the nipple central left breast. Residual calcifications are present extending anteriorly to the nipple. A coil-shaped biopsy marking clip is present within the upper inner left breast, corresponding to the site of ultrasound guided biopsy. Distance between these clips is 6.5 cm on the MLO view.BILATERAL BREAST MRI (2/2/2015): Bilateral breast MRI was performed without and with gadolinium per outside hospital protocol. Susceptibility artifact is present from biopsy clips within the upper inner and mid central left breast. There is diffuse non-mass enhancement within the central and inner left breast extending from the pectoralis muscle posteriorly to the nipple base anteriorly, spanning 10.2 cm AP x 5.3 cm transverse x 8.0 cm craniocaudal. No pectoralis enhancement is present to suggest muscular involvement.Within the outer right breast, there is a circumscribed, enhancing, mass measuring 0.8 x 0.9 x 0.8 cm. No further suspicious areas of morphology or enhancement are present in the right breast. No suspicious axillary nodes. ULTRASOUND RIGHT BREAST (2/4/2015): Targeted right breast ultrasound was performed. At the 10 o'clock position of the right breast, 5 cm from the nipple there is a 0.9 x 0.7 x 1.1 cm circumscribed hypoechoic mass without internal vascularity. This is correlative to the MRI finding. ULTRASOUND GUIDED RIGHT BREAST BIOPSY and POST-BIOPSY MAMMOGRAM (2/2/2015): Images from ultrasound guided biopsy of the right breast mass at the 10 o'clock position are submitted. Targeting appears appropriate. Two standard views of the right breast were obtained post biopsy. A wing shaped clip is present within the upper outer right breast, corresponding to the mass on MRI.PATHOLOGY: Per outside report, pathology results for the ultrasound guided biopsy of the left breast mass resulted invasive ductal carcinoma, grade 2. Pathology results for the stereotactic guided biopsy of left breast calcifications resulted ductal carcinoma in situ, grade 2. Pathology results of the ultrasound guided biopsy of the right breast mass resulted fibroadenoma.", "output": "1. Left breast mass and extensive calcifications status post biopsy revealing invasive ductal carcinoma and DCIS, respectively. There is diffuse non-mass enhancement of the central and inner left breast on MRI, corresponding to calcifications on mammogram, copmpatible with extensive DCIS. Total area of enhancement spans 10.2 x 5.3 x 8.0 cm (AP x ML x CC).2. Right breast biopsy proven fibroadenoma. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male with elevated PSA, PSA 7.9, prior biopsy revealed Gleason 6, was on active surveillance PELVIS:PROSTATE:Prostate Size: 4.5 x 3.6 x 5.0 cm.Peripheral Zone: Focus of T2 hypointensity measuring 6 x 4 mm in the right mid gland peripheral zone (series 501, image 94) with corresponding asymmetric restriction. ADC restriction measures approximately 6 mm in largest dimension.Central Gland: Moderate degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.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.Focus of T2 hypointensity in the right mid gland peripheral zone as described suspicious for malignancy."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: History of lung cancer. Please evaluate for metastases. Signs and symptoms: Lung cancer. Enhanced CT of brain:There is no definite evidence of metastatic disease to the brain, leptomeninges or the calvarium. This examination is essentially within normal limits for patient's stated age of 73. CAT scan can miss very small metastatic lesions. Please correlate with history and follow-up with an enhanced MRI is recommended.Calvarium, visualized orbits, paranasal sinuses and mastoid air cells are unremarkable.90 cc of Omnipaque 3 350 is administered for above study.", "output": "No evidence of metastatic disease and essentially unremarkable enhanced CT of brain for patient's stated age of 73."}
{"instruction": "Generate impression based on findings.", "input": "56Yrs female with a history of breast cancer treated with mastectomy, radiation, and chemotherapy in 2008 found to have atrial arrhythmia and left ventricular dysfunction. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 105 ml/m2 (normal range: 65+/-11), the LVEDV is 219 ml (normal range 109+/-23), the LV end systolic volume index is 63 ml/m2 (normal range 18+/-5), the LVESV is 130 ml (normal range 31+/-10), the LV mass index is 63 g/m2 (normal range 67+/-11), and the LV mass is 130 g (normal range 114+/-24). The left ventricular dysfunction is global with regional variation. There is septal bounce of unknown etiology. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 90 ml/m2 (normal range 69+/-14), the RVEDV is 187 ml (normal range 110+/-24), the RV end systolic volume index is 57 ml/m2 (normal range 22+/-8), and the RVESV is 118 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. 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 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. The left ventricle is moderately dilated with mildly reduced systolic function(LVEF 41%). The left ventricular dysfunction is global with regional variation. There is septal bounce of unknown etiology. 2. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process."}
{"instruction": "Generate impression based on findings.", "input": "History of ovarian cancer, BRCA1 mutation carrier and family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Susceptibility artifact is present in the lower lateral right breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "60 years Male (DOB: 3/14/1956)Reason: 60F with h/o MS, neuro c/s service requesting MRI Javed protocol to further assess History: diffuse pain, joint contractures, poor appetitePROVIDER NAME: IRSK J ANDERSON IRSK J ANDERSON MRI brain:There is a moderate degree of periventricular white matter lesions present associated with some volume loss. These are perpendicularly oriented to the lateral ventricles. They are hyperintense on T2 and FLAIR and hypointense on T1. There is no associated contrast enhancement. Additional similar appearing punctate lesions are identified in the brainstem, left cerebellar hemisphere and subcortical white matter.There is a small focus of encephalomalacia involving the right inferior parietal lobule and postcentral gyrus which involves a portion of the right supramarginal gyrus. Another small focus of encephalomalacia is present along the left temporal lobe posteriorly.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery flow-void is smaller than the right vertebral artery flow-void. This is nonspecific.The visualized portions of the paranasal sinuses demonstrate scattered opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is an old left-sided medial blowout fracture present.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a vague signal hyperintensity within the spinal cord at the C2-3 level. No abnormal enhancing lesions are identified in the cervical spine. There is reversal of the normal cervical curvature presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small right paramedian disc protrusion at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc protrusion at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes at this level which are worse on the right side where there is some encroachment on the right-sided exiting nerve roots..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.", "output": "1.There are multiple periventricular, subcortical, brainstem and cerebellar lesions present which are compatible patient's clinical diagnosis of demyelinating disorder. There is no abnormal enhancing lesion within the brain parenchyma to suggest acute plaque formation.2.There is a vague spinal cord lesion present at the C2-3 level. One possibility is that this represents a demyelinating lesion.3.There are small foci of encephalomalacia identified in the right parietal lobe and left temporal lobe as detailed above which are of unknown cause. Is possible they are vascular related or related to other injury.4.There are degenerative changes present in the cervical spine worse at C5-6 where there is some encroachment of the right-sided exiting nerve roots due to osteophytes."}
{"instruction": "Generate impression based on findings.", "input": "Paresthesia of skin [R20.2], Reason for Study: ^Reason: please rule out thalamic infarct History: right hemibody numbness Brain MRI.No evidence of acute ischemic or hemorrhagic lesion.Scattered T2/flair high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate slightly ectatic and tortuosity of intracranial vasculature indicating atherosclerotic changes. Otherwise, there is no evidence of intracranial significant luminal stenosis. No evidence of intracranial arterial aneurysm.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific small vessel ischemic disease.3. No evidence of intracranial arterial aneurysm. No evidence of intracranial significant luminal stenosis. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Aphagia, status post TPA. Signs and symptoms: Aphagia Previously noted on MRI examination from 11 -- 16 left thalamic infarct is again identified with no evidence of hemorrhagic transformation. Subtle mass effect by the edema of the stroke on the third ventricle is noted. There is however no evidence of hydrocephalus. No evidence of hemorrhage is detected. No evidence of new findings. Cortical sulci, ventricular system and all CSF cisterns remain within normal.", "output": "Subacute nonhemorrhagic left thalamic stroke."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Patient hypoechoic, concern for cord paralysis. Signs and symptoms: Hypotonia. Enhanced CT of the soft tissues of the neck:Limited images of intracranial space demonstrated ring enhancing lesions in bifrontal lobes at the site of previously noted large parenchymal hemorrhages. There is complete resolution of head CT of blood product at this site since prior head CT from 10 -- 4 -- 10.Images through the skull base, cavernous sinuses, paranasal sinuses and bilateral petrous bones are within unremarkable.Examination demonstrates edematous changes of the left piriform sinus with partial effacement of sinus and subtle enhancement. There is also evidence of left vocal cord paralysis and thickening. There is no evidence of a mass. The above findings could be result of trauma and extended duration of intubation. There is evidence of a sclerotic changes of left aspect of thyroid cartilage with some irregularity. This finding could represent a healing fracture. Further evaluate an MRI of larynx is recommended. There is no evidence of compromise of the airway. The thyroid lobes are within normal size and density. Trachea is intact. No definitive abnormality of the cervical spine is noted. Limited images of the apices of the lungs and mediastinum are within normal limits.60 cc of Omnipaque 350 is administered.", "output": "Edematous changes of the left piriform sinus with asymmetrical enhancement of the mucosal compared to the left may represent inflammatory change. There is evidence of left vocal cord paralysis with soft tissue thickening of the vocal cord. Above changes could be result of long term intubation. The sclerotic changes of the left aspect of thyroid cartilage compared to the right may be an anatomical variation however possibility of a posttraumatic fracture and healing process cannot be ruled out. Follow-up with a dedicated MRI of larynx is recommended if patient's symptoms do not resolve."}
{"instruction": "Generate impression based on findings.", "input": "History of relapsed AML status post transplant with back pain. Thoracic Spine: There is diffuse T1 and T2 vertebral bone signal hypointensity. There is degenerative disc disease in the cervical spine seen on sagittal view without evidence of cord compression. There is no intrathecal hematoma, abscess, or tumor deposit. However, there is posterior epidural lipomatosis at multiple levels, measuring up to 10 mm in thickness and resulting in anterior displacement of the spinal cord and marked effacement of the intrathecal cerebrospinal fluid. Nevertheless, there is not convincing spinal cord deformity or signal abnormality. The vertebral column alignment is anatomic. The vertebral body heights are preserved. There is diffuse subcutaneous edema.Lumbar Spine: There are partially-imaged geographic heterogeneous areas in the bone marrow of the bilateral sacral ala and iliac bones. Otherwise, there is a background of diffuse T1 and T2 vertebral bone signal hypointensity. The conus is normal in morphology and terminates at L1 level. There is a posterior disc-osteophyte complex at the L4-5 level without significant spinal canal or neural foraminal stenosis. There is lack of the usual lordosis, but no spondylolisthesis. The vertebral body heights are preserved. There are bilateral renal cysts. There is diffuse subcutaneous edema.", "output": "1. Diffuse bone marrow signal abnormality related to leukemia. Partially-imaged heterogeneous bone marrow of the bilateral sacral ala and iliac bones may also be related to leukemia and/or treatment effects, although osteonecrosis is a potential consideration. Please refer to the separate pelvis MRI report for additional details.2. Epidural lipomatosis in the thoracic spine associated with multilevel spinal canal narrowing.3. Mild degenerative disc disease at the L4-5 level without significant spinal canal or neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with stuttering, right arm and chest heaviness, pain. There is no restricted diffusion to indicate acute infarct. Focal T2 hyperintensity in the right posterior frontal lobe, left thalamus, and the left pons are consistent with chronic prior infarcts. Other scattered small foci of T2 hyperintensity in the cerebral white matter suggest chronic small vessel ischemic disease. Previously seen T2 hyperintensity in the right medullary olives indicative of hypertrophic olivary degeneration is no longer clearly appreciated. There is no acute intracranial hemorrhage, mass effect, or midline shift. The ventricles and sulci are normal in size and configuration. There is no evidence of pathologic enhancement.", "output": "1.No evidence of acute cerebral infarct as clinically questioned.2.Chronic infarcts in the right posterior frontal lobe, left thalamus, and left pons.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Left-sided ataxia. Posterior circulation stroke. Study is mildly limited by patient motion.BRAIN MRI: There is a wedge-shaped area of diffusion restriction and T1-hypointense/T2-hyperintense signal involving the superior aspect of the left cerebellar hemisphere and the left superior cerebellar peduncle and left posterolateral aspect midbrain, with associated mild swelling causing very minimal mass-effect on the fourth ventricle. This is associated with mild, heterogeneous contrast enhancement reflecting the subacute nature of the infarct. Otherwise, there is encephalomalacia in the lateral left occipital lobe extending into the inferior part of the left parietal lobe, with associated ex vacuo enlargement of the left lateral ventricular occipital horn. There are punctate foci of susceptibility effect within these infarcts which probably reflect mineral deposition or minimal hemorrhage. There are also multiple small CSF intensity lesions in the basal ganglia and in the left subinsular region, compatible with chronic infarcts. There is also moderate periventricular and deep T2-hyperintense lesions, which most likely represent chronic microvascular ischemia, superimposed on moderate brain volume loss. There is no midline shift or brain herniation. Caval septum pellucidum and cavum vergae noted and common incidental findings. There is trace mucosal thickening the paranasal sinuses. There is no gross orbital abnormality. There is no destructive skull lesion.CRANIAL MRA:There is moderate narrowing of the terminal part of right V4 segment and mild narrowing involving the mid left V4 segment and distal basilar artery. The left posterior cerebral artery is mildly attenuated. The right A1 segment is hypoplastic. Otherwise, the anterior circulation shows mild irregularity from mild atherosclerosis but no large vessel occlusion. NECK MRA:Accounting for limitation caused by patient motion, there is no significant, flow-limiting stenosis or occlusion of the cervical carotid arteries or vertebral arteries. However, the origin of the right vertebral artery is suboptimally assessed. Also an apparent severe stenosis involving the mid right V2 segment at C4-C5 level is probably artifactual. Otherwise, the vertebral arteries are mildly irregular, reflective of mild atherosclerosis. There are tiny thyroid nodules, the largest measuring up to 4 mm in the right lobe.", "output": "1.Acute to subacute left cerebellar infarct in the territory of the superior cerebellar artery, associated with only minimal mass-effect.2.Chronic left occipital infarct with punctate foci of hemorrhage or mineral deposition. Moderate chronic cerebral white-matter microvascular ischemia and moderate global brain volume loss.3.There is moderate narrowing of the terminal right V4 segment. Otherwise, there is mild atherosclerotic involvement of the intracranial arteries but no large vessel occlusion. Specifically, the superior, anterior inferior and posterior inferior cerebellar arteries are visualized bilaterally.4.Vertebral arteries in the neck are suboptimally evaluated. There is at least mild atherosclerotic disease involving the vertebral arteries in the neck. No long segment occlusion. Repeat MRA neck or CTA can be considered as clinically indicated. No significant stenosis involving the common or internal carotid arteries. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: mass or old infarct? History: new headache with left-sided numbness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Increased DWI signal in the anterior medial frontal lobes likely represents artifact. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Right maxillary mucous retention cyst/polyp.", "output": "No acute infarct or other findings to explain patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "CT of the lumber spine without effusion. The construct parallel to the disks. Finding pedicular screw placement. Fusion at L4 -- L5. Non-infused CT of lumber spine:Axial 1.0-mm CT images of the entire lumbosacral spine were performed. Sagittal and coronal 2-D reformatted images were also acquired.The alignment the vertebral column is unremarkable.Examination demonstrates advanced degenerative disk disease at L1 -- L2 with significant loss of intravertebral disk height and extensive adjacent endplate sclerosis.Minimal degenerative changes of disks at the other levels are noted.There is significant hypertrophic changes of posterior elements in particular of the ligamentum flavum with heavy calcification at multiple levels. This is more severe at L4 -- L5 level with evidence of mass-effect by hypertrophied ligamentum flavum on the thecal sac and results in central spinal stenosis. There is a focus of low attenuation of the bone with internal thick articulation in the left pedicle of L5 vertebrae highly suspected of skeletal hemangioma. This finding a is also visible on prior MRI examination. On the current exam this finding is most noticeable on axial image 43 of series 80228. On prior MRI exam this finding was visible on sagittal T2 weighted image 12 of series 2 and axial T2-weighted image 31 of series 5.", "output": "1.Extensive degenerative changes of posterior elements throughout the lumber spine in particular of the ligamentum flavum with heavy calcification and resultant central spinal stenosis at L4--L5.2.Small hemangioma of left L5 pedicle measuring approximately 9.6 x 8.6-mm in size."}
{"instruction": "Generate impression based on findings.", "input": "Memory loss. ? Late-onset Alzheimer dementia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate T2-hyperintense lesions in the cerebral white-matter. The brain parenchyma appear unremarkable otherwise. There is unchanged mild expansion of the sylvian fissures and the sulci, reflecting age-appropriate brain volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The expanded, empty sella remains unchanged. There is also a small CSF-filled invagination into the floor of the left middle cranial fossa anterior to the left foramen ovale which is unchanged since the previous examination. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1.Age-appropriate global brain volume loss without specific distribution, not significantly changed since October 2014. 2.Relatively mild white-matter lesions that are nonspecific but most likely vascular related"}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out intracranial bleed. Signs and symptoms: multiple falls. Unenhanced head CT:Findings highly suspected for moderate to advanced small vessel disease of indeterminate age are noted. The large area of low-attenuation in high convexity right frontal lobe white matter with associated mass effect suspected for edema. Recommend further follow-up with an enhanced CT or an MRI with infusion to exclude possibility of malignancy. This is a new finding since prior examination from 2006.There is no evidence of hemorrhage, hydrocephalus or midline shift. Calvarium is intact. Extensive right maxillary sinus opacification and otherwise unremarkable visualized paranasal sinuses.There is also subtle low attenuation of the cortex of the right posterior high convexity frontal lobe suspected for subacute ischemic disease.", "output": "1.High convexity right frontal low attenuation of white matter has the appearance of vasogenic edema and recommend further follow-up with an enhanced study to exclude underlying malignancy.2.Small vessel disease of indeterminate age.3.Subtle low attenuation of the right posterior high convexity frontal cortex may represent a focal area of subacute stroke.4.Recommend follow-up with an enhanced MRI for further evaluation of the above findings."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question to be answered: Hydrocephalus. Signs and symptoms: Mental confusion. No definitive appreciable interval change since prior exam. Limited view of cortical sulci remain similar to what was noted on the prior study. Minimal residual blood within the subarachnoid space in high convexity remains stable. No change in the size of ventricular system. No definitive evidence of new bleed, new area of ischemic change or hydrocephalus. Follow-up with an MRI is recommended if patient's clinical symptoms do not improve.", "output": "Stable exam."}
{"instruction": "Generate impression based on findings.", "input": "Backache, unspecified [724.5] / Malignant neoplasm of breast (female), unspecified site [174.9], Reason for Study: ^Reason: met breast CA, urinary retention, eval for leptomeningeal spread. Also include upper sacrum given known met there. History: met br For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Again demonstrated multifocal metastatic lesions including right sacral ala (the largest one, 24mm x 25.2mm x 28mm), left sacral ala, left ilium and right ilium lesions. There is also subcutaneous nodule on the left side at the level of obturator foramen. On the L-spine, there are small metastatic lesions on the L4 and L5 vertebral bodies.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. No evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L2 level.There is no evidence of abnormal enhancement, cord compression or mass. There are multiple non enhancing low signal intensity lesions on post gadolinium T1 weighted images, no interval change comparing to Jun 20 2015 abdominal CT scan.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.", "output": "1. Multiple various sized vertebral bodies, sacrum, bilateral iliac and subcutaneous metastatic nodules as described above.2. No evidence of spinal canal stenosis or abnormal enhancement indicating spinal canal or spinal cord involvement. "}
{"instruction": "Generate impression based on findings.", "input": "38 year old with strong family history of breast cancer and BRCA2 mutation. History of breast cancer in mother diagnosed at the age of 44 and maternal grandmother diagnosed at the age of 63. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Focal enhancement of the left breast skin is noted at lower outer aspect.", "output": "1. No MRI evidence for malignancy. 2. Focal skin enhancement in the left breast at lower outer aspect. Clinical correlation is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: stroke History: confusion headacheDOB: 4/30/192788 yearsFemale MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Patchy T2 and FLAIR signal hyperintense foci are present in the brainstem, thalami and internal capsules. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Punctate foci of T2 signal hypointensity are present in the left thalamus as well as periventricular white matter.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small in diameter. The left A1 segment is slightly larger than the right A1 segment. The posterior communicating arteries are intact. The right posterior communicating artery is small. The left posterior communicating artery is tiny. The left vertebral artery is larger than the right vertebral artery. There is mild narrowing along the intracranial right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The proximal vertebral arteries are better assessed on the axial MRA of the neck images series #1310 where no stenosis is appreciated along the left vertebral artery course, however, there appears to be narrowing at the origin of the right vertebral artery with a 60%stenosis.", "output": "1.There is no evidence for acute ischemic cerebral infarction.2.There is 60% stenosis at the origin of the right vertebral artery.3.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 4.Patchy lesions in the brainstem and thalami are likely vascular related.5.There are microhemorrhages present in the periventricular white matter as well as in the thalami.6.There is no evidence for intracranial cerebrovascular occlusive disease appreciated."}
{"instruction": "Generate impression based on findings.", "input": " Limited imaging was obtained for surgical localization purposes. Post operative changes are again seen from left frontal parietal temporal craniotomy with minimal underlying scattered dural thickening and enhancement remaining. There is a small CSF signal intensity resection cavity along the anterior/superior left temporal lobe. There is adjacent lesion in posterior to the resection cavity in the left temporal lobe, better previous outside MRI.There is redemonstration of a masslike area of enhancement in the remaining left superior temporal gyrus, as well as additional nodule of enhancement in the inferior anterior left temporal lobe. The larger mass measures 12 x 17 mm in greatest dimensions by 15 mm in greatest CC dimension, enlarged since the previous outside exam (7 x 13 x 11 mm) allowing for differences in technique. The other smaller mass along the anterior/inferior aspect of the resection cavity measures 10 x 11 mm in greatest axial dimensions by 10 mm CC progressed since the previous exam, where the nodule measured 5 mm. It now demonstrates central hypoenhancement. The masses may be contiguous via curvilinear enhancement seen along the inferior margin of the resection cavity on 302/37. Branches of the left middle cerebral artery course in close proximity to these masses.The cisterns remain patent. There is no midline shift or mass effect. There is extensive abnormal T2/FLAIR hyperintensity involving the bilateral cerebral white matter and in near confluent pattern, left greater than right side, with ex vacuo dilatation of the left lateral ventricle. No extra-axial fluid collection is identified. The right cerebellar hemisphere is absent, likely developmental.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.", "output": "1. Interval progression of left temporal lobe enhancing masses which may be minimally contiguous via curvilinear enhancement, when compared to outside MRI. Findings are consistent with tumor progression.2. Redemonstration of extensive abnormal white matter signal, left greater than right side, which overall likely represents post treatment changes, although the left temporal lobe findings may represent a combination vasogenic edema and/or nonenhancing tumor.3. Right cerebellar hypoplasia."}
{"instruction": "Generate impression based on findings.", "input": "44 years Female (DOB:1/21/1972)Reason: extent of brain damage post MVA History: headaches, post traumatic amnesiaPROVIDER/ATTENDING NAME: ANTHONY T REDER ANTHONY T REDER The CSF spaces are appropriate for the patient's stated age with no midline shift. There is no evidence for intracranial hemorrhage.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "MRI of the brain is within normal limits. No MRI visible sequela of traumatic brain injury are appreciated."}
{"instruction": "Generate impression based on findings.", "input": "Female, 13 years old. C-spine tenderness after closed head injury There is straightening of the normal cervical lordosis, likely positional. Otherwise, the cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable. There is no evidence of ligamentous injury.The cerebellar tonsils extend 5-6 mm below the level of the foramen magnum, maintaining a rounded morphology, most compatible with cerebellar tonsillar ectopia.", "output": "1.Normal MR appearance of the cervical spine, without evidence of acute osseous or ligamentous injury. No evidence of cord compression.2.Findings most compatible with cerebellar tonsillar ectopia as above."}
{"instruction": "Generate impression based on findings.", "input": "Gait instability. Remote history of right caudate infarct (in 2009). There is focal encephalomalacia involving the right frontal coronal radiata as well as the lateral aspect of the right caudate head and the anterior part of the right external capsule, which is unchanged since previous CT scan. Lacunar infarct involving the posterior aspect of the left caudate head is not definitively seen on prior CT. There are also scattered foci of T2-hyperintensity in the cerebral white-matter which are nonspecific but most compatible with chronic small vessel ischemia. There is tiny focus of susceptibility effect in the central superior aspect of the pons without associated edema, which likely represents chronic microhemorrhage. There is no acute infarct or acute intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. There is no abnormal intracranial contrast enhancement.The lateral and third ventricles are moderately dilated, which has mildly increased compared to the previous CT scan. There is also focal dilatation involving some of the sulci.There is minimal ethmoid mucosal thickening. The orbits are grossly unremarkable. There is no destructive skull lesion. Sella turcica is partially empty which is usually normal variant in this age group.", "output": "1.There is no acute infarct or intracranial mass. 2.Mild to moderate chronic small vessel ischemic disease with small chronic infarcts as described above. 3.Suggestion of mild disproportionate enlargement of the ventricles compared to the degree of volume loss. Finding may represent communicating hydrocephalus/NPH in the appropriate clinical setting."}
{"instruction": "Generate impression based on findings.", "input": "Diffuse neuropathy. There is mild kyphosis centered at C4-5, but no spondylolisthesis. There is an eccentric right disc-osteophyte at C4-5 that abuts the spinal cord and results in moderate right and mild left neural foraminal narrowing. There is also a small eccentric right disc-osteophyte at C5-6 that results in mild right neural foraminal narrowing, but no significant left neural foraminal or spinal canal narrowing. There is no significant left neural foraminal or spinal canal narrowing at C2-3, C3-4, C6-7, or C7-T1. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal. The paravertebral soft tissues are unremarkable.", "output": "1. Mild kyphosis centered at C4-5, but no spondylolisthesis. 2. An eccentric right disc-osteophyte at C4-5 that abuts the spinal cord and results in moderate right and mild left neural foraminal narrowing. 3. A small eccentric right disc-osteophyte at C5-6 that results in mild right neural foraminal narrowing, but no significant left neural foraminal or spinal canal narrowing. "}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with right knee pain. Evaluate for meniscal injury or ligament injury. MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the medial femoral condyle (image 11; series 901). There is bone marrow signal abnormality in the underlying area of the medial femoral condyle, likely degenerative. There is articular cartilage degeneration affecting the medial and lateral facet of the patella. There is fraying of the articular cartilage of the trochlea. Subcentimeter cystic focus in the proximal tibia likely represents a subchondral cyst.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL", "output": "Degenerative changes including a focal full-thickness articular cartilage defect along the medial femoral condyle as described above. No evidence of meniscal injury, as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "16-year-old male with pain and swelling, history of ACL repair in 12/2013, with new injury during cheerleading MENISCI: There is a complex tear of the posterior horn of the medial meniscus with a double PCL sign suggestive of a buckle handle tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. No marrow edema is evident.LIGAMENTS: Postsurgical changes of a prior ACL reconstruction. The ACL graft fibers are not well visualized suggestive of a rupture. The posterior cruciate ligament is intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1.Poor visualization of the ACL graft fibers suggestive of ACL graft rupture.2.Bucket-handle tear of the posterior horn of the medial meniscus."}
{"instruction": "Generate impression based on findings.", "input": "68 year old female who is status post right lumpectomy (1/23/15) for biopsy proven IDC grade 3, presents for MRI assessment. The pathology results for the recent lumpectomy revealed 2 foci of ILC and extensive LCIS within the specimen in addition to the known IDC. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is a post-operative seroma, 74 x 34 x 32 mm (all measurements: AP x LR x CC) at 6 o'clock position in the right breast from the middle depth to immediate anterior of the pectoralis muscle. Anterior to this seroma cavity, there is an extensive non mass enhancement, measuring 53 x 27 x 41 mm, including a small non mass enhancement (11 x 15 x 5 mm), located 1 cm anterior to the seroma, which shows more distinct contrast. This extensive non mass enhancement extends from the anterior edge of seroma to the nipple. Post surgical changes are seen in the right axilla. No abnormal axillary lymph nodes are identified in right axillary regionNo abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in left axillary region.", "output": "1. Suspicious non mass enhancement in the right breast, extending from the anterior border of seroma to the right nipple. If biopsy is needed for this lesion, MR guided biopsy will be of choice.2. No MR evidence of malignant in the left breast or either axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with cellulitis and left great toe ulceration. Evaluate for osteomyelitis. Skin ulceration is noted along the dorsal aspect of the great toe. Surrounding the great toe is a large area of devitalized tissue with interspersed pockets of fluid measuring approximately 2.2 x 1.9 cm in greatest dimensions (series 1101, image 10). These findings extend from the distal tuft of the great toe along the flexor tendon to the level of the tarsometatarsal joint.Foci of low T1 and bright T2 signal involving the bone marrow of the distal tuft of the great toe are suggestive of distal osteomyelitis. There is diffuse subcutaneous edema as well as moderate osteoarthritis involving the first MTP joint.", "output": "1.Findings compatible with osteomyelitis of the distal tuft of the great toe as described above.2.Large area of devitalized tissue and interspersed fluid surrounding the great toe and extending proximally along the flexor and extensor tendon."}
{"instruction": "Generate impression based on findings.", "input": "Personal history of right breast lumpectomy for DCIS in 2002 followed by radiation and hormonal therapy. BRCA2 mutation carrier. Family history of breast carcinoma in her mother, maternal first cousin, and paternal aunt; ovarian carcinoma in her maternal aunt diagnosed at age 35. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Post-surgical volume loss and distortion of the right anterior breast are stable. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male 23 years old Reason: PSC, eval for stricturing or lesions History: PSC ABDOMEN:LIVER, BILIARY TRACT: Multifocal biliary ductal stricturing and dilatation appears similar to prior exam, including strictures of the left hepatic and common ducts.T1 and T2 hypointense lesion which enhances and measures 10 mm (series 13/71), unchanged in size consistent with pseudoaneurysm. Segment 8 wedge-shaped T2 hyperintense region consistent with hepatic artery to portal vein fistula, unchanged. No suspicious hepatic lesions.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No evidence of peritoneal carcinomatosis.", "output": "1.Stable biliary tree findings consistent with PSC. No suspicious hepatic lesions.2.Pseudoaneurysm, and likely hepatic artery to portal venous fistula, unchanged in appearance."}
{"instruction": "Generate impression based on findings.", "input": "Cystic pineal gland 6 month follow up. There is an unchanged cystic pineal gland that measures up to 11 mm. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "Unchanged cystic pineal gland. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Status post pericardial window POD #1. Now with new facial droop. Evaluate for acute stroke, intracranial hemorrhage. Signs and symptoms: Left facial droop, right pronator drift. CT of brain without infusion:Images through posterior fossa demonstrate minimal prominence of the fourth of the cerebellum and vermis and are otherwise unremarkable.Images through supratentorial space demonstrate an area of low attenuation involving the subcortical white matter of right frontal lobe. This appears to apply mass effect on the adjacent cortical sulci and is highly suspected for an acute stroke. If clinically is desired an MRI can further evaluate this area of stroke. There is no evidence of hemorrhage, ventriculomegaly or midline shift. Calvarium, limited view of paranasal sinuses and mastoid air cells are also unremarkable.", "output": "1.Focal area of edema in subcortical right frontal lobe suspected for an acute/subacute stroke considering patients provided clinical data.2.No evidence of hemorrhage, hydrocephalus or midline shift."}
{"instruction": "Generate impression based on findings.", "input": "11-year-old female with a history of MEN I presents with hypoechoic lesions found on endoscopic ultrasound. ABDOMEN:LIVER, BILIARY TRACT: No focal lesions. No intra or extrahepatic biliary ductal dilatation. The gallbladder is normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: High T2 signal focus in the pancreatic head measures 0.8 x 0.7 cm (series 501, image 11) and does not enhance. Additional high T2 signal focus in the pancreatic tail, abutting the spleen, measures 0.6 x 0.8 cm (series 501, image 20), does not enhance, and follows splenic intensity on all sequences. No pancreatic ductal dilatation. No peripancreatic fluid collections.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No discrete lesion or evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "High T2 signal, nonenhancing, foci in the pancreatic head and tail. The focus in the pancreatic tail follows signal intensity of the spleen on all sequences and may reflect an intrapancreatic accessory spleen."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female patient with FNH. Surveillance imaging. ABDOMEN:LIVER, BILIARY TRACT: Again seen are multiple T2 hyperintense lesions throughout the liver parenchyma, similar compared to prior.In the posterior right hepatic dome there is a T2 hyperintense and arterially enhancing lesion that measures 1.9 x 1.2 cm on arterial enhanced images (series 1002 image 297), unchanged when measured similarly. This lesion does not retain contrast on delayed hepatobiliary phase images and demonstrates trace washout on hepatic phase imaging.There is a lesion in the anterior left lobe of the liver that measures 1 cm and is dark on T1 and T2 and does not demonstrate enhancement and may represent a hemorrhagic cyst.Numerous additional high T2 and arterially enhancing lesions within the liver demonstrate retention of contrast on hepatobiliary phase imaging, compatible with focal nodular hyperplasia. These lesions appear similar compared to prior exam.No intra or extra hepatic biliary ductal dilatation.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Peribronchovascular soft tissue thickening in the right lower lobe noted and optimally evaluated on prior CTs of the chest.", "output": "1.Lesion within the posterior right hepatic dome with atypical imaging characteristics may represent an atypical FNH or an adenoma.2.Numerous additional lesions throughout the liver parenchyma with imaging features compatible with FNH appear similar compared to prior."}
{"instruction": "Generate impression based on findings.", "input": "20 yo female with a history of hypopituitarism (central adrenal insufficiency, central hypothyroidism) as well as Chiari malformation, POTS on florinef/midodrine (since 2012), pseudotumor s/p LPS revision most recently 12/16/2014, and MTHFR mutation who presented with acute on chronic refractory headaches, nausea, and vomiting. Urinary incontinence, evaluate for tethering or compression. Brain: Again seen are postsurgical changes of suboccipital craniectomy for Chiari decompression. Low-lying cerebellar tonsils with pointed morphology are unchanged. There are mildly diminished CSF spaces ventrally and dorsally at the foramen magnum but not significantly changed. Biphasic flow is slightly diminished but otherwise preserved ventrally and dorsally. Finding is unchanged. There is a small focus of tenting involving the left dorsal cerebellar surface seen on the high-resolution fiesta sequence which is unchanged since 8/1/2013 and may represent scarring.Compared to MRI dated 5/27/2014, there is slight increase in sagging appearance of the brain with mildly diminished suprasellar cistern compared to prior. There is no restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are unchanged in size and configuration without evidence of hydrocephalus. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is stable prominence of the pituitary gland measuring up to 11 mm in the craniocaudal dimension and is appropriate for patient's age. Subcentimeter nonenhancing pituitary lesion measuring 3 mm at the junction of the pituitary gland and infundibulum (sagittal postgad series 1801 image 8/15 and axial 3D T1 PG series 1901 image 123/350) remains unchanged since at least 12/31/2013. Mild apparent thickening of the pituitary infundibulum is also unchanged. There is contact of the pituitary gland with the optic chiasm. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Complete Spine:No evidence of cervical syrinx or other cord signal abnormality. The spine alignment is anatomic. The vertebral body heights are preserved. Bone marrow signal is within normal limits. No evidence of significant disk disease, spinal canal or neural foramina stenosis. The paraspinal soft tissues and musculature are unremarkable.The conus medullaris normally at mid L1. Filum terminale appear normal in signal intensity, length and caliber. No signal abnormality or masses including lipoma involving the filum terminale. The spinal canal is intact with no evidence of dysraphism. Prone images demonstrate appropriate ventral displacement of the conus.There are several Schmorl nodes of the thoracic spine. There is small disc protrusion at T11-T12 which is stable to minimally minimally more prominent compared to 4/18/2012 and associated with mild indentation of the right ventral cord. No cord signal abnormality.", "output": "1. Postsurgical changes of Chiari decompression with no significant change in appearance of the low-lying cerebellar tonsils. There is mildly diminished CSF space ventrally and dorsally which is not significantly changed. Biphasic flow is slightly diminished but otherwise preserved ventrally and dorsally at the foramina magnum. No significant change. There is a small focus of tenting involving the left dorsal cerebellar surface seen on the high-resolution FIESTA sequence which is unchanged since 8/1/2013 and may represent scarring. Compared to 5/27/2014 there is suggestion of brain sagging and slight interval decrease in size of the suprasellar cistern; finding may be related to some intracranial hypotension possibly related to recent lumbar puncture; correlate with any postural component of headaches or low CSF pressures. 2. Unchanged ventricles without evidence of hydrocephalus. No intracranial mass or mass-effect is seen.3. Unchanged prominence of the pituitary gland which measures up to 11 mm in the craniocaudal dimension is appropriate for the patient's age. Tiny 3-mm focus of non-enhancement in the superior aspect of the pituitary gland is unchanged and may represent a tiny microadenoma.4. No evidence of syrinx or other cord signal abnormality. Conus is in normal position. No findings to suggest tethered cord. Appropriate ventral conus motion on the prone sequence.5. Small disk protrusion at the T12-L1 level is stable to minimally more prominent compared to 4/18/2012 and is associated with mild indentation of the right ventral cord at this level."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female with adnexal mass seen on CT and ultrasound. Evaluate adnexal mass. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions are noted. Mild intra and extra hepatic biliary prominence. The common bile duct tapers smoothly to the level of the ampulla without evidence of lesion or mass.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Asymmetric prominence of left breast tissue.PELVIS:UTERUS, ADNEXA: There is a large left adnexal nonenhancing lesion demonstrating T2 hyperintensity, T1 hypointensity, and measuring 7.1 x 6.5 x 5.4 cm. There is a thin nonenhancing septation within this adnexal lesion.T2 heterogenous, heterogeneously enhancing subserosal uterine lesion, likely a fibroid.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": "1.Large left adnexal cystic lesion without suspicious features measuring approximately 7 cm. Thus, this favors a benign ovarian neoplasm. Consider gynecological consultation.2.Uterine fibroid.3.Asymmetric prominence of left breast tissue is noted. Correlation with recent mammography is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Left hamstring pain There is increased signal at the origin of the hamstring tendons on the left suggesting partial tearing and degeneration. There is no frank tendinous retraction. The sciatic nerve is normal. Similar findings are also noted on the right side however a discrete attachment of the conjoined tendon to the ischium is not well seen which may represent full-thickness tearing without retraction due to the presence of an intact sacrotuberous ligament. The remaining ligamentous structures, muscles, and tendons appear intact.Best seen on radial images is a small focal tear of the left anterior superior labrum at the 2:00 position. The left hip otherwise is unremarkable. There is mild osteoarthritis of the pubic symphysis.", "output": "Chronic appearing bilateral degeneration/tearing of the hamstring origins. Additional findings are described above."}
{"instruction": "Generate impression based on findings.", "input": "Right sided shaking. Evaluate for central etiology for seizure. There is no evidence of mesial temporal sclerosis, gray matter heterotopia or structural abnormality. 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable.", "output": "No evidence of seizure focus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "A 47 year old male with ventricular tachycardia referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is in the upper limit of normal range for size with low-normal systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 218 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 135 g (normal range 164+/-36). There is subtle global hypokinesis with regional variation. There is focal late gadolinium enhancement at the basal inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native myocardial T1-times are mildly increased at the base inferolateral wall (~1100ms). These findings are compatible with an old inflammatory process (myocarditis) and not with myocardial infarction.No intracavitary thrombus was seen.Left AtriumThe left atrium is mildly dilated (100ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 105 ml/m2 (normal range 82+/-16), the RVEDV is 244 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 120 ml (normal range 54+/-17). No fatty infiltration of the myocardium, no aneurysm or regional wall abnormalities were seen. No MRI findings to support the diagnosis of ARVD.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 mildly dilated (33mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings4.2 cm solid lesion within the mid inferior pole of the left kidney.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. 4.2 cm solid lesion within the mid inferior pole of the left kidney, highly worrisome for renal cell carcinoma. 2. The left ventricle is in the upper limit of normal range for size with low-normal systolic function, the LVEF is 50%. There is subtle global hypokinesis with regional variation. 3. There is focal late gadolinium enhancement at the basal inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native myocardial T1-times are mildly increased at the base inferolateral wall. These findings are compatible with an old inflammatory process (myocarditis) and not with myocardial infarction.4. The left atrium is mildly dilated. 5. The right ventricle is normal in size with normal systolic function, the RVEF is 51%. No fatty infiltration of the myocardium, no aneurysm or regional wall abnormalities were seen. No MRI findings to support the diagnosis of ARVD.Dr Tung was notified by email about the findings by email."}
{"instruction": "Generate impression based on findings.", "input": "A 28 year old female with personal history of mild asthma recently with dyspnea and atypical chest pain during exercise. A recent echocardiography showed mildly reduced right ventricular systolic function with flattened septum. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 117 ml/m2 (normal range: 65+/-11), the LVEDV is 186 ml (normal range 109+/-23), the LV end systolic volume index is 56 ml/m2 (normal range 18+/-5), the LVESV is 89 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 92 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is normal wall thickness. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1-time are in the upper-normal range (~1060-1080ms). The global relative enhancement (GRE) and extracellular volume fraction are within normal ranges. These findings suggest the absence of an underlying infiltrative, inflammatory, or fibrosis process in the myocardium.Left AtriumThe left atrium is normal in size (97ml).Right VentricleThe right ventricle is severely dilated with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 132 ml/m2 (normal range 69+/-14), the RVEDV is 209 ml (normal range 110+/-24), the RV end systolic volume index is 66 ml/m2 (normal range 22+/-8), and the RVESV is 105 ml (normal range 35+/-13). The heart is shifted into the left thorax as a consequence of the decreased sternum to spine dimension. The sternum is extrinsically compressing on the RV free wall, distorting its shape and causing variation in the regional motion. However, there is no evidence that this extrinsic compression is hemodynamically significant. 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 drain normally into the right atrium. IVC is grossly normal. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is significant scoliosis and decreased space between the sternum and spine without evidence of a classical pectus deformity. 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. The left ventricle is severely dilated with low normal systolic function, the LVEF is 52% without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. The right ventricle is severely dilated with low normal systolic function, the RVEF is 50%. 3. Significant changes of scoliosis are noted. Although there is no classical pectus deformity of the sternum, the anterior-to-posterior dimension between the sternum and spine is as small as 4.5cm. The reduced space has caused the heart to be shifted into the left thorax and distorted the shape of the right ventricle. This extrinsic compression of the right ventricle does not appear to be causing any hemodynamically significant changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " The exam was not performed as a pituitary MRI which somewhat limits evaluation. In addition, there is mild motion degradation of the images. Within these limitations, there is an enhancing pituitary mass measuring 19 CC x 16 ML x 17 AP mm with effacement of the suprasellar cistern, abutting the optic chiasm without significant displacement or mass effect on the optic chiasm. Although evaluation of the cavernous sinuses is limited, the mass appears to the confined within the sella, abutting the cavernous and supraclinoid internal carotid arteries without clear invasion. There are no other areas of suspicious intracranial enhancement. There is no acute infarct, or midline shift. There is patchy T2 signal abnormality adjacent to the trigone of the left lateral ventricle without enhancement, nonspecific, possibly vascular related. There is no hydrocephalus.", "output": "19 x 16 x 17 mm enhancing pituitary mass most likely representing a macroadenoma. Metastatic disease is considered much less likely.No additional intracranial lesions are seen to suggest metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: possible meniscus/ligamentous injury MENISCI: There is mild intermediate signal in the medial meniscus, consistent with intrasubstance degeneration without discrete tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. There is no abnormal bone marrow signal intensity.LIGAMENTS: The ACL, PCL, LCL, and MCL are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL", "output": "Mild muscle edema involving the popliteus tendon which may represent an underlying sprain without discrete tear."}
{"instruction": "Generate impression based on findings.", "input": "Headache and hand numbness. There is mild scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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, and scalp soft tissues are grossly unremarkable. There are bilateral maxillary sinus retention cysts.", "output": "1. No evidence of acute infarction.2. Mild nonspecific cerebral white matter T2 hyperintensity may represent small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "Female, 68 years old, with psoas abscess undergoing treatment. Compare to prior study to assess for resolution. Findings are again seen reflecting prior posterior instrumented fusion from L3 through L5 as well as interbody fusion at L3-4 and L4-5. Previously seen rim-enhancing fluid collections within the posterior operative soft tissues and within the bilateral psoas muscles are not clearly appreciated and have likely resolved or nearly completely resolved.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow edema, replacement or enhancement is seen. The visualized distal spinal cord and conus are within normal limits. The cauda equina is unremarkable where not obscured by metallic artifact.L1-2: Facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Marked facet arthropathy. Ligamentum flavum thickening. Mild disc bulging. Mild generalized spinal canal stenosis. The left lateral recess remains narrowed. Left foraminal narrowing. No interval changes. L4-5: Marked facet arthropathy. Ligamentum flavum thickening. Mild bulging disc. Mild spinal canal stenosis. Moderate to severe right foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. No significant foraminal narrowing. No interval changes.", "output": "1.Redemonstrated is evidence of L3-L5 posterior and interbody instrumented fusion.2.Since the prior examination, abscesses within the posterior operative soft tissues and the psoas muscles have resolved or nearly completely resolved. No new abnormalities are detected."}
{"instruction": "Generate impression based on findings.", "input": "Female, 58 years old, with altered mental status status post OLT. No evidence of restricted diffusion, parenchymal edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected.Mild symmetric T1 hyperintensity of the bilateral globus pallidus may reflect manganese deposition from chronic liver dysfunction. Minimal T2 hyperintense rimming of the lateral ventricles is a nonspecific finding and may be within normal limits.No evidence of significant intracranial hemorrhage is seen. A few scattered foci of susceptibility are seen in the cerebral hemispheres compatible with chronic micro-hemorrhage. No abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.The left maxillary sinus is small showing evidence of mucosal thickening or layering secretions.", "output": "1.No acute intracranial abnormality.2.T1 signal abnormality in the globus pallidus likely reflects the sequelae of chronic liver dysfunction.3.Findings suggestive of chronic left maxillary sinusitis."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Headache. Family history of ischemic heart disease and other diseases of the circulatory systemClinical question: headache, family h/o cerebral aneurysm, please evaluate for aneurysmSigns and Symptoms: headache, family h/o cerebral aneurysm MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is small. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.", "output": "1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for intracranial mass lesion or acute ischemic cerebral infarction."}
{"instruction": "Generate impression based on findings.", "input": "83-year-old male patient with grade III oligodendroglioma status post resection, RT, and TMZ. There are stable post-operative changes of a right anterior temporal lobectomy with unchanged T2 signal abnormality surrounding the resection site extending to the right basal ganglia. There is no abnormal enhancement surrounding the right temporal resection cavity. Two new small foci of enhancement within the left paramedian cerebellar hemisphere which demonstrate correlating T2 hyperintensity. No other new or pathologic intracranial enhancement is seen. There is no restricted diffusion. Encephalomalacia involving the left anterior frontal lobe, and to a lesser degree the right inferior frontal lobe, appears similar to the prior study. Scattered periventricular and subcortical abnormal T2 signal may represent chronic small vessel ischemic disease and/or post-treatment related white matter changes. A focus of susceptibility within the left frontal lobe white matter is unchanged. The ventricles are unchanged in size. There is no midline shift or herniation. The major cerebral flow voids are intact. There are scattered tiny maxillary sinus mucous retention cysts.", "output": "1. Stable post-operative changes of a right anterior temporal lobectomy without definite evidence of tumor recurrence.2. Two new foci of enhancement within the left paramedian cerebellar hemisphere are non-specific and could potentially be vascular/ischemic in nature; attention on close follow up imaging is suggested.3. Stable periventricular and subcortical T2 signal abnormality which may represent chronic small vessel ischemic disease and/or post-treatment related white matter changes.4. Areas of frontal lobe encephalomalacia appearing similar to the prior study."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other malaise and fatigueClinical question: r/o acute processSigns and Symptoms: weakness MRI of the brainMultiple small foci of diffusion restriction are present in the territory of the left precentral artery at the left middle frontal and lateral precentral gyri as well as a small portion of the operculum. These are accompanied by FLAIR and T2 signal hyperintensity.A small focus of diffusion restriction is present in the right thalamusThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. There is extra-cranial origin of the right PICA.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The RVA is larger than the LVA.", "output": "1.Patchy distribution of left precentral artery territory acute cerebral infarction. 2.Small acute cerebral infarction in the right thalamus.3.No evidence for intra-cranial or extra-cranial cerebrovascular occlusive disease is appreciated."}
{"instruction": "Generate impression based on findings.", "input": "Male, 15 years old, with seizure-like episodes. Assess for structural abnormalities. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. In particular, the mesial temporal structures are symmetric and free of pathologic signal abnormality. No restricted diffusion is seen.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. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.", "output": "Unremarkable evaluation with no specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "13-year-old male with neurofibromatosis. Periorbital neurofibroma causing ptosis. Please provide craniofacial protocol. There is redemonstration of a soft tissue mass located along the right eyelid along the extraconal space on the right side along the superior and temporal aspect of the right orbit which goes as far back as the posterior aspect of the right eye. It does extends into the expected location of the right lacrimal gland. This known to represent a plexiform neurofibroma based on clinical history. This is stable in overall morphology and extent compared to the MRI from 8/15/09. There is associated enophthalmus and inferior displacement of the eye on the right side.There is opacification of the right maxillary sinus. the right maxillary sinus is smaller than its left counterpart and almost completely involuted. Mastoid air cells and middle ears are clear.", "output": "1.Findings consistent with plexiform neurofibroma involving the right eyelid with extending into the right lacrimal fossa and adjacent extraconal space with no intraconal extension. There is associated enophthalmus and inferior displacement of the eye on the right side. In part this displacement and enophthalmos may also be related to right maxillary sinus atelectasis (silent sinus syndrome).2.Small opacified right maxillary sinus consistent with hypoplasia of the right maxillary sinus. Please correlate with clinical history for silent sinus syndrome or prior trauma."}
{"instruction": "Generate impression based on findings.", "input": "BRCA2 positive There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A few scattered enhancing foci are present, none suspicious in appearance. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. Annual MRI screening is recommended based on her history. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "64 year-old female with a history of metastatic ovarian cancer. Need reevaluation and comparison to previous scans. Suboptimal examination secondary to motion and wraparound artifact.ABDOMEN:LIVER, BILIARY TRACT: Small ventral hernia containing a portion of the liver and a small amount of fluid. Nonspecific thickening of the gallbladder wall may be related to ascites. No evidence of gallstones. 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: Reference left periaortic lymph node measures 1.5 x 1.4 cm, previously 1.4 x 1.1 cm on prior CT examination dated 12/4/2014 (40; series 13).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse soft tissue reticulation and subcutaneous edema.OTHER: Note is made of restricted diffusion along the anterior wall of the peritoneal cavity suspicious for peritoneal carcinomatosis.Small ventral hernia containing a portion of the liver and a small amount of fluid. Trace right pleural effusion. Loculated left pleural effusion. Left pleurex catheter in place. Small amount of abdominopelvic ascites. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Left external iliac lymph node measures 1.4 x 1.1 cm , previously 1.6 x 1.1 cm (19; series 20).BOWEL, MESENTERY: The previously described mesenteric lymphadenopathy is poorly measured on this examination, secondary to motion artifact.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid within the pelvis. There is an irregular enhancing mass in the pelvic cul de sac/pouch of Douglas which measures 4.2 x 2.6 cm consistent with pelvic peritoneal metastasis.", "output": "1.Peritoneal carcinomatosis, as detailed above. No significant interval change in the reference abdominopelvic lymphadenopathy consistent with the stated history of metastatic ovarian carcinoma.2.Loculated left pleural effusion. Pleural metastatic disease cannot be excluded. Left lower lobe consolidation is nonspecific. Superimposed infection cannot be excluded. Small right pleural effusion.3.Anasarca and a small amount of abdominopelvic ascites."}
{"instruction": "Generate impression based on findings.", "input": "23 year old female patient with abdominal pain. Question of retroperitoneal mass. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. 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 retroperitoneal mass is identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post-surgical changes to the anterior abdominal wall.OTHER: Trace bilateral pleural effusions, right greater than left, with overlying compressive atelectasis. Free intraperitoneal air within the abdomen is likely related to recent surgery.PELVIS:UTERUS, ADNEXA: There is a 5.2 x 1.8 cm non-enhancing structure within the left adnexa which demonstrates heterogeneous internal T2 signal; this may represent a complicated ovarian or paraovarian cyst. The right ovary is unremarkable.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: Small amount of free fluid in the pelvis.", "output": "1.No evidence of a retroperitoneal mass.2.Non-enhancing, heterogeneously cystic left adnexal lesion may represent a complicated ovarian or paraovarian cyst. 3.Cholelithiasis without evidence of acute cholecystitis. 4.Free intraperitoneal air compatible with recent abdominal surgery."}
{"instruction": "Generate impression based on findings.", "input": "6th and 7th nerve palsy with headache. No evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal scattered high signal intensities on bilateral hemispheres on FLAIR images indicate minimal non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or 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.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.", "output": "No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal non specific small vessel disease.Normal brain MRV. "}
{"instruction": "Generate impression based on findings.", "input": "60-year-old man with history of Gleason 7 prostate adenocarcinoma in the right lateral apex. PELVIS:PROSTATE:Prostate Size: 57 x 33 mmPeripheral Zone: In the left prostatic apex (401/53, 503/184) there is a poorly defined 6 x 5 mm area of mild T2 hypointensity and ADC signal abnormality. Otherwise, the peripheral zone appears relatively normal.Central Gland: Within the right mid prostate gland anterior transitional zone (503/224, 401/59) there is ADC abnormality and markedly decreased T2 signal measuring 30 x 23 mm which crosses the midline.Seminal Vesicles: The seminal vesicles appear unremarkable.Extracapsular Extension: There are small areas of abnormal signal which may represent extraprostatic extension of tumor from the right anterior transitional zone (503/244).BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: In the proximal right femur (2001/13), right juxta-articular ilium (2001/114), and right iliac wing (2001/156), there are areas of abnormal enhancement and marrow signal.Bilateral inguinal hernias noted.OTHER: No significant abnormality noted.", "output": "1.Large area of abnormality in the right mid anterior transitional zone highly suspicious for neoplasm, possibly with a focus of extraprostatic extension.2.Questionable area of signal abnormality in the left apex, indeterminate for tumor. 3.Proximal right femur and right ilium lesions highly suspicious for metastases. The right femur lesion should be evaluated urgently for risk of pathologic fracture. Consider radiographs or bone scan. Findings discussed with Dr. Labbate by phone at 5:19 p.m. on 10/14/2016.4.No lymphadenopathy noted."}
{"instruction": "Generate impression based on findings.", "input": "42 year old with strong family history of breast cancer. Family history of breast carcinoma in her sister (diagnosed at age 36), two aunts (diagnosed at age 40), and a cousin. Family history of ovarian cancer diagnosed in two aunts. BRCA mutation. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "28 year old man with history of recently diagnosed biventricular dysfunction who was admitted with cardiogenic shock, referred now for cardiac MRI to evaluate for possible etiologies of his non-ischemic cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 212 ml/m2 (normal range: 74+/-15), the LVEDV is 427 ml (normal range 142+/-34), the LV end systolic volume index is 182 ml/m2 (normal range 25+/-9), the LVESV is 368 ml (normal range 47+/-19), the LV mass index is 95 g/m2 (normal range 85+/-15), and the LV mass is 191 g (normal range 164+/-36). Wall motion is globally hypokinetic. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Artefact makes detailed evaluation of LV myocardium difficult on T2* imaging; there were no gross abnormalities appreciated in T2* sequences. There is an LV thrombus at the apex. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with severe systolic dysfunction. The overall RV ejection fraction is 18%, the RV end diastolic volume index is 109 ml/m2 (normal range 82+/-16), the RVEDV is 219 ml (normal range 142+/-31), the RV end systolic volume index is 89 ml/m2 (normal range 31+/-9), and the RVESV is 180 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 moderate-severe mitral regurgitation. This appears most evident on the short-axis views, and was not corroborated well on the 4-chamber cine.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 mildly dilated (31mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.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. Globular heart with severe LV dilatation.2. Severely reduced biventricular function (LVEF = 14%; RVEF = 18%)3. LV thrombus is noted at the apex4. Moderate-severe mitral regurgitation5. Small pericardial effusion 6. No late gadolinium enhancement to suggest the presence of infiltrative, inflammatory or fibrosis disease of the myocardium. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 24 years old, with scotoma and tingling. Assess for multiple sclerosis. 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 detected.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. Dedicated imaging of the orbits is somewhat motion degraded. Within this limitation, no definite abnormalities of the optic nerves are detected. The extraocular muscles demonstrate normal morphology and pattern of enhancement. The globes are round and symmetric. No masses are identified.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.", "output": "Unremarkable examination of the brain and orbits allowing for motion degradation on many of the orbital sequences. In particular, no specific findings are seen to account for the patient's visual symptoms, and no evidence of any active demyelinating disease is detected."}
{"instruction": "Generate impression based on findings.", "input": "Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: Concern for neurovegetative disease History: numbness, weakness There is no evidence of abnormal enhancement on this scan.Subtle T1 low signal intensity lesions on bilateral white matter which are corresponding to T2/FLAIR high signal intensity lesions are seen without showing any evidence of contrast enhancement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels.", "output": "No evidence of abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "32 year old male with history of Ewing sarcoma off therapy. Assess for recurrence. Again seen is a well circumscribed mass within the retrovesicular space, not significantly changed in size, measuring 6.2 x 5.5 cm previously 6.1 x 5.6 cm. This mass again demonstrates heterogeneous high T1 and T2 signal with a hypointense rim likely reflecting blood products of varying ages. Following gadolinium administration, there is no enhancement. Mass effect on the adjacent rectosigmoid is also similar to prior.Amorphous curvilinear signal abnormality involving the left sacral wing and along the SI joint are similar to prior and may represent insufficiency fracture, post therapy changes or metastasis. Round focus of low signal with no enhancement in the posterior aspect of the left iliac wing may represent a treated metastasis and also appears similar to prior.No new foci of abnormal signal or enhancement.Wall thickening of the bladder and rectosigmoid may be related to radiation.", "output": "1.Unchanged pelvic mass.2.Foci of signal abnormality within the pelvic bones appear similar to prior and may represent a combination of treated metastases and post radiation changes. 3.No new foci of abnormal signal."}
{"instruction": "Generate impression based on findings.", "input": "Female, 28 years old, with radicular pain and paresthesias. Brain:Several scattered small foci of T2 hyperintensity are seen within the bilateral frontal white matter. The largest of these is on the right and measures up to 2 mm.There is no evidence of restricted diffusion or any parenchymal edema. No pathologic parenchymal or extra-axial enhancement is detected. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection are observed. The ventricles are normal in size and morphology. The cerebellar tonsils terminate 2 to 3 mm below the plane of the foramen magnum.Bilateral maxillary sinus and ethmoid air cell mucosal thickening is seen.C-spine:Mild reversal of the normal cervical lordosis may be positional. Spinal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality or pathologic marrow enhancement is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No focal lesions or any pathologic parenchymal or leptomeningeal enhancement is seen.The intervertebral discs are within normal limits. No significant spinal canal or foraminal stenosis is seen.", "output": "1.Several very small foci of white matter signal abnormality are seen in the frontal lobes. These are associated with no evidence of edema and no pathologic enhancement. Findings are nonspecific, and in particular, they are not typical for demyelinating disease.2.Cerebellar tonsillar ectopia is seen. This finding is of uncertain significance relative to the patient's presentation.3.Unremarkable evaluation of the cervical spine with no specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": " There is stepwise trace grade 1 retrolisthesis of C4 on C5-6 and C7. There is also minimal grade 1 anterolisthesis of C7 on T1. The cervical spine is otherwise in normal alignment, with mild reversal of the normal cervical lordosis centered at C3-C4. The vertebral body heights are well-maintained. There is multilevel disc narrowing, moderate in degree at C3-C4 through C6-C7. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. At C2-C3, there is minimal left facet arthropathy and uncovertebral hypertrophy and mild left foraminal narrowing.At C3-C4, there is uncovering of the disc with a mild posterior osteophyte disk complex. There is right-sided uncovertebral hypertrophy with overall moderate-severe right and moderate left foraminal narrowing.At C4-C5, there is uncovering of the disc with a rightward predominant posterior osteophyte disk complex. Right-sided uncovertebral hypertrophy. There is resultant mild-moderate central spinal canal stenosis and severe right as well as mild-moderate left foraminal narrowing.At C5-C6, there is uncovering the disc with a diffuse posterior osteophyte disk complex and bilateral uncovertebral hypertrophy resulting in moderate-severe bilateral foraminal narrowing and mild central spinal canal stenosis. There is also ligamentum flavum thickening.At C6-C7, there is uncovering the disc with a superimposed posterior osteophyte disk complex with bilateral uncovertebral hypertrophy. There is moderate-severe bilateral foraminal narrowing.At C7-T1, there is uncovering of the disc with mild ligamentum flavum thickening and facet arthropathy.There is trace fluid in underpneumatized right mastoid air cells. There is a probable mucus retention cyst in the posterior nasopharynx.LUMBAR SPINE", "output": "1. Moderate multilevel cervical spondylotic changes including minimal degenerative subluxations with high-grade foraminal narrowing on the right at C3-C4 and C4-C5, bilaterally at C5-C6, and on the left at C6-C7.2. Prominent dextroscoliosis of the lumbar spine. No significant interval change in previously described multilevel lumbar spondylotic changes including multilevel degenerative subluxations, except for decreased prominence of disc pathology at L1-L2. No high-grade central spinal canal stenosis at any level, although there are multiple levels of persistent high-grade foraminal narrowing as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "78-year-old woman with history of cancer of unknown primary and multiple hepatic and splenic lesions. ABDOMEN:LIVER, BILIARY TRACT: A well-defined area of T2 hyperintensity is seen in the left lobe of the liver (series 4, image 20) represents a cyst. A hypoattenuating focus seen in segment 7 of the liver on the prior CT is not well seen on the current examination. A peripheral focus of arterial enhancement in the right lobe of the liver (series 14, image 22) is likely perfusional.The gallbladder is unremarkable.SPLEEN: Innumerable T2 hyperintense lesions are seen in the spleen, the largest of which near the splenic hilum (series 4, image 15) demonstrates progressive nodular enhancement with centripetal filling is and is most likely a hemangioma. The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A septated cystic lesion in the right mid/upper pole is seen without definite enhancement and measures 27 x 22 mm (series 4, image 22). Multiple, additional subcentimeter cysts are seen in the right kidney. The left kidney appears normal.RETROPERITONEUM, LYMPH NODES: The enhancing paracaval focus seen on the prior CT is unchanged in size and measures 10 x 7 mm (series 4, image 29).BOWEL, MESENTERY: The visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Innumerable splenic lesions, not compatible with sarcoidosis by imaging, largest focus demonstrates characteristics consistent with that of a hemangioma, smaller additional lesions more difficult to characterize due to size but may be followed up with imaging as clinically warranted.2.Bosniak 2F equivalent right renal cyst which may be followed up as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Diabetes, alcohol abuse, 40lbs weight loss, CT showed soft tissue infiltration around head of pancreas, evaluate for underlying neoplasm ABDOMEN:LIVER, BILIARY TRACT: No significant biliary duct dilatation. SPLEEN: No significant abnormality noted.PANCREAS: Dilatation of main pancreatic duct, measuring up to 7 mm, seen to level of ampulla, no evidence of obstructing mass. Intraductal stones/debris seen. No definite obstructing lesion seen. Marked pancreatic parenchymal atrophy with relative sparing of head. Curvilinear T2 hyperintensity at level of pancreatic head likely the cystic duct, image 14 series 501.ADRENAL GLANDS: 1 cm right adrenal nodule demonstrating signal loss on opposed phase imaging, consistent with adrenal adenoma, image 47 series 901.KIDNEYS, URETERS: Mild perinephric stranding. 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. Findings compatible with chronic pancreatitis with ductal dilatation, secondary to stones. No definite obstructing lesion seen.2. Right adrenal adenoma."}
{"instruction": "Generate impression based on findings.", "input": " Images are slightly limited by patient motion. There is again abnormal caudal extension of the cerebellar tonsils below the level of foramen magnum, extending 11 mm. Overall, the cerebral tonsils remain rounded in configuration without significant pointing. There is moderate associated crowding at this level. Biphasic CSF flow is again diminished dorsally at the level of the foramen magnum.The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. There is minimal disc narrowing at C4-C5 and C5-C6. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. There is trace fluid within mastoid air cells bilaterally.", "output": "Abnormal caudal extension of the cerebellar tonsils 11 mm below the level of the foramen magnum, although they remain rounded in morphology, with moderate crowding of structures. Diminished CSF flow dorsally at this level. Please correlate clinically for possible Chiari I malformation."}
{"instruction": "Generate impression based on findings.", "input": "Multiple sclerosis with head and fatigue. There are several cerebral white matter lesions. A lesion in the left frontal centrum semiovale has slightly increased in size, although the associated enhancement has essential resolved. On the other hand, an anterior right frontal lobe lesion has decreased in size. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.", "output": "Multiple demyelinating lesions related to multiple sclerosis, including decrease in size of a right anterior frontal lobe and slight increase in size of a left frontal centrum semiovale lesion."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Preoperative Stealth brain MRI. Signs and symptoms: Craniotomy CCM resection. Pre-and post enhanced Stealth brain MRI:Examination demonstrates a tiny focus of enhancement in the lower posterior pons consistent with a tiny cavernoma. This finding demonstrated susceptibility signal changes on prior MRI and enhancement without interval change. It measures approximately 1.9 mm in size.Examination also redemonstrated a right frontal cavernoma in the cingulate gyrus measuring approximately at 11 times 12-mm in transaxial dimensions. This lesion demonstrates no surrounding encephalomalacia or edema however hemosiderin staining is present similar to prior exam. Ventricular system are within normal size and the maintained midline. Diffuse punctate foci of T2 hyperintensity in the subcortical and periventricular white matter remains stable since prior exam.Note should be made that this exam he is performed as a surgical guidance and is not a true diagnostic study.", "output": "1.Right anterior frontal cingulate gyrus cavernoma without change since prior exam.2.Inferior posterior pontine enhancing cavernoma measuring1.9 mm without change since prior exam.3.Stable scattered subcortical and periventricular foci of flair hyperintensity since prior exam."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female, status post transsphenoidal surgery on 4/21/16 for lymphoplasmacytic inflammatory infiltrates suggestive of lymphocytic panhypophysitis in a young, pregnant/postpartum woman, surveillance. There has been continued interval evolution of findings related to transphenoidal surgery, with persistent mild heterogeneity of the pituitary gland. The pituitary gland proper has decreased in maximal depth, now measuring 6 mm (previously 8 mm). There is no encroachment of the optic apparatus. The pituitary infundibulum is intact. The posterior pituitary bright spot is still not apparent on this scan. Left sphenoid sinus secretions have resolved. The imaged portions of the brain are unremarkable.", "output": "There has been continued interval evolution of findings related to transphenoidal surgery, with persistent mild heterogeneity of the pituitary gland. The pituitary gland proper has decreased in maximal depth, now measuring 6 mm (previously 8 mm). "}
{"instruction": "Generate impression based on findings.", "input": " BRAIN: There is no acute infarct, mass effect, or cerebral edema. There are few nonspecific punctate white matter T2 hyperintense foci in the bilateral frontal white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is retroflexion of the dens tip effacing the ventral CSF. The lower brain stem/upper cervical cord is somewhat draped along the dens, and there is resultant mild mass effect on the inferior cerebellar tonsils and vermis. There is mild resulting crowding of soft tissue of the foramen magnum without Chiari I malformation.PITUITARY: The pituitary gland is not enlarged. There is homogeneous enhancement of the pituitary gland without focal lesion. The posterior pituitary T1 hyperintense focus is present. The cavernous sinuses symmetrically enhance. The pituitary stalk is not deviated. There is no mass effect on the optic chiasm.", "output": "1.No evidence of pituitary lesion.2.Retroflexion of the dens tip with draping and displacement of the lower brain stem/upper cervical cord posteriorly with secondary mild mass effect on the inferior cerebellar tonsils and vermis. There is also mild crowding of structures at the foramen magnum without Chiari I malformation. It should be noted that this exam is a static exam. Therefore, this appearance may change with changes in positioning of the head. Please correlate clinically.3.Few punctate nonspecific white matter signal abnormalities in the frontal lobes."}
{"instruction": "Generate impression based on findings.", "input": "Lumbar radiculopathy, claudication. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal anterolisthesis of L3 on L4 and minimal retrolisthesis of L4 and L5 which appear new since prior. Alignment is otherwise maintained. Multilevel degenerative changes are present with multilevel disc desiccation, progressed particularly at the L4-L5 level with also new endplate edematous marrow signal changes at the L4-L5 level. Bone marrow signal is benign. The conus medullaris is normal in position at the L1-L2 level.Multilevel degenerative changes are seen, as described below:T12-L1: Severe disc height loss with disc osteophyte complex. There is effacement of the ventral thecal sac, right greater than left. There is also bilateral facet arthropathy. There is overall mild to moderate spinal canal stenosis. There is mild to moderate right and mild left neural foraminal narrowing. These findings have progressed.L1-L2: Minimal disc bulge and advanced bilateral facet arthropathy with moderate spinal canal stenosis which has progressed in the interval. There is mild narrowing of the bilateral neural foramina.L2-L3: Mild disc bulge, advanced facet arthropathy, and ligamentum flavum thickening are again seen with moderate to severe spinal canal stenosis similar to prior. There is mild narrowing of the neural foramina.L3-L4: There is severe bilateral facet arthropathy and ligamentum flavum thickening as well as minimal disc bulge. There is moderate to severe spinal canal stenosis which is slightly progressed in the interval. Minimal narrowing of the neural foramina.L4-L5: Disc bulge and bilateral facet arthropathy. There is partial effacement of the lateral recesses. No significant central spinal canal stenosis. There is mild right and minimal left neural foraminal narrowing.L5-S1: Thecal sac terminates at this level with epidural fat again evident, likely developmental. There is bilateral facet arthropathy, more advanced on the right and progressed in the interval. There is mild to moderate right and mild left neural foraminal stenosis.", "output": "Multilevel degenerative changes throughout the lumbar spine which have progressed since prior MRI since 2/9/2011. There is moderate to severe spinal canal stenosis at L2-L3 and L3-L4 and to a lesser degree at the L1-L2 and T12-L1 levels. Multilevel neural foraminal stenoses and additional details as above."}
{"instruction": "Generate impression based on findings.", "input": "Cellulitis and abscess There is a large soft tissue defect along the posteromedial aspect of the lower leg which appears continuous with a nonenhancing collection in the underlying subcutaneous fat which tracks laterally along the posterior margin of the soleus. At this level, the collection measures 5.5 x 2 cm, demonstrates rim enhancement, and tracks superiorly between the soleus and medial head of the gastrocnemius into the proximal calf where there is edema of the adjacent posterior calf musculature. The collection also extends distally, disrupting the fibers of the Achilles tendon, where it communicates with a second skin defect approximately 4 to 5 cm above the calcaneus. The total craniocaudal extent of this collection measures approximately 25 cm.Intermediate signal intensity material overlying the above-mentioned skin wounds likely reflects packing material. There is a small collection of nonenhancing fluid deep to the soleus which we suspect is reactive in nature. There is deformity of the tibial and fibular diaphyses indicating prior trauma and orthopedic intervention. There is no bone marrow edema or enhancement to suggest osteomyelitis. Small foci of signal abnormality within the tibia likely reflect areas of osteonecrosis. There is mild fatty atrophy of the peroneal muscles and there is circumferential subcutaneous edema that becomes confluent lateral to the proximal tibia/fibula.", "output": "Large soft tissue defect appearing continuous with a large nonenhancing fluid collection that extends beneath the medial head of the gastrocnemius into the proximal calf and distally through the Achilles tendon. There is no evidence of osteomyelitis. Additional findings are described above.These findings were discussed with Dr. S. Catlett of the primary service at 9:35 AM."}
{"instruction": "Generate impression based on findings.", "input": "58 year old man with ischemic cardiomyopathy, referred for follow up evaluation of LV function after medical therapy. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 150 ml/m2 (normal range: 74+/-15), the LVEDV is 291 ml (normal range 142+/-34), the LV end systolic volume index is 90 ml/m2 (normal range 25+/-9), the LVESV is 175 ml (normal range 47+/-19). There is hypokinesis of the mid anterior/anteroseptal walls. There is akinesis of the apical anterior wall. There is dyskinesis in the apex. There is extensive transmural late gadolinium enhancement in the mid to apical anterior, septal and entire apex. This pattern is typical for myocardial infarction. This is not significantly changed from prior study.Left AtriumThe left atrium is moderate to severely enlarged. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 129 ml/m2 (normal range 82+/-16), the RVEDV is 251 ml (normal range 142+/-31), the RV end systolic volume index is 65 ml/m2 (normal range 31+/-9), and the RVESV is 126 ml (normal range 54+/-17).Right AtriumThe right atrium is moderate to severely dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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 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 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. The left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 40%.2. There is hypokinesis of the mid anterior/anteroseptal walls. There is akinesis of the apical anterior wall. There is dyskinesis in the apex. There is extensive transmural late gadolinium enhancement in the apex, mid to apical anterior, septal and distal inferior walls. This pattern is typical for myocardial infarction. This is unchanged from the prior study on 9/17/15.3. The right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%.4. Overall, there is no significant change from prior study on 9/17/15.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "25 year-old female with right hip pain, no improvement with physical therapy or medications. ACETABULAR LABRUM: Gadolinium traverses the anterior/superior labrum, at approximately the two o'clock position, indicating a full thickness tear.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears intact. We see no CAM deformity. Suspected edema-type signal within the superior pubic rami on the previous study is not present on today's study. The bone marrow signal intensity is within normal limits.SOFT TISSUES: The musculature appears normal. The remaining soft tissues are unremarkable.", "output": "Anterior/superior labral tear, as above."}
{"instruction": "Generate impression based on findings.", "input": "Male, 81 years old, with altered mental status. No restricted diffusion is seen. Numerous scattered foci of periventricular and cortical T2 hyperintensity are seen, becoming somewhat confluent in the periatrial regions. The quantity and distribution of these lesions appear similar to the prior MRI exam. No evidence of mass effect or edema is seen. No intracranial hemorrhage or abnormal extra-axial fluid collection is detected. No pathologic parenchymal or extra-axial enhancement is seen. The ventricles and sulci are prominent compatible with underlying volume loss, similar to prior.", "output": "1.No acute intracranial abnormality.2.Findings compatible with chronic microvascular ischemic disease without significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Magar is a 33-year-old female with a family history of breast cancer in her maternal aunt, great aunt, grandmother, and two cousins. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.In the left upper inner breast, there is a faint focus of enhancement identified. However, this area of enhancement corresponds to a small cluster of cysts as confirmed on the T2-weighted imaging. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": " There are partially-imaged postoperative findings related to T1 corpectomy and C7-T1 fusion with prior C6-T1 laminoplasty. There is no evidence of abnormal enhancement in the extradural space to suggest tumor. However, there is a partially-imaged lobulated mass in the left paraspinal region at the C7-T1 level. The vertebral column alignment is unchanged. The vertebral body 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.", "output": "1. Partially-imaged postoperative funding at C6-T1 without evidence of recurrent tumor within the spinal canal.2. Partially-imaged lobulated mass in the left paraspinal region at the C7-T1 level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with history of chronic abdominal pain, nausea, vomiting, diarrhea, weight loss. Rule out inflammatory bowel disease or other small bowel pathology. 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: Large volume of stool is noted throughout the colon. Appropriate distention of the small bowel loops for this MR enterography exam. No abnormal wall thickening or abnormal wall enhancement. Normal appearance of the terminal ileum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Normal uterus. Normal appearing right ovary containing an involuting corpus luteal cyst (series 17 image 65).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free fluid in the dependent pelvis likely physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No evidence for inflammatory bowel disease or acute small bowel pathology.2.Large volume stool throughout the colon compatible with constipation, may be correlated clinically."}
{"instruction": "Generate impression based on findings.", "input": "64 year old male with right elbow pain. TENDONS: There is thickening and heterogeneity of the common extensor tendon indicating moderate to severe tendinopathy. There are foci of near fat signal intensity within the tendon corresponding to ossicles seen on outside hospital radiographs. There is a band of high signal intensity which separates the tendon and ossicles from the underlying lateral humeral condyle compatible with partial thickness tearing. There are tiny enthesophytes at the origin of the common flexor tendon, better seen on recent radiographs, but the tendon itself is unremarkable. The biceps, brachialis, and triceps tendons appear intact.LIGAMENTS: The ulnar collateral ligament appears intact. The radial collateral ligament proper is difficult to separate from the thickened common extensor tendon. What we believe to be the ligament appears separated from the humerus by high signal intensity, suggestive of a tear at its humeral attachment. The lateral ulnar collateral ligament appears intact.ARTICULAR SURFACES AND BONE: There are small foci of signal abnormality within the lateral epicondyle and the more proximal of the 2 intratendinous ossicles which are likely degenerative in etiology. There is subjective thinning of the articular cartilage of the radiocapitellar articulation, representing mild to moderate degeneration. The articular cartilage of the ulnohumeral articulation appears relatively intact.ADDITIONAL", "output": "Tendinosis and partial-thickness tearing of the common extensor tendon and possible tear of the radial collateral ligament proper of the right elbow."}
{"instruction": "Generate impression based on findings.", "input": "Male, 71 years old, with left-sided paresthesias. Patchy periventricular and subcortical T2 hyperintensity is seen, a nonspecific finding. No definite evidence of restricted diffusion is noted. There is a small focus of bright diffusion signal in the right doral pons but with no clear ADC correlate. No parenchymal edema or mass effect is detected. There are a few punctate foci of susceptibility scattered throughout the brain compatible with chronic micro-hemorrhage. No acute intercranial hemorrhage or any abnormal extra-axial fluid collections are seen. Diffuse prominence of the sulci likely reflects a mild degree of parenchymal atrophy. The ventricular system is within normal limits for size and morphology.", "output": "1. Patchy white matter signal abnormality is nonspecific but most commonly reflects chronic microvascular ischemic disease.2. No definite evidence of acute ischemia is seen. A small focus of bright diffusion signal within the right dorsal pons does not show a clear ADC correlate and therefore does not clearly represent restricted diffusion. This may indicate an imaging artifact, or T2 shine through of a chronic lesion, or perhaps a late subacute resolving ischemic lesion. The ascending spinothalamic tract does traverse through this area of the pons which would coincide with the reported symptomatology. Correlation with timing and nature of symptomatology is suggested. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Gagnon is a 59-year-old female with biopsy-proven IDC/DCIS of the right breast, spanning approximately 7.3 cm on prior MRI. She is currently undergoing neoadjuvant chemotherapy. She presents today for repeat MRI to assess for imaging evaluation to treatment response. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST: There has been an interval decrease in size of biopsy-proven heterogeneously enhancing mass in the right upper outer breast, posterior depth, now measuring 2.1 x 1.5 x 1.8 cm, previously measuring 2.8 x 2.3 x 2.4 mm (AP x LR x CC). There continues to be a thin fat plane between thismass and pectoralis muscle on T2 weighted images, and there is no pectoral enhancement, suggesting no invasion into the muscle. There continues to be segmental nonmass enhancement extending anteriorly from the mass in the right upper outer breast, measuring approximately 5.0 x 1.6 cm, previously measuring 5.1 x 1.7 cm. However, this non-mass enhancement has decreased in overall enhancement intensity and pattern. Overall measurement including mass and non mass enhancement is 6.6 x 2.3 cm, compared to 7.3 x 2.8 cm.LEFT BREAST:No abnormal enhancement is seen in left breast. AXILLAE:No abnormal lymph nodes are identified in either axillary region.A vascular port overlies the left upper chest wall.", "output": "(1) Decreasing size of index malignancy in the right upper outer breast with residual total enhancement measuring 6.6 cm in the AP dimension (compared to 7.3 cm).(2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Right knee pain, proximal tibia, fever, leukocytosis, elevated ESR/CRP, assess for osteomyelitis Extensive osseous T1 hypointensity predominantly involving the proximal tibial metaphysis, and to a lesser degree, the proximal tibial epiphysis, proximal and middle thirds of the tibial diaphysis, as well as the proximal fibular epiphysis, metaphysis, and diaphysis. There is associated T2 hyperintensity in these regions. The cortex of the proximal tibial is thin and indistinct, particularly posterolaterally. These findings are compatible with acute osteomyelitis. There is associated enhancement in these regions on the post contrast images but no evidence of enhancing fluid collection to suggest abscess. There is a small knee joint effusion. Subcutaneous and intramuscular soft tissue edema is present in the upper leg.", "output": "Acute osteomyelitis of the proximal tibia and fibula as above without evidence of abscess. Findings discussed with Orthopaedics x4081 at 1045 am on 2/11/2016."}
{"instruction": "Generate impression based on findings.", "input": " Examination is limited due to patient motion artifact and inability to complete all sequences. There is an area of diffusion restriction centered in the left basal ganglia and left caudate nucleus that also involves a portion of the corona radiata, corresponding to area of hypoattenuation seen on prior CT. This area is also associated with T2 hyperintensity. There are other scattered punctate foci of T2 hyperintensity in the periventricular and deep white matter and left thalamus. Again seen is an area of volume loss in the right occipital lobe, in the area of hypoattenuation on CT.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or significant mass effect. No extra-axial fluid collection is identified.Normal flow-voids are grossly demonstrated in the visualized major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.", "output": "1.Limited examination demonstrating an acute to subacute infarct centered in the left basal ganglia.2.Foci of T2 hyperintensity in the periventricular, deep white matter, and left thalamus likely represent mild chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "History of sacral decubitus ulcer and fever, evaluate for osteomyelitis. BONE MARROW: Scattered foci of decreased T1 marrow signal are present in a distribution suggestive of red marrow reconversion. Abnormally decreased T1 signal and increased T2 signal with associated contrast enhancement is present within the lesser trochanter of the right femur (series 401, image 21) compatible with osteomyelitis. There is abnormally decreased T1 signal with associated abnormally increased T2 signal with associated increased heterogenous enhancement involving the right ischial tuberosity (series 401, image 24) which is also suspicious for osteomyelitis. There is abnormally decreased T1 signal with associated increased T2 signal and enhancement involving the left ischial tuberosity (series 401, image 24) which is compatible with osteomyelitis. Abnormal signal extends from the bilateral ischial tuberosities into the adjacent inferior pubic rami. The bone marrow of the sacrum appears within normal limits.SOFT TISSUES: Extensive soft tissue ulceration is present superficial to the bilateral ischial tuberosities and right lesser trochanter with foci of air extending to the aforementioned bones. There is associated increased soft tissue enhancement compatible with infection. No discrete drainable fluid collections are identified.JOINTS: Small joint effusions present bilaterally.ADDITIONAL", "output": "1.Decubitus ulcers with associated osteomyelitis of the right lesser trochanter of the femur as well as bilateral ischial tuberosities.2.Small bilateral hip joint effusions. Given presence of adjacent osteomyelitis, infection of the joint spaces cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "Multiple sclerosis [G35], Reason for Study: ^Reason: MS, follow up progression History: paresthesias There are wedge shaped ill defined FLAIR high signal intensity lesions on bilateral corpus callosum body portion, best seen on sagittal scan.Another small focal lesion is seen on the left frontal lobe superior frontal gyrus.A small right anterior thalamic FLAIR high signal lesion is non specific.Subtle FLAIR high signal intensity lesions are seen on bilateral periventricular white matter especially trigone area. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "Multifocal bihemispheric FLAIR high signal intensity lesions on bilateral corpus callosum and periventricular white matter. Considering the patient's clinical history of MS, these lesions are consistent with demyelinating lesions."}
{"instruction": "Generate impression based on findings.", "input": "Female, 68 years old, with new diagnosis of stage IV lung cancer. Numerous scattered small T2 hyperintense lesions are seen within the periventricular and subcortical white matter of the bilateral cerebral hemispheres. No evidence of mass effect or edema is seen. No pathologic parenchymal or extra-axial enhancement is detected.There is no evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.Marrow signal characteristics are unremarkable. Degenerative spondylosis is partially visualized in the upper cervical spine.", "output": "1.No evidence of intracranial metastatic disease.2.Scattered nonspecific white matter lesions which likely represent chronic microvascular ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: History of newly diagnosed MS, restarting Tysabri after pregnancy. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Examination demonstrates extensive periventricular and to a lesser degree subcortical and corpus callosum foci of flair hyperintensity consistent with patient's known demyelinating disease. There is no convincing evidence of interval change in the extent of the findings. There is no detectable abnormal enhancement to suggest an active plaque.Also stable since prior exam are mild findings of chronic demyelinating disease involving the mid brain, pons and the right cerebellum.The cerebral cortex, cortical sulci and ventricular system remain normal for patient's stated age of 31. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.", "output": "Stable findings of multiple sclerosis and without evidence of new or enhancing lesions since prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: altered mental status. Signs and symptoms: Nonenhanced head CT:Technique.Axial 5 mm CT images of the head without administration of contrast is obtained. Sagittal and coronal 2-D reformatted images rendered.There is paucity of cortical sulci, small supratentorial ventricular system and in the CSF cisterns. Although this finding may be well within normal for patient stated age of 19 possibility of subtle increase intracranial pressure/edema cannot be entirely ruled out. The gray -- white matter differentiation remains well within normal. Images through posterior fossa demonstrate crowding of the cerebellar tonsils which is suspected for Chiari malformation. This finding is best appreciated on sagittal reformatted images in particular on number 26. Recommend follow-up with an MRI examination.There is no evidence of hemorrhage or midline shift.", "output": "1.Ectopia of cerebellar tonsils evident by crowding of the foramen magnum. Recommend follow-up with an MRI exam.2.No definitive evidence of density abnormality of brain parenchymal or morphologic abnormality. Paucity of cortical sulci and the small size of ventricular system and CSF cisterns are noted which could still be within normal range for patient stated age of 18. Subtle intimal may present with this appearance."}
{"instruction": "Generate impression based on findings.", "input": " There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The midline structures and craniocervical junction are within normal limits. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mucosal thickening within the right maxillary sinus.", "output": "No evidence of intracranial anomalies.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Recent posterior fossa tumor resection. There are postsurgical changes of a left retrosigmoid suboccipital craniectomy for posterior fossa tumor resection, with a small amount of extra-axial fluid deep to the craniotomy flap. There is an enhancing nodular lesion with measuring approximately 15 mm in diameter in the posterior left cerebellomedullary angle cistern region, along the lateral aspect of the fourth ventricle. There is also a 12 mm diameter nodular enhancing lesion more anteriorly in the left cerebellomedullary angle cistern region. There is extensive encephalomalacia in the left cerebellar hemisphere and middle cerebellar peduncle and what may represent a small amount of acute ischemia in the left cerebellar hemisphere. There is no midline shift or herniation. The third and lateral ventricles are not enlarged. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are skin fiducial markers.", "output": "Recent postoperative findings with residual tumor in the left cerebellomedullary angle cistern region."}
{"instruction": "Generate impression based on findings.", "input": "History of cirrhosis and portal vein thrombosis. Evaluate portal vein. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology.Cholelithiasis within a normally distended gallbladder without specific evidence of gallbladder inflammation.No suspicious arterially enhancing and washing out lesion.The portal vein is nonopacified and is markedly attenuated. There is reconstitution of attenuated left portal vein at the hepatic hilum, as well as proximalmost right portal vein.SPLEEN: Splenomegaly measuring 15.4 cm in craniocaudal dimension. Trace perisplenic ascites. Perisplenic collateral vessel formation.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: Small volume of abdominopelvic ascites. Extensive right-sided retroperitoneal and mesenteric collateral vessels.BONES, SOFT TISSUES: Mild dependent body wall edema. Gynecomastia.OTHER: Moderate right-sided pleural effusion with adjacent consolidation/atelectasis, slightly improved from prior.", "output": "1.Cirrhotic liver with no suspicious lesion. 2.Chronically thrombosed main portal vein. Reconstitution of an attenuated left portal vein as well as proximalmost right portal vein at the hilum.3.Moderate size right-sided pleural effusion with adjacent consolidation/atelectasis, slightly improved. 4.Stigmata of portal hypertension including extensive portosystemic collateral vessel formation and splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Male, 2 years old, status post Chiari decompression with syrinx, one year follow-up from surgery. Postoperative findings are seen compatible with Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. The cerebellar tonsils terminate above the level of the neo-foramen magnum, and demonstrate a relatively normal round morphology. The degree of CSF expansion along the posterior aspect of the foramen magnum appears similar to prior. Robust biphasic CSF flow is seen along the ventral neo-foramen magnum. Only a mild blush of flow related signal is seen dorsally through the neo-foramen magnum.A previously seen syrinx in the cervical region has decreased both in craniocaudal extent and in maximal diameter. The syrinx previously began at C4 and extended to the upper thoracic level. It is now only reliably detected at the C6 and C7 levels. The maximum dimension measures 1 mm, previously 2 mm.A larger syrinx cavity seen previously within the thoracic region has also decreased in craniocaudal extent, though the maximum caliber remains similar to prior. The syrinx previously extended from T4-5 down to T9, and currently extends from T5 to T8. The maximum caliber measures 7 x 7 mm, unchanged from prior.The conus tip terminates at L1 which is normal. No intraspinal masses are seen.Spinal alignment and vertebral body morphology are within normal limits. No concerning marrow signal abnormality is detected. The intervertebral discs are normal. No significant spinal canal or neuroforaminal stenosis is detected.", "output": "1.Demonstration of findings compatible with Chiari decompression. The cerebellar tonsils remain above the level of the neo-foramen magnum and show a round morphology.2.Robust CSF flow is seen along the ventral aspect of the neo-foramen magnum, with only a small amount of detectable flow dorsally.3.Interval decrease in caliber and longitudinal extent of a small cervical cord syrinx.4.Interval decrease in longitudinal extent of a large thoracic cord syrinx.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "59M w/ no significant PMHx presenting with SOB and evaluation for CABG and aortic valve replacement. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%. The LVEDV is 475 ml (normal range 142+/-34), the LV end diastolic volume index is 215 ml/m2 (normal range: 74+/-15), the LVESV is 313 ml (normal range 47+/-19) and the LV end systolic volume index is 142 ml/m2 (normal range 25+/-9). The LV mass is 159 g (normal range 164+/-36) and the LV mass index is 72 g/m2 (normal range 85+/-15). There is akinesis of the inferior and severe hypokinesis of the inferoseptum from base to LV apex. There is transmural late gadolinium enhancement in the inferior and inferospetal walls. These areas are likely not viable. There is also subendocardial late gadolinium enhancement in the basal posterior wall. This area is of intermediate viability. This pattern of late gadolinium enhancement is consistent with prior myocardial infarction. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 41%. The RVEDV is 244 ml (normal range 142+/-31), RV end diastolic volume index is 110 ml/m2 (normal range 82+/-16), the RVESV is 143 ml (normal range 54+/-17), and the RV end systolic volume index is 65 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThere is calcification of the aortic valve leaflets. The aortic valve is functionally bicuspid with likely fusion of the right and non coronary cusps. Qflow measurement was limited by patient's frequent PVCs. Regurgitant volume (Qflow method = 53%). Using ventricular stroke volume, regurgitant fraction was 38%. Taking these finding into account, there is at least moderate aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. The mitral valve leaflets appear thickened.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.Ao sinus of valsalva = 41 x 41 x 41 mmAo sinotubular junction = 35 x 34 mmAscending aorta pre-branching = 37 x 38 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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.The LV is severely dilated with moderately reduced systolic function (LVEF 34%)2.There is akinesis of the inferior and severe hypokinesis of the inferoseptum from base to LV apex. There is transmural late gadolinium enhancement in the inferior and inferoseptal walls. These areas are likely not viable. There is also subendocardial late gadolinium enhancement in the basal posterior wall. This area is of intermediate viability. This pattern of late gadolinium enhancement is consistent with prior myocardial infarction.3.The RV is normal in size with mildly reduced systolic function (RVEF 41%)4.Functionally bicuspid aortic valve. There is at least moderate aortic regurgitation, quantification limited by frequent PVCs.5.Aortic measurements as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "84 year old male with bilateral leg weakness, stool incontinence, history of metastatic prostate cancer. Evaluate for cord compression. No large marrow infiltrating lesions are appreciated within the cervical, thoracic, or lumbar spine. No obvious epidural tumor. The vertebral bodies heights are grossly maintained. There is mild reversal of cervical lordosis. Alignment of the spine is otherwise grossly maintained. There are no findings to suggest acute cord compression.Degenerative changes are seen throughout the cervical spine with at least moderate degree of spinal canal stenosis at C3-C4 and C5-C6 and to a lesser degree C4-C5 levels related to disc bulge and ligamentum flavum thickening. Additional multilevel degenerative changes are also seen involving the lumbar spine, most prominently involving the L3-4 level where there is moderate to severe spinal canal stenosis which is better appreciated on the dedicated lumbar spine performed subsequently.Prominent endplate degenerative changes are present at L3-L4 and to a lesser degree at the L4-L5 levels. There is a prominent Schmorl's node involving the superior endplate of L4. There is also edema involving the superior L4 endplate which is favored to be on an advanced degenerative basis.", "output": "This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No acute cord compression is identified. Degenerative changes at multiple levels in the cervical and lumbar spine with at least moderate spinal canal stenosis at C3-C4 and C5-C6 and moderate to severe spinal canal stenosis at L3-L4. Please refer to separate dedicated lumbar spine MRI report.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female 69 years old Reason: myeloma with worsening sciatic pain left buttock Multiple sequences are limited by motion. BONE MARROW: Diffusely heterogeneous bone marrow signal on T1 and T2 imaging consistent with patient's known history of myeloma. Again seen is a focal T1 hypointense lesion replacing much of the L5 vertebral body, probably on the right. There is a soft tissue component to this lesion, similar to the recent lumbar MRI, which extends into the right retroperitoneum has mass effect on the vessels.SOFT TISSUES: Again seen is a T1 and T2 hypointense lesion in the far lateral left L5-S1 foramen which has mass effect on and appears to impinge the exiting L5 nerve root (series 5, image 8). Remaining sacral nerves are well-visualized and appear to be surrounded by fat. Large fluid collection adjacent to the left greater trochanter most likely represents bursitis. The left gluteal muscles are atrophied compared to the contralateral side.JOINTS: There is a large subchondral cyst at the lateral femoral head neck junction. ADDITIONAL", "output": "1.Diffuse abnormal bone marrow signal consistent with known myeloma.2.Large fluid collection adjacent to the left greater trochanter likely represents bursitis. Atrophy of the left gluteal muscles compared to the contralateral side.3.Lesion causing destruction of the L5 vertebral body is not significantly changed compared to most recent lumbar spine MRI.4.Impingement of the exiting L5 nerve root caused by a soft tissue abnormality in the lateral left foramen."}
{"instruction": "Generate impression based on findings.", "input": "62 year old man with OHT, referred for evaluation of underlying rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 93 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 time is moderately elevated and the ECV fraction is mildly elevated, both in a diffuse non-focal pattern.T2 ratio = 1.6 (<2 normal)Global relative enhancement ratio = 3.2 (<4 normal)Native myocardial T1 = 1167ms (<1050ms normal)Native LV cavity T1 = 1668msECV Fraction = 32% (20-30% normal)Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 69 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.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 FindingsModerate sized 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. Normal left ventricular size and systolic function (LVEF 61%) without evidence of underlying myocardial replacement fibrosis. However, native myocardial T1 times are moderately elevated and the ECV fraction is mildly elevated (see values above). A recent publication (Miller et al. JCMR 2014;16:52) suggests that the native T1 time by 3 months is expected to be 1089 +/-62ms and the ECV is 30.1+/- 0.5%. 2. Normal right ventricular size and systolic function (RVEF 54%).3. Moderate sized right pleural effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female with posterior fossa meningioma. Evaluate for mass change. Heterogeneous mass within the left posterior fossa extending into the upper cervical spine is seen. There is mass effect on the left cerebellar hemisphere and fourth ventricle with surrounding vasogenic edema corresponding to recent MRI. There is no significant hydrocephalus. The basal cisterns are normal in size and configuration. There is no evidence of intracranial hemorrhage. Extensive of subcortical lucencies consistent with small vessel ischemic disease is unchanged.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. No acute change in left posterior fossa meningioma with no evidence of hydrocephalus2. Extensive small vessel ischemic disease of indeterminate age."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Lumbago with sciatica, unspecified sideClinical question: low back painSigns and Symptoms: low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a mild degree of anterior subluxation of L1 on L2. The patient is status post lower lumbar spine surgery.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is left-sided facet hypertrophy present at this level which was also present on the prior exam and associated with mild encroachment of the nerve roots of the left lateral recess. There is ligamentum flavum hypertrophy present bilaterally at this level. Overall compared to the prior exam there appears to be some mild progression of the facet hypertrophy.At L4-5 there is a diffuse disc bulge present associated loss of disc space height and disc desiccation as well as a moderate degree of bilateral facet and ligamentum flavum hypertrophy. There is progression of loss of disc space height at this level. There is disc desiccation present at this level. There is obliteration of CSF within the thecal sac at this level. Disc material extrudes behind the adjacent endplates at this level. Overall the spinal stenosis has progressed since the previous exam as has the disc extrusion in the facet hypertrophy. There is narrowing of the neural foramina bilaterally at this level with the encroachment of the left-sided exiting nerve roots within the neural foramen due to combination of disc disease and facet disease. There is a superimposed left far lateral disc protrusion at this level which is new compared to the prior exam. The neural foraminal encroachment of the left exiting nerve root is new since the prior exam. There is also some progression of encroachment of the right exiting nerve root without obliteration of the fat surrounding the right exiting nerve roots. Overall there is moderate to severe spinal stenosis at this level.At L3-4 there is progression of loss of disc space height and a diffuse disc bulge as well as ligamentum flavum hypertrophy. The endplate reactive changes are predominantly bright signal on T1 and suppresses on the inversion recovery T2 images. There is effacement of the fat at the lateral recesses bilaterally at this level which was also present on the prior exam. There is effacement of the CSF surrounding the nerve roots at this level. There is partial effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level. There is a left far lateral disc protrusion at this level which encroaches on the left exiting nerve root which was not evident on the prior exam. Overall there is moderate to severe spinal stenosis at this level.At L2-3 there is loss of disc space height and diffuse disc bulge as well as mild ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess bilaterally at this level. There is some narrowing of the neural foramina at this level, however, the exiting nerve roots are surrounded by fat within the neural foramina. Compared to the prior exam loss of disc space height has progressed. There are more endplate reactive changes on the current exam versus the prior exam. These endplate reactive changes are predominantly bright signal on T1 and suppresses on the inversion recovery T2 images. Overall there is a moderate degree of spinal stenosis at this level.At L1-2 there is loss of disc space height, disc desiccation and diffuse disc bulge which has progressed since the prior exam. There is ligamentum flavum hypertrophy present this level as well as a small left-sided ligamentum flavum cyst. Overall there is a mild degree of spinal stenosis at this level.", "output": "1.There are multilevel degenerative changes present in the lumbar spine which have progressed since 2006. There is a moderate to severe spinal stenosis at L4-5 and L3-4 and moderate spinal stenosis at L2-3 as detailed above. There is encroachment of exiting nerve roots on the left-sided L4-5 and L3-4 as detailed above. Please note that a contrast enhanced exam may help differentiate scar formation from degenerative change."}
{"instruction": "Generate impression based on findings.", "input": "60 years Male (DOB:10/19/1955)Reason: MRI with (wo already done) History: Eval source of L occipital bleedPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER There is a hematoma measuring approximately 3 cm located in the left cuneus and precuneus. It is not associated with any significant degree of contrast enhancement.There is a moderate degree of periventricular and subcortical punctate hypointense white matter lesions present identified on the T1 weighted images. These correspond to T2 hyperintense foci in the prior MR.There is a hypointense focus present in the right thalamus corresponding to T2 hyperintense focus in the prior MR.Incidental note is made of a developmental venous anomaly located in the right cerebellar hemisphere.There is a mucous retention cyst in the left maxillary sinus.", "output": "1.There is no associated enhancing lesion related the patient's left occipital and parietal lobe hematoma. There is no evidence for brain metastases.2.Exam is limited to pre and postcontrast T1-weighted imaging. There is a prior MRI from 1/31/2016. Please refer to that for further comments.3.Old lacunar infarct is redemonstrated in the right thalamus4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": " ORBITS: The globes, lenses, extraocular muscles, optic nerves, optic chiasm, and intraconal space are symmetric and normal. The orbital soft tissues are normal. There is no abnormal enhancement.The imaged intracranial contents are unremarkable, without evidence of mass, mass effect, hemorrhage, or acute infarct. There is minimal mucosal thickening of the bilateral maxillary sinuses and nasal cavity. There is mild leftward nasal septum deviation. NECK: The minimal diffuse mucosal thickening in the nasopharynx, oropharynx, and hypopharynx is unchanged. The effacement of the mucosal contours of the posterior nasopharynx are similar to prior. Asymmetry in the left oropharynx is noted and appears similar to prior. There is no enhancing mass identified. The salivary and thyroid glands appear within normal limits. There are small scattered lymph nodes, which are not enlarged by size criteria. Again noted is a left paracentral disc protrusion at C4-5, which effaces the left ventral spinal cord and contributes to mild to moderate spinal canal narrowing. There is T1 shortening of the skull base and upper cervical vertebrae, compatible with prior radiation therapy.", "output": "1. No MR evidence for local tumor recurrence or cervical lymphadenopathy.2. Unremarkable MRI of the orbits."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic esophageal cancer to brain, SRS treatment planning. There is a subcentimeter left cerebral hemisphere lesion. 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": "Pre-treatment planning MRI for a left cerebral hemisphere probable metastasis."}
{"instruction": "Generate impression based on findings.", "input": "psychosis, neuropsychiatric lupus. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement.Developmental venous anomaly (normal variation of venous drainage) is seen on the right temporal lobe superior temporal gyrus crossing underneath of the right Heschel's gyrus toward right lateral ventricle posterior horn ependymal vein.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate decreased luminal diameter of bilateral distal intracranial ICAs (left worse than right). In addition, bilateral proximal MCA M1 and bilateral ACA A1 segments also show decreased luminal diameter. However, distal MCAs and distal ACAs appear to be normal. Angiographically, these findings constitute Moyamoya syndrome.Vertebrobasilar system appears to be normal.Right Pcom artery appears to be patent and normal size.The left PCA is fetal origin.There is no intracranial arterial aneurysm.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement.3. DVA on the right superior temporal gyrus.4. Normal brain MRV.4. Bilateral distal intracranial ICA and proximal MCAs and ACAs luminal narrowing on MRA. This may represent Moyamoya syndrome. Clinical correlation is recommended.Discussed with Dr. Di-Ranieri at the time of this dictation. "}
{"instruction": "Generate impression based on findings.", "input": "43 year old woman with DLBCL, referred for evaluation of constrictive pericarditis. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 181 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 92 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 97 g (normal range 114+/-24). LV dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying replacement fibrosing, infiltrative, or inflammatory process. There is a moderate increase (in native myocardial T1 diffusely throughout the left ventricle suggesting the presence of interstitial myocardial fibrosis. The native myocardial T1 time is 1187ms, the LV T1 time is 1702ms. Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 159 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). 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 drain normally into the right atrium. PericardiumThe pericardium is thickened (about 6mm) circumferentially around the entire heart. Based on myocardial tagging, there is pericardial to myocardial tethering most pronounced along the basal left ventricle. A \"septal bounce\" (which is most pronounced with inspiration) is present and indicative of ventricular interdependence and the diagnosis of pericardial constriction. The majority of the pericardium has late gadolinium enhancement present but without increased T2-signal, indicative of pericardial fibrosis. No significant pericardial effusion is noted. Extracardiac FindingsThere are moderate to large bilateral pleural effusions. 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. There is evidence of significant pericardial thickening with evidence of chronic pericardial constriction as described above.2. The left ventricle is normal in size with mildly reduced systolic function (LVEF 49%) without evidence of late gadolinium enhancement to suggest the presence of underlying myocardial replacement fibrosis, inflammation, or infiltration. However, the native myocardial T1 time is moderately elevated diffusely, suggesting the presence of interstitial fibrosis. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%. 4. Moderate to large bilateral pleural effusions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " There is a suggestion of increased soft tissue density anterior to the interpeduncular cistern and extending leftward. Previous MRI from September demonstrated a suggestion of leptomeningeal enhancement at the level of the interpeduncular cistern, thus this may represent progression of cisternal leptomeningeal disease at this level, perhaps involving the left third cranial nerve.Redemonstrated is a right transfrontal ventriculostomy cathter that terminates in the expected region of the right foramen of Monro, unchanged in position. The ventricular system configuration remains unchanged. There is unchanged moderate cerebral white matter hypoattenuation, which may be treatment related. The gray-white matter differentiation is preserved. There is no mass effect, midline shift, or acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. Previously described mild bulging of the anterior optic nerves bilaterally is not well demonstrated on this study.", "output": "1.There is a suggestion of increased soft tissue density anterior to the interpeduncular cistern and extending leftward. Previous MRI from September demonstrated a suggestion of leptomeningeal enhancement at the level of the interpeduncular cistern, thus this may represent progression of cisternal leptomeningeal disease, perhaps involving the left third cranial nerve. This could be better characterized, and/or confirmed, by gadolinium enhanced brain MRI.2.The remainder the study is unchanged."}
{"instruction": "Generate impression based on findings.", "input": "50 year old woman with history of HFpEF who presents for cardiac MRI to evaluate for restrictive cardiomyopathy Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 90 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 32 ml (normal range 31+/-10), the LV mass index is 79 g/m2 (normal range 67+/-11), and the LV mass is 111 g (normal range 114+/-24). There is mild systolic flattening of the interventricular septum suggesting increased RV systolic pressure.Aside form the mild late gadolinium enhancement of the anterior and inferior RV insertion points, which is well described and common in patients with pulmonary hypertension, there is no other late gadolinium enhancement of the myocardium or pericardium to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. It is moderately hypertrophied. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 120 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation. There is aliasing of the tricuspid regurgitation jet suggesting increased TR velocity.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 mild to moderately dilated (34 mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is moderate sized pericardial effusion. There is no enhancement of the pericardium on late gadolinium imaging.Extracardiac FindingsThere is moderate sized right pleural effusion with evidence of septation and some complex features raising the possibility that it may be exudative in nature. This effusion was not present on the prior study. There is a trace left 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. Normal LV size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 50%) with significant hypertrophy and evidence of mild systolic flattening of the interventricular septum and late gadolinium enhancement of the anterior and inferior RV insertion points. All of these findings are consistent with the patients known history of pulmonary hypertension. 4. Severe biatrial dilation5. Moderate tricuspid regurgitation6. Mild aortic regurgitation7. Moderate sized pericardial effusion (slightly larger than on the prior study)8. Mild to moderately dilated main pulmonary artery (34 mm)9. In comparison to the cardiac mri done on 7/8/10, there is now a complex appearing right pleural effusion. The cardiac structures are essentially unchanged with the exception of mild late gadolinium enhancement involving the RV insertion points. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 54 years old, with spinal stenosis. Straightening of the lumbar lordosis is unchanged. At most there may be a trace retrolisthesis of L4 relative to L5. Alignment is otherwise unremarkable. Marrow signal characteristics are heterogeneous but overall benign in nature. Edematous endplate signal at L3-4 has slightly progressed.The distal spinal cord, conus and cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Mild facet arthropathy. Mild bulging disc. Narrowing of the lateral recesses but no significant spinal canal stenosis. Minimal if any foraminal narrowing. No interval changes. L3-4: Moderate facet arthropathy. Slight loss of disc height and minimal disc bulging. New left far lateral annular fissuring and protrusion. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, slightly progressed. L4-5: Moderate facet arthropathy. Loss of disc height with mild disc bulging. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. No significant interval changes. L5-S1: Moderate facet arthropathy with effusions. Progressive ligamentum flavum thickening. Effacement of the posterior aspect of the thecal sac with mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. Findings have progressed.", "output": "1.Progressive degenerative findings at L5-S1, particularly affecting the ligamentum flavum. As a result, there is progressive moderate bilateral foraminal narrowing.2.Degenerative findings at additional levels are stable or only mildly increased. No areas of high-grade spinal canal stenosis are seen."}
{"instruction": "Generate impression based on findings.", "input": "Male, 42 years old, with numbness and tingling of the hands. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.C2-3: Mild left facet hypertrophy. Mild left uncovertebral hypertrophy. No spinal canal stenosis. Mild left foraminal narrowing. No interval changes. C3-4: Mild bilateral facet hypertrophy. Mild left uncovertebral hypertrophy. No spinal canal stenosis. Mild left foraminal narrowing. No interval changes. C4-5: Mild facet hypertrophy, slightly progressed. No significant spinal canal stenosis. No significant foraminal narrowing. C5-6: Bilateral facet hypertrophy, slightly progressed. Posterior disc-osteophyte complex formation asymmetric to the left foraminal zone, slightly progressed. No spinal canal stenosis. Severe left foraminal narrowing slightly progressed. C6-7: Left facet hypertrophy, slightly progressed. Minimal posterior disc-osteophyte complex formation, slightly progressed. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, slightly progressed. C7-T1: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. No interval changes.", "output": "Slight interval progression of relatively mild multilevel degenerative disease of the discs and posterior elements. There is no significant spinal canal stenosis and at most levels only mild foraminal narrowing. However, on the left at C5-6, foraminal narrowing is severe."}
{"instruction": "Generate impression based on findings.", "input": "Biliary dilation and chronic pancreatitis. Portal vein thrombus. Hepatitis C and alcoholic liver disease. Per medical record, patient has history of chronic pancreatitis and dilated pancreatic and CBD ducts in 2004, s/p pancreaticojejunostomy, choledochoduodenostomy, cholecystectomy, splenectomy at Rush for obstructive jaundice. Since then, he has been found to have biliary dilatation on his MRI MRCP in July 2014. ABDOMEN:LIVER, BILIARY TRACT: Cavernous transformation of the portal vein, similar to that seen on the CT on 11/3/2014, reflecting chronic thrombosis. The recanalized right portal vein is seen, though narrow. The left portal vein is not well seen. There is diffuse nodular enhancement of the liver on arterial phase, which becomes homogeneous on venous phase, without washout to raise suspicious for focal lesions. No specific stigmata of cirrhosis. There is moderate diffuse biliary dilation. The hepatic duct measures up to 8 mm wide, with smooth narrowing of the common bile duct at the choledochoduodenostomy, which remains patent and similar to the CT on 11/3/14. No associated mass is seen.SPLEEN: Surgically absent.PANCREAS: Post surgical changes at the pancreatic head and pancreaticojejunostomy, without complication evident. The remaining pancreas is atrophic with heterogenous parenchymal T1 signal and beading irregularity of the pancreatic duct, compatible with the known history of chronic pancreatitis. No focal mass is seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts. Otherwise, no significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Evidence of pancreaticojejunostomy and choledochoduodenostomy, without acute abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "1. Stable post-surgical biliary changes and moderate biliary dilation. No specific evidence of complication. 2. Chronic portal vein thrombosis with cavernous transformation, similar to 2014. No specific evidence of cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "56M with h/o cervical arthritis, x-ray with degenerative changes, patient has decreased ROM and radicular pain (R > L arm) described as shooting, ?lesion amenable to surgery for pain relief? Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained aside from loss of cervical lordosis. Bone marrow signal is benignThe cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine with multilevel disc desiccation and disc height loss which is worst at the C4-C5 level. Individual levels as below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Partial effacement of the ventral thecal sac without significant spinal canal stenosis overall. No significant neural foraminal stenosis.C4-5: Small disc osteophyte complex and uncovertebral hypertrophy on the right resulting in mild to moderate right-sided neural foraminal stenosis. No significant spinal canal compromise or left neural foraminal narrowing.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: Small disc osteophyte complex and uncovertebral hypertrophy on the left. There is no significant spinal canal stenosis. There is mild to moderate left neural foraminal narrowing. No significant right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.Right vertebral artery is diminutive which may be related high-grade stenosis. Paraspinous soft tissue structures appear within normal limits.", "output": "1. Multilevel degenerative changes in the cervical spine. There is mild to moderate right C4-C5 and left C6-C7 neural foraminal stenoses. There is no significant spinal canal stenosis at any level.2. Right vertebral artery flow-void is diminutive which may be related to high-grade stenosis. Dedicated CTA or MRA neck may be considered for better assessment."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up hemangioma. History of P53 syndrome. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Segment 7 lobular T2 hyperintense lesion measuring 4.8 x 4.4 cm demonstrates peripheral nodular discontinuous enhancement which progressively fills in, compatible with a hemangioma.Numerous small and large gallstones within an elongated gallbladder without evidence of cholecystitis.No intrahepatic biliary duct dilatation, additional suspicious liver lesion or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild bilateral left greater than right adrenal thickening without a discrete nodule.KIDNEYS, URETERS: Right renal superior pole simple appearing cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral breast prostheses. Diastases of the rectus abdominis muscles with broad base fat-containing hernia without evidence of complication.OTHER: No significant abnormality noted.", "output": "1.The right hepatic lobe lesion currently measures 4.8 x 4.4 cm compared to 3.6 x 3.4 cm in 2013 and remains compatible with a hepatic hemangioma.2.Bilateral hyperplastic adrenal glands, unchanged.3.Hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old woman with supratherapeutic INR now with acute mental status change. Parenchymal hemorrhage with layering blood products is present at the left posterior temporoparietal junction. The hemorrhage measures 3.4 x 3.0 cm in the axial plane (series 2 image 12). A rim of edema surrounds the hemorrhage. There is no underlying lesion evident by CT. There is mild mass effect upon the left lateral ventricle but no appreciable midline shift. The 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. Extensive soft tissue abnormality is present in the occipital region. This may represent sequela of prior soft tissue hemorrhage as seen on the MRI dated 1/17/2007.", "output": "Left temporoparietal junction parenchymal hemorrhage as detailed above. No underlying lesion is evident by CT -- MRI is recommended for further evaluation if clinically appropriate."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question:? Central lesion resulting in visual field defect. Signs and symptoms: Possible left hemianopia on visual field testing. Nonenhanced brain MRI:Negative diffusion weighted images.There are numerous small foci of flair hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres, minimally in bilateral basal ganglia and pons with abdomen is soft hemorrhagic changes. Although the findings are nonspecific this appearance is often result of microvascular chronic ischemic strokes. Less likely possibility of demyelinating disease cannot be entirely excluded. Correlate with history and risk factors for both disease processes. There is no detectable cortical, cerebellar or vermian abnormalities.Ventricular system as well as the CSF spaces and cortical sulci remain within normal for stated age. There is no detectable mass in the midline and basal cistern is unremarkable.Signal void the major intracranial arterial branches are identified.Unremarkable calvarium, scalp, orbits and paranasal sinuses.", "output": "1.No acute intracranial process.2.No evidence of mass as these clinically questioned.3.Periventricular, subcortical, basal ganglia and pontine foci of flair hyperintensity although nonspecific the appearance is often result of microvascular ischemic disease. Less likely possibility of demyelinating disease cannot be entirely excluded."}
{"instruction": "Generate impression based on findings.", "input": "Female 59 years old Reason: new met, fracture, dislocation History: left elbow pain There is soft tissue swelling predominantly along the dorsal aspect of the forearm. There is also elevation of the fat pads indicating a joint effusion. We see no fracture line. There is a mottled appearance of the coronoid process of the ulna with poor definition of the cortex best seen on the internal oblique view. This corresponds to a focus of increased radiotracer activity on a bone scan in 2015, suggesting metastatic disease. If further evaluation is clinically warranted, MRI may be obtained.", "output": "1.Soft tissue swelling and joint effusion without fracture.2.Findings suggestive of metastatic disease to the proximal ulna. MRI may be helpful for further evaluation, if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female patient with Crohn's disease and fistula in 6/2015. Evaluate for perianal Crohn's disease. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered small mesenteric lymph nodes.BOWEL, MESENTERY: There is an 8 cm segment of rectum and distal sigmoid colon with mild wall thickening and increased edema signal that extends to the anal verge with enhancement. The ischiorectal fat is indurated and there is an enhancing left anterior transsphincteric perianal fistula that extends from the 2:00 position to the left perineum (series 9 image 76). There is also a blind ending tract extending from the anterior anus, 12:00 position (series 9 image 74).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Left anterior transsphincteric perianal fistula extending to the left perineum.2.Blind ending tract from the anterior anus.3.Active inflammatory changes of the rectosigmoid colon compatible with history of Crohn's disease."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Anesthesia of skinClinical question: please do dr Javed MS protocol and compare to priorSigns and Symptoms: numbness The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of partial empty sella.There is redemonstration of multiple T2 and FLAIR hyperintense punctate lesions in the subcortical and periventricular white matter which were also present on the previous exam. They tend to be hypointense on T1. They appear to have been present on the prior exam and not substantially changed in number or location. However, they're more conspicuous on the current exam. The conspicuity may be explained in part due to differences in MR acquisition technique.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There is redemonstration of multiple periventricular and subcortical white matter lesions which are nonspecific but compatible with the patient's clinical history of demyelinating disorder. They appear stable when compared to the prior exam in number and location. Differences in conspicuity may be accounted for on the basis of differences in MR acquisition technique."}
{"instruction": "Generate impression based on findings.", "input": "9 months Female (DOB:6/4/2015)Reason: is there any evidence of tumor or aqueductal stenosis? History: child with NF1 and very large head but soft anterior fontanelle.PROVIDER/ATTENDING NAME: JAMES H. TONSGARD JAMES H. TONSGARD The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There is no evidence for aqueduct stenosis or intracranial mass lesion. No stigmata for neurofibromatosis are appreciated on the current exam."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female status post left triple wire localization lumpectomy and sentinel lymph node biopsy in September 2015 after neoadjuvant chemotherapy, final pathology showed DCIS grade 3, 0 out of 7 nodes ypTisN0). There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Seroma cavity is seen in the left central breast measures 52 x 32 mm. No abnormal enhancement noted around the seroma cavity. Redemonstrated is a focus of enhancement in the central left breast around 6:00 position.No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "Postoperative changes in the left breast.No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with prostate cancer. PSA 7.2. Adenocarcinoma right medial mid gland, Gleason 3 + 3 = 6. PELVIS:Evaluation is moderately degraded by artifact from right hip prosthesis.PROSTATE:Prostate Size: 4.9 x 3.4 cm.Peripheral Zone: No suspicious peripheral zone lesion is identified.Central Gland: Nodules in the central gland demonstrate benign morphology without suspicious characteristics. No suspicious lesion is identified.Seminal Vesicles: No significant abnormality is identified.Extracapsular Extension: No significant abnormality is identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No candidate lesions are identified for patient's known prostatic adenocarcinoma."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with history of jejunal diverticulitis, assess resolution ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly measuring 22.5 cm in craniocaudal dimension. Punctate right hepatic hypodensity is too small to characterize but likely represents a cyst. Loss of signal on out of phase images suggests steatosis.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.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": "1.Resolution of diverticulitis without evidence of a small bowel lesion.2.Hepatomegaly and hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review is MRI dated March 13, 2015 performed at DuPage Medical Group in Naperville, Illinois. For comparison, prior mammograms dated June 13, 2014 and March 21, 2014 are available. Bilateral screening breast MRI was performed per outside institution protocol without and with gadolinium based contrast agent. Interpretation of this examination is somewhat limited given the inability to upload and interpret the dynamic images utilizing Dynacad.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.An area of non-mass enhancement is present within the upper inner right breast, mid depth, measuring 1.9 x 1.1 x 1.9 cm, and is not appreciated on prior examinations. Additionally, there is mild skin indentation overlying the area of enhancement within the medial right breast. Elsewhere, multiple patchy areas of enhancement are appreciated throughout both breasts, unchanged from prior examinations. No abnormal lymph nodes are identified in either axillary region.", "output": "New area of non-mass enhancement within the upper inner right breast with overlying skin indentation. Correlation with history of biopsy or other surgical procedure recommended. MRI guided ultrasound is recommended. If no sonographic correlate is identified, MRI with possible biopsy is advised.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status and ataxiaClinical question: r/o stroke, NPHSigns and Symptoms: r/o stroke, AMS ataxia There is a 20x29mm axial dimension cyst in the pineal region compatible with arachnoid cyst. It follows CSF on all pulse sequences. There is associated flattening of the tectal plate.The lateral ventricles are relatively large in relation to the sulci.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is loss of volume along the left middle frontal gyrus associated with medial displacement of the adjacent vasculature.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.", "output": "1.Large lateral ventricles. The possibility of normal pressure hydrocephalus cannot be excluded. Another possibility is that this is related to the pineal region arachnoid cyst.2.Pineal region arachnoid cyst associated with flattening of the tectal plate.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for acute ischemic cerebral infarction.5.Focal volume loss along the left middle frontal gyrus is non-specific."}
{"instruction": "Generate impression based on findings.", "input": "44 year old female with DM, HTN, fibromyalgia, DKA, syncope and unexplained LVOT gradient with SAM of the mitral valve. Left VentricleThe left ventricle is normal in size with mild concentric hypertrophy and normal systolic function. The overall LV ejection fraction is 73%. The LVEDV is 127 ml (normal range 109+/-23), LV end diastolic volume index is 88 ml/m2 (normal range: 65+/-11), LVESV is 35 ml (normal range 31+/-10), and LV end systolic volume index is 24 ml/m2 (normal range 18+/-5). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is evidence for flow acceleration in the LVOT.The native T1 myocardial relaxation time is upper normal and similar in the septum and other myocardial segments. There is no LV thrombus. There is mild sigmoid hypertrophy of the interventricular septum.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 45%, the RVEDV is 177 ml (normal range 110+/-24), the RV end diastolic volume index is 122 ml/m2 (normal range 69+/-14), the RVESV is 98 ml (normal range 35+/-13) and the RV end systolic volume index is 68 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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. CVenous AnatomyThe SVC and IV 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.Normal sized left ventricle with mild concentric hypertrophy and hyperdynamic systolic function.2.Normal sized right ventricle with normal systolic function.3.Mild sigmoid hypertrophy of interventricular septum.4.No evidence of infiltrative disorder.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral lower extremity weakness, evaluate for cord compression Again seen are postsurgical changes of cervical laminoplasty with laminectomies from C3 to C7, spinous processes resection, and placement of bone graft at the C4 and C6 levels on the left. There are foci of T2 hyperintensity involving the right lateral aspect of the cord at the C5-C6 and C6-C7 levels with volume loss consistent with myelomalacia, and similar to 6/8/2015. Vertebral body heights are maintained. Reversal of cervical lordosis again seen as well as trace retrolisthesis of C4 on C5 and C5 on C6.Multilevel degenerative changes are seen, individual levels as below:C2/3: No significant neural foraminal or central canal stenosis.C3/4: Diffuse disc bulge results in effacement of the ventral thecal sac and minimal indentation of the ventral cord. Dorsal thecal sac is patent. Uncovertebral hypertrophy results in moderate left and mild right neural foraminal stenoses. C4/5: Disk osteophyte complex and ligamentum flavum thickening result in partial effacement of the ventral and dorsal thecal sac and overall mild spinal canal stenosis. There is severe right and moderate to severe left neural foraminal narrowing.C5/6: Disc osteophyte complex is present without significant spinal canal stenosis. Uncovertebral hypertrophy results in mild to moderate left and moderate to severe right neural foraminal stenoses.C6/7: Disc osteophyte complex is associated with effacement of the ventral and dorsal thecal sac, particularly on the right. Severe right and moderate to severe left neural foraminal stenosis again seen related to uncovertebral hypertrophy. C7/T1: Mild disc bulge and ligamentum flavum thickening without significant spinal canal or neural foraminal stenosis.", "output": "1. Postoperative changes of C3-C7 cervical laminoplasty are again seen. Spinal canal caliber is improved when compared to preoperative MRI from 2/14/2015. There does remain however mild degree of spinal canal stenosis/thecal sac effacement at C3-C4, C4-C5, and to a slightly greater degree relatively at C6-C7 levels, similar to prior from 6/8/2015.2. T2 hyperintensity in the right lateral cord at the C6-C7 level and to a lesser degree C5-C6 level related to myelomalacia as seen before."}
{"instruction": "Generate impression based on findings.", "input": "54 years Female (DOB:12/25/1961)Reason: stroke? History: L sided weaknessPROVIDER/ATTENDING NAME: NAOUM ISSA MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The left maxillary sinus is small. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Some narrowing of the upper cervical spine is present.Exam is mildly degraded due to patient motion.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is hypoplastic. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. There is extracranial origin of the posterior inferior cerebellar artery bilaterally.Exam is mildly degraded due to patient motion.", "output": "1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction.4.Periventricular and subcortical white matter signal changes of a mild to moderate degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 5.Examination is mildly degraded due to motion artifact which may obscure more subtle abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "Recent surgery on left hip. Pain in the right hip. Rule out fracture. Components of a left total hip arthroplasty device are situated in near-anatomic alignment, although the distal extent of the prosthesis is not included on the field-of-view of this study.I see no fracture.The bones appear demineralized, suggesting osteopenia. The lateral margin of the right femoral head is slightly indistinct, which I suspect simply reflects the patient's underlying osteopenia/osteoporosis; however if the patient has a known primary malignancy, then I would recommend CT or MRI for further evaluation to exclude an unusual metastatic focus.Mild degenerative arthritis affects the pubic symphysis. Degenerative arthritic changes also affect the visualized lower lumbar spine.", "output": "I see no fracture. The bones are demineralized, suggesting osteopenia. The lateral margin of the right femoral head is slightly indistinct which I suspect simply reflects the patient's underlying osteopenia; however, if the patient has a known primary malignancy, then I would recommend CT or MRI for further evaluation to exclude an unusual metastatic focus."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for rotator cuff tear. Left shoulder pain. ROTATOR CUFF: There is marked thickening and fraying of the supraspinatus tendon suggesting an intrasubstance tear, with intact fibers identified. There is mild atrophy of the supraspinatus muscle. The teres minor and subscapularis are normal. There is mild to moderate tendinopathy of the infraspinatus.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There are mild degenerative changes of the glenohumeral joint. There is a focus of T2 hyperintensity within the posterior lateral aspect of the humeral head, probably secondary to degenerative changes given location and patient's age, less likely posttraumatic. The labrum is grossly intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "Intrasubstance tear of the supraspinatus and mild to moderate tendinopathy of the infraspinatus."}
{"instruction": "Generate impression based on findings.", "input": "Patient with history of juvenile idiopathic arthritis, presenting with thoracic back pain, evaluate. Minimal dextroscoliosis of the thoracic spine is identified, better seen on recent radiograph from 7/6/2016. Otherwise the alignment is anatomic. There is diffuse T1 hypointensity and T2 hyperintensity involving the T6 vertebral body as well as the anterior aspect of the T10 vertebral body. There are endplate irregularities of the vertebral bodies at these levels, with mild loss of height involving the left aspect of the T6 vertebral body. Otherwise the remainder of the vertebral body heights are maintained. There are areas of abnormal enhancement involving the T6 and T10 vertebral bodies. No associated paraspinous or epidural soft tissue mass.There is no evidence of spinal cord signal abnormality. No spinal canal or neural foraminal stenosis is identified.", "output": "Edema and abnormal enhancement involving the T6 vertebral body and to a lesser degree T10 vertebral body with irregularity/erosion involving the inferior endplates at these levels. Differential is broad and includes: endplate erosion related to known inflammatory arthropathy with reactive edema and enhancement; chronic recurrent multifocal osteomyelitis; Langerhans cell histiocytosis or neoplastic process seem less likely but remain in the differential given the nonspecific appearance of these lesions. Appearance would also be unusual for Schmorl's nodes with reactive vertebral edema and enhancement or for bone infarcts.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "62 year-old female with nausea, vomiting, and dizziness. Evaluate for bleed.IMAGE ACQUISITION: Nonenhanced CT of the head and MRI of the brain dated 8/20/11 There is a rounded focus of hyperattenuation in the left pons, correlating with the site of abnormality seen on recent MRI. There is no midline shift or hydrocephalus.Mild hypoattenuation in the periventricular and subcortical white matter is most consistent with small vessel ischemic disease. No skull fracture is evident. Visualized paranasal sinuses are grossly clear.Postsurgical changes are again seen with left temporo-occipital encephalomalacia, unchanged.", "output": "Rounded focus of hyperattenuation in the left pons correlating with site of abnormality seen on MRI. This most likely represents a hemorrhagic metastases. A subsequent MRI was ordered."}
{"instruction": "Generate impression based on findings.", "input": "Female, 77 years old. Reason: 77 yo with amyloidosis, fever having worsening somnolence History: somnolence There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Calcifications are seen at the level of the upper cervical cord likely corresponding to known expansile mass at the cervicomedullary junction as seen on prior MRI scan from 8/21/09.", "output": "No intracranial abnormality. Known spinal cord mass is partially visualized on this study."}
{"instruction": "Generate impression based on findings.", "input": "Frequent ankle sprains Metallic susceptibility artifact overlies the distal fibula representing suture anchors as seen on prior radiographs. TENDONS: The Achilles tendon is unremarkable. Note is made of a type I accessory navicular. A small amount of fluid surrounds the medial tendons which is of doubtful clinical significance. There is a longitudinal tear of the peroneus brevis tendon as it courses posterior and beneath the lateral malleolus. The anterior tendons are unremarkable.LIGAMENTS: The anterior talofibular ligament is indistinct with an adjacent ossicle in its location, representing a chronic tear. The calcaneofibular ligament is likewise indistinct, likely from prior tearing. The posterior talofibular ligament appears attenuated which may reflect prior partial tearing. The distal tibiofibular syndesmotic complex is intact. There is loss of the normal fatty striations of the deep tibiotalar fibers of the deltoid ligament likely reflecting prior sprain. The spring ligament is grossly intact.ARTICULAR SURFACES AND BONE: A small focus of signal abnormality is noted within the talar dome laterally with heterogeneity of the overlying articular cartilage, representing an osteochondral defect that may be degenerative in nature or related to prior trauma. Subchondral edema is noted within the tibial plafond laterally that may also be degenerative in nature or represent a bone contusion. There is signal abnormality within the body of the calcaneus below the angle of Gissane which may represent a large normal vascular remnant or less likely early intraosseous ganglion formation. Mild osteoarthritis affects the subtalar joint with osteophytes noted along the posterior facet and degenerative edema within the sustentaculum talus.", "output": "1. Tears of the anterior talofibular and likely calcaneofibular ligaments, with attenuation of the posterior talofibular ligament which may reflect partial tearing.2. Longitudinal tear of the peroneus brevis tendon.3. Osteoarthritis of the subtalar and tibiotalar joints with other findings detailed above."}
{"instruction": "Generate impression based on findings.", "input": " MRI brain: There is inferior descent of the cerebellar tonsils up to 11 mm below the foramen magnum compatible with Chiari I malformation. There is diminished CSF space at the level of foramen magnum, worse posteriorly.CSF flow sequence is technically limited and direction of the flow cannot be evaluated. Magnitude images demonstrate mildly diminished CSF flow ventrally and more severe diminished flow dorsally.There is no diffusion abnormality. There are no areas of abnormal signal. The ventricles and sulci are within normal limits. There is no hydrocephalus. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is minimal opacification of the paranasal sinuses. MRI spine: There is a large cervical syrinx which begins at the upper C4 level and more inferiorly occupies nearly the entire diameter of the cervical cord, measuring approximately 11 x 9 mm in the axial plane at the C6 level. There is further extension of the syrinx down to the thoracic cord at the lower T12 level.Conus terminates normally at the upper L2 level. There is no evidence of filar lipoma or other lesions within the lumbar spinal canal. On prone sagittal imaging, there appears to be minimal ventral motion of the conus, approximately 1 mm; however, there is greater ventral motion of the cauda equina about 4 mm at the L3 level. The apparent reduced ventral motion of the conus is of questionable significance given the normal position of the conus, appropriate ventral motion of the cauda equina nerve roots, and absence of additional lesions in the lumbar spinal canal.The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant spinal canal or foraminal stenosis within the spine at any levels. The paraspinal soft tissue structures are unremarkable.", "output": "1. Inferior descent of the cerebellar tonsils of up to 11 mm below the foramen magnum consistent with Chiari I malformation. 2. Extensive syringohydromyelia involving the cervical and thoracic spinal cord extending from upper C4 to the lower T12 vertebral levels.3. No convincing imaging evidence of tethered cord. Please see comment above."}
{"instruction": "Generate impression based on findings.", "input": "History of right intraocular retinoblastoma s/p intraocular chemotherapy x 2: disease status evaluation. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There is a lesion that measures approximately 2 x 6 mm in cross section along the posterolateral aspect of the right globe, which is not significantly changed. The right optic nerve appears to be intact and the rest of the right intraorbital structures appear to be unremarkable. The left orbit appears to be unremarkable.", "output": "1. Unchanged treated subcentimeter right intraocular retinoblastoma. 2. No evidence of left orbital tumor.3. No evidence of intracranial tumor to suggest trilateral retinoblastoma."}
{"instruction": "Generate impression based on findings.", "input": "Female, 36 years old, with left hemi-body sensory loss. Evaluate for right thalamic infarct. No parenchymal edema or mass effect is detected. No restricted diffusion is evident. There is no intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles are normal in size and morphology.", "output": "Unremarkable evaluation with no evidence of acute ischemia or any other specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Left ischium pressure ulcer to bone. Rule out osteomyelitis. Large soft tissue ulceration is seen laterally extending from the skin to the greater trochanter. Surrounding soft tissue edema suggests inflammation or infection. There is cortical loss of the underlying bone and marrow signal abnormality in the proximal femur centered in the greater trochanter, with increased T2 signal and decreased T1 signal as well as enhancement on postcontrast images, compatible with osteomyelitis.Small skin ulceration is also seen in the posterior subcutaneous soft tissues superficial to the coccyx with soft tissue enhancement suggesting inflammation or infection. No clear evidence of marrow signal abnormality, cortical disruption, or abnormal osseous enhancement is seen to suggest underlying osteomyelitis.There are no other areas of bone signal abnormality. Specifically, there is no involvement of the ischium. Small bilateral hip joint effusions are present, right greater than left.", "output": "1.Large ulceration of the lateral left hip and underlying osteomyelitis centered in the greater trochanter of the left femur.2.Additional sacral ulcer without evidence of osteomyelitis in this region."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with history of benign biopsy of the right breast and strong family history of breast cancer in her mother presents for MRI Surveillance. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Multiple cysts are present in both breasts.Focal non-mass enhancement is unchanged at middle 12 o'clock position in the left breast.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": "Erb's palsy. The study is limited, especially axial fat saturated T2 weighted images for technical reasons. The avulsion of the right C8 nerve root from the spinal cord with retraction has not changed and there is persistence of the increased T2 signal in the right C7-T1 neural foramen, reflecting an associated small pseudomeningocele which abuts the thecal sac. The right T1 nerve root shows minimally increased T2 signal and is also slightly less distinct than the contralateral T1 nerve root, with slight asymmetric prominence of the right T1 nerve root sleeve. There is no other definite abnormality of the right brachial plexus. There is no mass. The cervical spinal cord shows no abnormality.The right humeral head is posteriorly subluxed relative to the glenoid. However, this study is not optimized for shoulder assessment and this may relate to positioning.", "output": "1. Avulsion and retraction of the right C8 nerve root with associated small pseudomeningocele, as on the previous examination from January 2015. Please correlate with Klumpke palsy.2. Subtle abnormality of the right T1 nerve root and sleeve may represent partial injury as well. 3. There is suggestion of posterior right glenohumeral subluxation. However, this study is not optimized for shoulder assessment. If there is clinical concern for glenohumeral derangement, dedicated shoulder MRI would be helpful."}
{"instruction": "Generate impression based on findings.", "input": "Female, 68 years old. Reason: evaluate thyroid nodule History: incidental thyroid nodule RIGHT LOBE MEASUREMENTS: 2.6 x 2.2 x 5.6 cm.LEFT LOBE MEASUREMENTS: 3.1 x 2.5 x 6 .0 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Mildly heterogeneous echotexture, with a few benign-appearing subcentimeter cysts.LEFT LOBE: Mildly heterogeneous echotexture. A well marginated, heterogeneous noncalcified solid nodule in the left thyroid lobe, with surrounding hypoechoic rim and mildly increased peripheral blood flow measures 2.7 x 1.4 x 2.4 cm.ISTHMUS: Mildly heterogeneous echotexture without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "A 2-3 cm solid, noncalcified left thyroid nodule is identified as detailed above, and is amenable to biopsy for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "64 year-old male with sharp disabling pain across the upper abdomen before meals. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is a subcentimeter focus of fluid signal intensity in the body of the pancreas which is too small to characterize but may represent a branch type IPMN or cyst.ADRENAL GLANDS: There is a 1.7 x 1.3 cm left adrenal nodule with loss of signal on out of phase imaging and fat saturated sequences consistent with a lipid rich adrenal adenoma. KIDNEYS, URETERS: Multiple subcentimeter foci of fluid signal intensity are identified in the kidneys, which are too small to characterize, likely represent simple cysts. Simple cysts in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a large amount of debris, as well as an air-fluid level within a distended stomach.BONES, SOFT TISSUES: Leftward curvature of the lower thoracic spine.OTHER: No significant abnormality noted.", "output": "1.Large amount of debris with associated air fluid level within a distended stomach is nonspecific but can be seen in gastroparesis. Correlation with a nuclear medicine gastric emptying study could be considered if clinically indicated. 2.Left adrenal nodule appears most consistent with an adrenal adenoma. 3.Subcentimeter cystic lesion in the body of the pancreas may represent a branch type IPMN or cyst. "}
{"instruction": "Generate impression based on findings.", "input": "34 years, Male, with multiple sclerosis, evaluate for progression. Again seen is a tiny nonspecific focus of T2/FLAIR hyperintensity in the right frontal corona radiata, axial FLAIR series 701 image 56. No new lesions are identified. There is unchanged linear enhancement in the left posterior frontal lobe which likely represents an incidental developmental venous anomaly. No suspicious foci of enhancement in the brain. Brain parenchyma is otherwise unremarkable without convincing evidence of demyelinating lesions within the brain. Brain parenchymal volume is preserved. No intracranial mass or mass effect. Ventricles and sulci appear within normal limits. Calvarium and extracranial soft tissues are grossly unremarkable.", "output": "No evidence of progressive demyelinating disease in the brain. Tiny punctate focus of FLAIR hyperintensity in the right frontal white matter is unchanged and nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "HCV cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology without a focal lesion biliary ductal dilatation or vascular abnormality.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: Scattered retroperitoneal and porta hepatis lymph nodes are not pathologically enlarged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Cirrhosis without a suspicious lesion."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: pre-op for tomorrowSigns and Symptoms: pre-op for tomorrow There is redemonstration of a 20 mm x 20 mm well-circumscribed enhancing mass located along the superior aspect of the left cerebellar hemisphere. There is redemonstration of a 16 x 19 mm axial dimension ring-enhancing lesion in the vermis. There is redemonstration of a 25 x 27 mm axial dimension ring-enhancing mass in the right cerebellar hemisphere centered in the inferior semilunar nodule. There is associated with vasogenic type edema with these cerebellar lesions. Overall compared to the prior exam there does not appear to be a significant interval change.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Multiple cerebellar metastases appear stable compared to prior exam. Examination is performed for the purpose of stereotactic guidance during surgery."}
{"instruction": "Generate impression based on findings.", "input": "Female 17 years old Reason: left heel pain evaluate for stress fracture History: left heel pain TENDONS: Tendons are intact without evidence of abnormal thickening or tear.LIGAMENTS: Ankle ligaments are intact.ARTICULAR SURFACES AND BONE: There is hazy and mildly serpiginous low T1 signal within the posterior calcaneal apophysis. There is also associated edema within this apophysis. The physis is not completely fused, however this abnormal low T1 and high T2 signal situated posteriorly and inferiorly to the physis. These findings are concerning for stress reaction or early stress fracture. The remaining articular surfaces and bone marrow is normal in signal.ADDITIONAL", "output": "Stress reaction or early stress fracture within the calcaneal apophysis."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with right kidney lesion ABDOMEN:LIVER, BILIARY TRACT: T2 hyperdense cyst in the posterior right liver lobe. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right partial nephrectomy. T2 hyperintense simple cyst in the right kidney. Enhancing subcentimeter nodule at the right kidney resection bed measuring 6 x 5 mm (series 12, image 296). This lesion corresponds to the enhancing nodule seen on prior CT, unchanged in size since 9/10/2015. 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.Partial right nephrectomy with unchanged (from 9/2015 CT imaging) subcentimeter enhancing nodule in the surgical bed, differential considerations include postsurgical sequelae but continued followup suggested."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old male with history of stage I seminoma (92) status post left orchiectomy and XRT. Evaluate for recurrence. As per oacis, subcutaneous lesion in the back muscles was biopsy proven granular cell tumor. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Precarinal lymph node measuring 1.3 x 0.6 cm, (image 36, series 4) a second reference lymph node measures 0.9 x 1.4 cm, (image 48, series 4).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Three well-defined hypervascular lesions are seen within the liver which are not identified on prior examinations. Segment two liver lesion measures 0.9 x 0.8 cm, (image 75, series 4). Segment eight liver lesion measures 1.4 by 1.2 cm, (image 82, series 4). Segment four A liver lesion measures 1.3 x 1.1 cm, (image 86, series 4). Dedicated liver protocol was not obtained.These lesions demonstrate an appearance of hemangioma however since these lesions are not seen on previous examinations other considerations must include hypervascular metastatic lesions which would be atypical for seminomatous dissemination. Further evaluation with MRI or PET CT may be considered as clinically indicated.SPLEEN: Single ill-defined hypodense lesion remains stable compared to previous examinations.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "1. Nonspecific mediastinal lymphadenopathy. 2. Multiple hypervascular hepatic lesions likely demonstrate an appearance of hemangioma however since these lesions are not seen on previous examinations other considerations must include hypervascular metastasis which would be atypical for seminomatous dissemination. Further evaluation with MRI or PET CT may be considered as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Low back pain bilateral leg pain altered gait. There is multilevel degenerative spondylosis. At L5-S1, there is an eccentric left disc protrusion that impinges upon the nerve roots in the left lateral recess and results in mild left neural foraminal narrowing medially. There is also slight anterolisthesis and facet hypertrophy that contribute to neural foraminal narrowing bilaterally. At L4-5, disc bulging and facet hypertrophy result in effacement of the bilateral lateral recesses and narrowing of the central spinal canal, as well as mild neural foraminal narrowing bilaterally. At L3-4, there is a disc bulge and superimposed small eccentric left protrusion and mild bilateral facet hypertrophy that results in mild spinal canal and neural foraminal narrowing bilaterally. At L2-3, there is a disc bulge and superimposed and bilateral facet hypertrophy that results in mild spinal canal and neural foraminal narrowing bilaterally. At L1-2, there is mild disc bulging, with slight left neural foraminal narrowing, but no significant right neural foraminal or spinal canal narrowing. There is no significant degenerative disease at T12-L1. There is mild lumbar levoscoliosis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged portions of the spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a partially imaged right renal lesion.", "output": "1. Multilevel degenerative spondylosis, which is most pronounced in the lower lumbar spine, left worse than right. 2. Partially imaged right renal lesion. Renal ultrasound may be useful for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Left lower extremity weakness and back pain 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 diffusely heterogeneous similar to prior, which is nonspecific, and without discrete suspicious osseous lesions. The conus medullaris is normal in position.Mild degenerative changes are seen including multilevel disc desiccation with relatively preserved disc heights. Additional details as 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 bulge, ligamentum flavum thickening, and facet arthropathy. No significant spinal canal stenosis. Mild bilateral neural foraminal narrowing. L4-L5: Mild disc bulge eccentric to the left with dorsal annular fissure, ligamentum flavum thickening, and bilateral facet arthropathy. No significant spinal canal stenosis. There is mild to moderate right neural foraminal stenosis. There is moderate left neural foraminal stenosis, which is slightly worse than prior. Bilateral facet joints are distended with fluid.L5-S1: Mild disc bulge which is eccentric to the left. No significant spinal canal or right neural foraminal stenosis. There is mild to moderate left neural foraminal stenosis similar to prior. Bilateral facet arthropathy with facet joint distention.", "output": "1. There is moderate left L4-L5 and mild to moderate left L5-S1 neural foraminal stenosis which may be contributing to patient's left lower extremity weakness. Overall degenerative changes are stable to minimally worse since 1/21/2010. 2. Facet arthropathy at L4-5 and L5-S1 with facet distension similar to prior. Additional details as above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 60 years old, with history of parotid cancer with lymph node metastases. Brain:Scattered foci of FLAIR hyperintensity are demonstrated in the cerebral white matter and pons, without significant interval change. No diffusion restricting lesions are seen. No edema or mass effect is detected. There is no pathologic parenchymal or left meningeal enhancement. No abnormal extra-axial fluid collections or evidence of intracranial hemorrhage is seen. Ventricular size and morphology remain within normal limits.Neck:Postoperative findings are redemonstrated compatible with right parotidectomy, right neck dissection and radiotherapy. No masslike lesion or pathologic enhancement is seen in the operative bed. Persistent enhancement of the geniculate, tympanic and mastoid portions of the right facial nerve are again seen similar to prior. The right submandibular gland remains smaller than the left. No pathologic adenopathy is detected in the visualized portion of the neck. T2 hyperintense material within the subcutaneous tissues of the face may reflect prior cosmetic instrumentation. The right mastoid air cells remain opacified similar to prior.", "output": "1.No evidence of intracranial metastases.2.Redemonstration of postoperative and posttreatment findings in the neck with no evidence of recurrent tumor or pathologic adenopathy.3.Persistent enhancement of the right facial nerve is redemonstrated without significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "Headaches and hypertension. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant intracranial steno-occlusive lesions or cerebral aneurysms.", "output": "1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant intracranial steno-occlusive lesions."}
{"instruction": "Generate impression based on findings.", "input": " BRAIN: There is an approximately 1 cm focus of restricted diffusion in the region of the left posterior limb of the internal capsule and lateral left thalamus with associated increased T2 signal compatible with an acute ischemic infarction. No additional foci of restricted diffusion are identified. There are several punctate and confluent foci of increased T2/FLAIR signal within the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Incidental note is made of a partially empty sella. There is redemonstration of a chronic right lamina papyracea fracture.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.", "output": "1.Small, acute lacunar infarct within the region of the left lateral thalamus/posterior horn of the left internal capsule.2.Mild chronic small vessel ischemic changes.3.MRA without intracranial aneurysm or significant stenosis.Discussed with FINTEL, BARA at 12:48 on 8/29/2015. "}
{"instruction": "Generate impression based on findings.", "input": "53 year old female patient with sickle cell anemia with acute chest, obtunded. Question of CVA or encephalitis. There are scattered foci of restricted diffusion throughout both cerebral hemispheres consistent with perfusional acute ischemic infarcts. This is on a background of extensive chronic small vessel and lacunar ischemic disease which is in a watershed distribution. Patchy cortical and subcortical edema is seen involving the cerebral hemispheres and particularly the right temporal lobe. There has been interval progression in diffuse cerebellar edema, right greater than left, causing crowding of the brainstem and effacement of the 4th ventricle.There are innumerable punctate and ill-defined foci of susceptibility artifact throughout the cerebral hemispheres and particularly in the cerebellum. There is no abnormal intracranial enhancement. The supratentorial ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. A few small acute perfusional ischemic infarcts are seen on a background of extensive watershed distribution chronic small vessel ischemic disease.2. Extensive susceptibility artifact is evident throughout the brain, and particularly the cerebellum, which could represent a component of chronic ischemic microhemorrhage or perhaps hemosiderosis from iron overload. Microhemorrhage secondary to a chronic coagulopathy would also be a reasonable consideration.3. The cerebellum appears diffusely edematous, the etiology of which is unclear. This could be ischemic in etiology, although there is no definite acute ischemia by diffusion-weighted imaging, or possibly related to toxicity from excessive hemosiderin deposition. Inflammatory and infectious disease can also produce a similar appearing cerebellitis type pattern of inflammation.4. Relatively asymmetric edema involving the right temporal lobe is of uncertain significance but coud be secondary to an infectious or inflammatory process, including viral infection."}
{"instruction": "Generate impression based on findings.", "input": "Chiari malformation: autism. Brain: There cerebellar tonsils extend up to approximately 6 mm inferior to the foramen magnum, but display rounded to minimally pointed morphologies. There is flow of cerebrospinal fluid across the foramen magnum, albeit slightly blunted posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. 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. Low-lying cerebellar tonsils may represent a mild form of Chiari type 1 malformation.2. No evidence of syringohydromyelia in the cervical spine. "}
{"instruction": "Generate impression based on findings.", "input": "Secondary malignant neoplasm of bone [C79.51], Reason for Study: ^Reason: with metastatic breast cancer and concerning cervical spine lesion, back pain; please evaluate for risk of cord compression/nerve compression History: with metastatic breast cancer Cervical spine MRIThere are interval development of soft tissue signal intensity at the level of C3 and C4 vertebral bodies, and left side lateral mass. On Gad enhancement scan, the enhancing portion of the soft tissue mass extend toward left side C23 and C34 neuroforamen as well as transverse foramen and encasing vertebral artery.Diffuse bulging of disc at the level of C45 and broad based disc protrusion central to right laterally at the level of C56 do not show any interval change since prior scan.At the level of C56 in conjunction with protruded disc with bilateral ligamentum flavum results mild to moderate spinal canal stenosis, grossly unchanged since prior scan.Spinal cord signal intensity is normal. There is normal cervical lordosis. The cranial-cervical junction is normal. Thoracic spine MRIThere are multilevel various sized soft tissue lesions on thoracic vertebral bodies including T3, T5, T8, T9, T10, T11, T12, L1 and L2. Left side T8, T9, T10, T11 and T12 ribs also show soft tissue lesion involvement. Especially at the level of T10, there is evidence of soft tissue extension from the left side rib toward pleura.The T10 vertebral body shows about 10% of compression fracture.There is normal thoracic kyphosis and the alignment is anatomic. The cord signal is normal. The conus medullaris terminates at the level of T12-L1.", "output": "1. Multilevel metastatic lesions involving both cervical and thoracic level as well as left lower ribs. In particular, at the level of C3 and C4, the lesion involves and encasing left side neural foramen and transverse foramen. There is also pleural extension of metastatic rib lesion at the level of T10.2. There is about 10% of compression fracture of T10 vertebral body. 3. Spinal cord signal intensity remains normal. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o infection, look for signs of increased icp History: fevers, confusion in liver transplant patient There is no evidence of intracranial hemorrhage, mass or edema. Patchy periventricular and subcortical white matter hypoattenuation is consistent with small vessel ischemic disease of indeterminate age.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": "Small vessel ischemic disease of indeterminant age. Otherwise, no acute intracranial abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Epilepsy, surveillance. Again seen are postsurgical changes related to right amygdo-hippocampal laser ablations. There is continued evolution of laser ablation affects involving the right hippocampus and posterior amygdala with increase in encephalomalacia. Previously seen nodular enhancement in this region has decreased, also consistent with evolution.Evidence of prior burr holes as well as focus of encephalomalacia in the right frontal lobe along a prior surgical tract is again seen. Foci of chronic hemorrhage are also evident along the surgical tracts including in the right medial temporal lobe.There is no evidence of acute infarct, new hemorrhage, intracranial mass, or mass effect. No midline shift or herniation. Ventricles are normal in size. Major flow-voids are preserved.", "output": "Continued evolution of the laser ablation effects involving the right hippocampus and posterior amygdala with mild increase in encephalomalacia and decrease in enhancement at the ablation site. "}
{"instruction": "Generate impression based on findings.", "input": "30 years Male (DOB:5/20/1986)Reason: epilepsy History: seizuresPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE There is a heterogeneous appearance of the medial aspect of the left temporal lobe which appears similar to the prior exam.The patient status post left temporal burr hole placement. Patient's also status post left occipital burr hole placement. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left side. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "Examination was performed for stereotactic guidance. There are postoperative changes present related to left medial temporal lobe stereotactic surgery."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male with inflammatory bowel disease, ulcerative colitis. Evaluate for small bowel Crohn's disease. 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 bowel obstruction or ascites. No abnormal wall thickening or enhancement. No definite stricture formation. No obvious fistulization.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No evidence for active inflammatory bowel disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 14 years old Reason: evaluate for ligament/tendon pathology; History: patient with persistent ulnar sided wrist pain LIGAMENTS: Scapholunate ligament is intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Contrast is seen in the body of the triangular fibrocartilage complex most consistent with tear, although this does not communicate with the distal radial ulnar joint.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL", "output": "Findings most consistent with tear of the triangular fibrocartilage complex."}
{"instruction": "Generate impression based on findings.", "input": " Redemonstrated are changes from previous craniotomy involving the skull bilaterally. Encephalomalacia is present involving the anterior right temporal lobe with adjacent gliosis as well as susceptibility abnormality from presumed hemosiderin staining, stable in appearance.There are multiple foci of T2 hypointensity with matching susceptibility abnormality throughout the supratentorial and infratentorial brain, including a lesion within the left lateral upper cervical cord, not demonstrated on the prior study. More foci of hypointensity are noted with susceptibility technique. The largest of these lesions resides in the left periatrial white matter measuring approximately 11 x 14 mm in transaxial dimension on T2 imaging, unchanged. A small lesion involving the right perisylvian region has slightly decreased in size, and a previous heme/fluid level within it is no longer evident. A previous lesion identified only on susceptibility weighted imaging involving left frontal subcortical white matter now demonstrates a small heme/fluid level, suggesting interval hemorrhage, however without current perilesional edema to suggest recent hemorrhage. No other lesions demonstrate perilesional edema. There are no associated developmental venous anomalies.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. No diffusion-weighted abnormalities are identified to suggest the presence of acute ischemia. 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.", "output": "1.MRI evidence for multiple cerebral cavernous malformations. 2.There appears to be a new lesion within the left lateral upper cervical cord, not demonstrated on the prior study, although axial images on the prior study did not extend inferiorly to this level.3.A small lesion involving the right perisylvian region has slightly decreased in size, and a previous heme/fluid level within it is no longer evident. 4.A previous lesion identified only on susceptibility weighted imaging involving left frontal subcortical white matter now demonstrates a small heme/fluid level, suggesting interval hemorrhage, however without current perilesional edema to suggest recent hemorrhage. 5.No other lesions demonstrate perilesional edema."}
{"instruction": "Generate impression based on findings.", "input": "Male 12 years old Reason: Patient with history of RLE osteomyelitis, neutropenic at time of last imaging that was negative for osteomyelitis. Now with recovered counts and persistent fevers. Please assess for osteomyelitis. History: Persistent fevers, other workup thus far negative. There is no evidence of cellulitis, osteomyelitis or abscess. Normal bone marrow and soft tissues as well as cortical bone signal.", "output": "Normal examination."}
{"instruction": "Generate impression based on findings.", "input": "2-year-old male with sacral dimple. There is a fat signal intensity lesion that measures up to 25 mm in length along the posterior aspect of the conus medullaris, which is slightly indented by the lesion and terminates at the L2 level. The rest of the spinal cord displays normal signal and morphology. However, there is an additional fat signal lesion that measures up to 3 mm in length along the filum terminale at the L3-4 level. There appears to be deficiency of the posterior elements of L5 and portions of the sacral spine. However, the reported overlying dimple is not apparent. The prone images are degraded by patient motion, thereby limiting the assessment of cord mobility. 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 paravertebral soft tissues are unremarkable.", "output": "1. An intradural lipoma along the posterior aspect of the conus medullaris measures up to 25 mm and a fibrolipoma along the filum terminale at the L3-4 level measures up to 3 mm.2. The prone images are degraded by patient motion, thereby limiting the assessment of cord mobility.3. Apparent deficiency of the posterior elements of L5 and in portions of the sacral spine may indicate dysraphism. "}
{"instruction": "Generate impression based on findings.", "input": " Examination is motion degraded which limits assessment for subtle findings. Laminectomies are again seen from T6 to T9. Again seen is extensive long segment T2 signal abnormality involving the thoracic cord extending from approximately the T2 to the T12 levels not significantly changed in longitudinal extent since prior. Compared to examination from 2/18/2015, the expansile component of the signal abnormality appears to be improved. Many of the areas of T2 hyperintensity appear to be related to areas of cavitation with thinning of the cord parenchyma. Due to the motion degradation, the margins of the cord are difficult to define. There is evidence of adhesions in this thecal sac with areas of contour deformity of the cord and loculations of CSF. Shunt catheter is seen in the spinal canal at approximately the T9 level. There is a right pleural effusion which is again seen.T1 hyperintense lesions involving the T9 and T12 vertebral body are again seen. No suspicious osseous lesions. Vertebral body heights and alignment are grossly maintained. There is no significant spinal canal or neural foraminal stenosis at any level.", "output": "Again seen is extensive T2 signal abnormality involving the thoracic cord from approximately the T2 to the T12 levels. Although the longitudinal extent of the signal abnormality is not significantly changed, the expansile nature appears less evident when compared to prior study from 2/18/2015. Most of the extensive T2 signal abnormality in the cord on the current study has the appearance of cavitation/cystic myelomalacia. There is also evidence of adhesions in the thecal sac/arachnoiditis as seen before. Findings are compatible with sequela of infection. "}
{"instruction": "Generate impression based on findings.", "input": "Male 44 years old Reason: 0.8 cm liver lesion on US for further characterization History: Liver lesion ABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology with widened fissures and a nodular contour. T2 hyperintense focus in segment 6/7 of the liver without central enhancement represents a cyst.No suspicious lesion in the left hepatic lobe to correspond to the abnormality seen on ultrasound. There are several sub-capsular nodules which do not have arterial enhancement which may be the abnormality seen on ultrasound.Hepatic and portal veins are patent.The gallbladder wall edema likely due to hypoalbuminemia and ascites. No gallstones are evident.SPLEEN: Status enlarged. Splenic vein is patent.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: Extensive upper abdominal varices including a recanalized paraumbilical vein. There are perihepatic paraesophageal and gastric vertices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate upper abdominal ascites.", "output": "1.Cirrhotic liver with a nodular contour but no lesion that meets criteria for HCC."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Brain metastases, extent? Signs and symptoms: None. Pre and post enhanced brain MRI:Examination demonstrates a well-demarcated inhomogeneously enhancing intra-axial left posterior paramedian parietal high convexity metastatic lesion. It measures at 32 x 23 x 30 mm in size. There is surrounding vasogenic edema with resultant regional mass effect which includes a mass effect on the left lateral ventricle.Additional focus of enhancement in the left basal ganglia measuring at 5 mm in transaxial dimensions without appreciable surrounding edema or mass effect. There is no convincing evidence of any additional parenchymal or leptomeningeal metastatic lesions.Calvarium also demonstrate normal signal intensity without evidence of abnormal enhancement/ metastases.Unremarkable images through the orbits.Examination in addition demonstrate multiple small foci of FLAIR hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres suggestive of mild chronic small vessel ischemic strokes.The signal void of major intracranial arterial branches are identified.", "output": "1.Left paramedian posterior parietal paramedian mildly hemorrhagic metastatic lesion measuring 32 x 23 x 30 mm with surrounding vasogenic edema and regional mass effect.2.5 mm enhancing metastatic lesion in the left basal ganglia as detailed.3.Negative diffusion weighted images and findings suggestive of mild chronic small vessel ischemic strokes.4.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells."}
{"instruction": "Generate impression based on findings.", "input": "67 year old woman with history of atrial fibrillation and hypertension referred for pre-ablation cardiac MRI to delineate pulmonary vein anatomy. Left VentricleThe left ventricle is normal in size with hyperdynamic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 72 g/m2 (normal range 67+/-11), and the LV mass is 161 g (normal range 114+/-24). There is eccentric hypertrophy of the left ventricle; at the base there is asymmetric hypertrophy of the septum/anterior wall, and mid chamber hypertrophy of the inferior wall. Wall motion is hyperdynamic with mid cavity obliteration and some evidence of flow acceleration in the LVOT. There are no regional wall motion abnormalities present. There is patchy late gadolinium enhancement in the septum which is associated with hypertrophy, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1060-1070ms, which is borderline elevated. Left AtriumThe left atrium is moderate-severely dilated. No evidence of left atrial appendage thrombus. The interatrial septum bows to the right suggestive of elevated left atrial pressure.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 71 ml/m2 (normal range 69+/-14), the RVEDV is 158 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is mild-moderately 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. The leaflet tips are thickened. There is no systolic anterior motion of the mitral valve.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 pseudobovine 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 evidence of pericardial effusion.Extracardiac Findings 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. The left ventricle is normal in size with hyperdynamic function (EF 68%). There is evidence of asymmetric/eccentric moderate hypertrophy of the basal anterior wall/septum and mid inferior wall, with mid cavity obliteration in systole and the appearance of flow acceleration in the LVOT. There is also mild patchy late gadolinium enhancement in the septal associated with areas of hypertrophy. However, there is no systolic anterior motion of the mitral valve. This is likely a hypertrophic variant and, less likely, eccentric hypertrophy due to hypertension.2. Normal size right ventricle with normal systolic function (EF 65%).3. Biatrial dilation with evidence of elevated left atrial filling pressures. 4. At least mild mitral regurgitation. "}
{"instruction": "Generate impression based on findings.", "input": "Laser fiber placement: pre surgical planning. There has been recent insertion of multiple right transtemporal and bilateral transoccipital temporal region deep brain electrodes. There is no gross evidence of intracranial hemorrhage, within the limits of the metal artifact. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is mucosal thickening in the right anterior ethmoid and frontal sinuses.", "output": "Preoperative planning MRI with bilateral temporal region deep brain electrodes."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for septic embolic infarction, subacute: subtle right face, arm motor deficit, and MSSA mitral valve endocarditis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia in the left anterior frontal lobe. There are also subcentimeter foci of T2 hyperintensity in the left basal ganglia and right corona radiata. In addition, there are a few nonspecific scattered foci of t2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right sphenoid sinus retention cyst. There is nonspecific scattered fluid signal in the left mastoid air cells.", "output": "Chronic left anterior frontal lobe infarct. Subcentimeter lesions in the left basal ganglia and right corona radiata also likely represent chronic lacunar infarct. No evidence of acute intracranial hemorrhage, mass, or acute infarct."}
{"instruction": "Generate impression based on findings.", "input": "A 24 year old male patient with known non-ischemic cardiomyopathy, severe left ventricular dysfunction, with a lifevest, referred to cardiac MRI for evaluation of etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 187 ml/m2 (normal range: 74+/-15), the LVEDV is 477 ml (normal range 142+/-34), the LV end systolic volume index is 151 ml/m2 (normal range 25+/-9), the LVESV is 385 ml (normal range 47+/-19), the LV mass index is 88 g/m2 (normal range 85+/-15), and the LV mass is 225 g (normal range 164+/-36). The myocardium is thin and there is global hypokinesis with regional variation. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process; however, due to patient related issues, the image quality is somewhat noisy.No iron overload.Findings not compatible with amyloid. The left ventricle is hyper-trabeculated up to the level of the papillary muscles. This finding could support the diagnosis of left ventricular non-compaction.No LV thrombus is noted.Left AtriumThe left atrium is severely dilated (184 ml). The inter-atrial septum bows to the left suggesting increased left atrial pressure.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 32%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 268 ml (normal range 142+/-31), the RV end systolic volume index is 71 ml/m2 (normal range 31+/-9), and the RVESV is 182 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely, it is bicuspid with fusion of the right and non-coronary cusp and there is mild to moderate aortic regurgitation (regurgitant volume 12ml, regurgitant fraction 16%). There is systolic doming of the aortic leaflets, consistent with bicuspid aortic valve.Mitral ValveThe mitral valve opens widely and there mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The ascending aorta was approximately 30mm in dimension.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. The left ventricle is severely dilated with severely reduced systolic function, LVEF 19%. The left ventricle is hyper-trabeculated up to the level of the papillary muscles. In the appropriate clinical scenario, this finding could support the diagnosis of left ventricular non-compaction.2. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No iron overload. Findings also not compatible with amyloid. 3. The right ventricle is normal in size with moderately reduced systolic function, RVEF 32%. 4. The left atrium is severely dilated (184 ml) and the right atrium is mildy dilated.5. The aortic valve is bicuspid with fusion of the right and non-coronary cusp and there is mild to moderate aortic regurgitation."}
{"instruction": "Generate impression based on findings.", "input": "Assess liver lesions. Enlarging liver lesion. Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with micronodular contour and widened fissures. No perihepatic ascites noted. Several prominent periportal lymph nodes are noted, likely reactive.Multiple lesions are identified in the liver. Two lesions demonstrate increased T2 signal and diffusion restriction. The larger of these lesions, in hepatic segment 5, measures 2.0 x 1.9 cm (series 10, image 44), previously 1.7 x 1.1 cm, and demonstrates arterial enhancement without washout. Second lesion, in hepatic segment 3, measures 1.8 x 1.8 cm (series 4, image 12), unchanged, with delayed enhancement and without washout. Additional smaller arterially enhancing lesions are also seen, without washout.Normal appearance of the gallbladder, without biliary ductal dilation.SPLEEN: Splenomegaly with siderosis.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.BONES, SOFT TISSUES: Increased T2 signal in the vertebral bodies near the endplates is incompletely evaluated though likely represents degenerative changes.", "output": "Multiple enhancing liver lesions, which do not meet criteria for hepatocellular carcinoma, indeterminate and suspicious for dysplastic nodules. The largest of these in hepatic segment 5 is increased in size when compared to prior imaging."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for rotator cuff injury History: shoulder pain Examination is slightly limited by patient motion artifact.ROTATOR CUFF: There is a full thickness tear of the supraspinatus tendon, with retraction to the level of the top of the humeral head. The tear appears to involve the majority of the supraspinatus tendon at its insertion on the greater tuberosity, although we suspect that the posteriormost portion of the tendon remains intact. The supraspinatus muscle appears normal. Increased signal intensity within the infraspinatus tendon reflects a combination of tendinosis and interstitial tearing, with mild atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear intact. There is also a complete tear of the subscapularis tendon with retraction to the level of the glenohumeral joint. There is mild atrophy of the subscapularis muscle. SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa, reflecting known rotator cuff tear, but there is no large bursal effusion. GLENOHUMERAL JOINT AND GLENOID LABRUM: Thin linear increased signal intensity incompletely traversing the posterior inferior labrum suggests a tear (best seen on series 4, image 16). Mild increased signal within the superior labrum suggests degeneration and degenerative fraying. There is a small glenohumeral joint effusion. BICEPS TENDON: The tendon of the long head of the biceps is not visualized within the rotator interval, suggesting rupture. Low signal intensity within the bicipital groove may reflect remnants of the torn biceps tendon. A band of low signal intensity within the anterior portion of the glenohumeral joint is favored to represent a large middle glenohumeral ligament, although could conceivably represent a displaced fragment of torn biceps tendon.", "output": "Full thickness tears of the supraspinatus and subscapularis tendons and other findings as above. Findings were discussed by telephone with Dr. Havlin (at pager 5876) on 11/7/2016 11:10 AM."}
{"instruction": "Generate impression based on findings.", "input": "16-year-old female patient with history of pancreatic lymphangioma status post distal pancreatectomy and splenectomy in March 2015. Now with recurrent left-sided pain, similar to how she presented before surgery. Assess pancreatic duct, evaluate for recurrence of lymphangioma. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion is identified. There is no intra or extrahepatic biliary ductal dilatation. The common bile duct is normal in diameter without dominant stricture.SPLEEN: Splenectomy has been performed.PANCREAS: Distal pancreatectomy has been performed. No dilatation of the main pancreatic duct. No focal pancreatic lesion is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A fluid-filled mass within the left retroperitoneum has been resected. A few small cystic foci are noted just superior and posterior to the left renal vein, along the inferior margin of prior tumor, which are nonspecific. Otherwise, there is no specific evidence of residual or recurrent disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Numerous bilateral ovarian follicles are present. The uterus is normal in appearance.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": "1.Changes of the distal pancreatectomy and splenectomy without specific evidence of residual or recurrent disease; a few cystic foci along the inferior margin of the tumor are nonspecific and should be followed on subsequent imaging.2.No specific findings to account for the patient's symptoms in the abdomen or pelvis."}
{"instruction": "Generate impression based on findings.", "input": "Other malaise [R53.81] / Other fatigue [R53.83], Reason for Study: ^Reason: rule out neoplastic, paraneoplastic process, or CO poisoning History: AMS, fatigue, LOC No evidence of acute ischemic or hemorrhagic lesion on the scan. There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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": "Normal brain MRI"}
{"instruction": "Generate impression based on findings.", "input": "Metastatic lung cancer, C7 and T1 symptoms. Cervical Spine:Again seen is metastatic lesion involving the C7 vertebral body with diffuse marrow infiltration. There is associated lytic changes which are better appreciated on CT. Noted is expansion and extension into the left pedicle, transverse process, facets as well as the spinous process. There is mild diffuse loss of height of the C7 vertebral body similar to prior. There is moderate to severe narrowing of the left C7-T1 neural foramen which was present previously but appears slightly worse. Abnormal signal involving the inferior articular facet of C6 on the left is again seen.Craniovertebral junction appears within normal limits. There is mild diffuse loss of C7 height, vertebral body heights are otherwise maintained. Alignment remains unchanged since 4/6/2015 with loss of normal cervical lordosis. No abnormal signal seen within the cervical cord.Individual levels as below:C2-3: Small central disk osteophyte complex with no spinal canal or neural foraminal stenosis.C3-4: Disk osteophyte complex and uncovertebral hypertrophy with mild facet arthropathy with no significant spinal canal or neural foraminal stenosisC4-5: Disk osteophyte complex and bilateral uncovertebral hypertrophy causing mild to moderate spinal canal stenosis. There is minimal left neural foraminal narrowing. No significant right foraminal stenosis.C5-6: Disk osteophyte complex eccentric to the left causing focal indentation of the ventral cord surface on the left. There is mild to moderate spinal canal stenosis particularly on the left. Mild left neural foraminal stenosis.C6-7: Disk osteophyte complex causing mild spinal canal stenosis. There is moderate to severe left neural foraminal stenosis which appears worse since 4/6/2015.C7-T1: Vertebral body metastasis extending into the posterior elements left greater than right causing moderate to severe left neural foraminal stenosis. There is mild right foraminal narrowing on a degenerative basis.There is minimal epidural soft tissue thickening and enhancement at the left ventral C7-T1 level suspected to represent minimal epidural tumor. There is no significant spinal canal stenosis associated with the epidural tumor. Thoracic Spine:Multiple metastatic lesions are seen in the thoracic spine. Small lesion is noted in the right posterior aspect of the T2 vertebral body. There is a lesion noted within the dorsal T3 vertebral body extending into the posterior elements. Small lesion is seen at T6. There is a lesion at T8 on the right which extends into the posterior elements. Small lesions are seen at T9 and T10. There is a larger lesion involving the T11 vertebral body extending into the posterior elements with expansion of the right pedicle and transverse process and infiltration of the adjacent rib. Small lesion is seen involving the inferior right T12 vertebral body.Vertebral body heights are maintained. No evidence of compression fractures. No significant spinal canal stenosis is demonstrated. Moderate right T10-T11 and mild right T11-T12 neural foraminal stenosis is seen related to tumor involving the posterior elements at T11. There is also mild right T8-T9 neural foraminal stenosis. Minimal epidural enhancement along the dorsal aspect of the lower thoracic spine is favored to be vascular. No convincing evidence of epidural tumor is appreciated. No cord signal abnormality. Abnormal marrow signal involving the ribs at multiple levels is also noted.", "output": "1. Vertebral body metastasis at C7 extending into the posterior elements on the left and to a lesser degree on the right is not significantly changed in size since 4/6/2015. There is minimal ventral epidural enhancement dorsal to the C7 level which is suspected to represent minimal epidural tumor. There is moderate to severe left C6-7 and C7-T1 neural foraminal stenosis which appears slightly worse in the interval.2. Multiple metastatic lesions throughout the thoracic spine without evidence of compression fracture. Several lesions extend into the posterior elements and narrow the neural foramina as detailed above particularly on the lesions at T8 and T11. No significant spinal canal stenosis in the thoracic spine. No definite evidence of epidural tumor in the thoracic spine.3. Degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at C4-C5, C5-C6, and C6-C7."}
{"instruction": "Generate impression based on findings.", "input": "Female 54 years old. Reason: Right hip pain and low back pain. History: Right hip pain Four views of the lumbar spine are provided. The disk spaces are preserved with minimal anterior osteophytes at L5. There is no significant change from prior exam in 2007.The single view of the right hip and the single AP view of the pelvis demonstrate osteophyte formation and superior joint space narrowing with sclerosis of the right hip indicating moderate to severe osteoarthritis. There is sclerosis and osteophyte formation of the left hip indicating moderate osteoarthritis.", "output": "Moderate to severe osteoarthritis of the right hip."}
{"instruction": "Generate impression based on findings.", "input": "Male; 72 years old. Reason: HCC s/p RFA, followup History: HCC, cirrhosis ABDOMEN:LUNG BASES: Large left pleural effusion with left lower lobe compressive atelectasis and trace right pleural effusion, partially visualized and similar to prior study.LIVER, BILIARY TRACT: Cirrhosis with recanalized umbilical vein. Paradoxical loss of signal on in-and-out of phase images, suggestive of iron deposition. Large amount of ascites, similar to prior study. Left hepatic lobe ablation cavity measures 3.9 x 3.9 cm, unchanged (series 14/34). No abnormal enhancement to suggest residual or recurrent disease. No new focal hepatic lesions. The portal vein is patent. Cholelithiasis.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.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "Left hepatic lobe ablation cavity without evidence of residual or recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent pain and swelling Exam is slightly limited by patient motion artifact.MENISCI: No meniscal tear identified.ARTICULAR CARTILAGE AND BONE: Generalized thinning of the posterior lateral femoral condyle cartilage. There is also generalized thinning of the patellar cartilage without focal defect.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Quadriceps and patellar tendons are intact.ADDITIONAL", "output": "Generalized thinning of the posterior lateral femoral condyle cartilage and patellar cartilage without focal defect."}
{"instruction": "Generate impression based on findings.", "input": "History of metastatic colon cancer. Lack of intravenous contrast limits evaluation for solid organ, bowel and vascular pathology. LUNG BASES: Multiple T2 hyperintense lung masses are noted and are suspicious for metastatic disease. A left lung base mass measures 1.9 x 1.9 cm (series 701/37).ABDOMEN:LIVER, BILIARY TRACT: Several right hepatic lobe T2-weighted moderately and very hyperintense lobular lesions are suspicious for metastatic mucinous colonic adenocarcinoma given the patient's history. A representative lesion in segment 8 measures 2.0 x 1.9 cm (series 701/34). No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple T2 hyperintense foci are incompletely characterized, likely cysts. Mildly hypointense T2 weighted foci are incompletely characterized and may represent proteinaceous/hemorrhagic cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Postsurgical changes from right hemicolectomy. No evidence of obstruction or fluid collection.BONES, SOFT TISSUES: Mottled marrow signal intensity is nonspecific.", "output": "Limited nonenhanced examination demonstrates the following.1.Suspected multiple right hepatic lobe metastases and multiple lung metastases which are partially imaged. New from 2012.2.Stable left external iliac T2 hyperintense lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Patient with idiopathic orbital inflammation; follow up- check for response to prednisone History: Eye pain, bilateral. There is no abnormal enhancement in the orbits. The lacrimal glands appear unchanged. The globes and ocular adnexa are unremarkable. There is no evidence of orbital mass lesions. The imaged portions of the brain and facial soft tissues are unremarkable. There is new scattered paranasal sinus mucosal thickening.", "output": "1. No evidence of orbital inflammation.2. New scattered paranasal sinus mucosal thickening may represent sinusitis."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: 51-year-old male with AML, Ommaya reservoir, history of peri ommaya hemorrhage. Now here with altered mental status. Please evaluate for intracranial hemorrhage or other intracranial process. Signs and symptoms: Altered mental status Right-sided ventricular catheter enters from high convexity right frontal bone and through the right frontal lobe with the tip at the right foramina of Monro. Slight prominence of the supratentorial ventricular system. Generalized uniform lower than normal density of white matter is noted. Please correlate with history. There are no old films available for comparison. This finding may be technique related. If clinical symptoms persist an MRI is recommended. Cortical sulci are within normal range for patient's stated age.No evidence of hemorrhage, mass-effect or midline shift. Calvarium, paranasal sinuses and mastoid air cells are unremarkable. A punctate air density within the temporal horn on the right.", "output": "No evidence of hemorrhage. Three see above comments."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Include ankle and mid foot. Assess lateral posterior superior calcaneal cyst. Ganglion vs reactive bursitis History: pain and swelling and increasing in size There is an ovoid mass within the soft tissues lateral to the Achilles tendon at its insertion on the calcaneus, corresponding to soft tissue opacity seen on prior radiographs. It measures approximately 13 x 8 mm in transverse dimension and approximately 15 mm in craniocaudal dimension. It is of similar signal intensity to muscle on non-fat-suppressed T1-weighted images, and is slightly hyperintense to skeletal muscle on fat-suppressed T1-weighted images. It is hyperintense on the fat-suppressed proton density weighted sequence, but is isointense to skeletal muscle on the STIR sequence. The mass enhances homogeneously following contrast administration. The mass abuts the lateral margin of the distal Achilles tendon and posterior calcaneus, but does not deform or invade either of these structures. The mass lies posterior to the sural nerve and lesser saphenous vein. We see no additional soft tissue masses. Bone marrow signal intensity is normal. We see no tenosynovitis or other significant tendon abnormalities.", "output": "Enhancing soft tissue mass along the lateral margin of the Achilles at its insertion on the calcaneus. This does not have the typical appearance of a cyst, ganglion or bursa, and its uniform enhancement suggests a solid tumor. Although the signal intensity of the mass is relatively low on the STIR sequence, overall the characteristics of this lesion are nonspecific, and tissue sampling is recommended. "}
{"instruction": "Generate impression based on findings.", "input": "Weakness [R53.1], Reason for Study: ^Reason: r/o ischemic stroke History: right arm weakness and slurred speech Brain MRI:There is a focal high signal intensity on the left parietal operculum which shows high signal intensity on diffusion-weighted imaging with equivocal restricted diffusion on ADC map, the lesion shows mild increased signal intensity on T2 weighted image, best seen on coronal T2-weighted image series #7 image #24. This lesion indicate either late subacute or early chronic ischemic infarct.There are linear and nodular susceptibility artifacts on the right frontal lobe indicating hemosiderin differentiation possibility due to prior localized subarachnoid hemorrhage.Underlying brain shows multiple patchy high signal intensity FLAIR lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.Otherwise there is no evidence of new acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate less than 50% focal luminal narrowing on the left MCA distal M1 segment.There are multifocal intracranial arterial luminal narrowings on bilateral distal MCAs and PCAs indicating intracranial atherosclerosis without evidence of significant (more than 50%) luminal stenosis.The right ACA A1 segment and distal left vertebral artery are hypoplastic.There is no intracranial arterial aneurysm.", "output": "1. Equivocal restricted diffusion with slightly increased T2 signal intensity on the left parietal operculum indicate late subacute or early chronic ischemic infarction without hemorrhagic transformation. 2. Nonspecific small vessel ischemic disease.3. Focal but less than 50% of luminal narrowing on the left MCA distal M1 segment.4. Intracranial atherosclerosis as described above without evidence of significant luminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 69 years old, with lumbosacral pain, with history of T11-12 fracture at outside hospital, evaluate for fracture and for neuroforaminal involvement. Thoracic:A compression deformity of the T12 vertebral body is seen with complete loss of height centrally. A compression deformity of the L1 vertebral body is also noted with 50-60% loss of vertebral body height centrally. Both vertebral bodies and the intervening disc spaces demonstrate mild STIR hyperintensity suggesting mild edema. No significant retropulsion is evident at either level. The intervening neural foramina are not significantly narrowed and the spinal canal is not compromised.The remaining vertebral bodies demonstrate normal morphology and are free of concerning marrow signal abnormality or edema. Sagittal spinal alignment is unremarkable with the exception of a mild accentuation of the kyphosis at T12 and L1. The visualized spinal cord is unremarkable. No epidural abnormalities are seen. No significant disc bulge or disc herniation is present, and the spinal canal and neural foramina remain patent.Lumbar:Based on counting from C2 down, and on the presence of the lowest set of visible ribs at T12, there are six lumbar type vertebral bodies with a mild transitional morphology of the L6 vertebral body.Compression deformity of the L1 vertebral body is discussed above. The remaining lumbar vertebral bodies demonstrate normal morphology. There is no concerning marrow replacement or marrow edema. Spinal alignment is anatomic.The conus tip terminates at the inferior L2 level which is within normal limits. The nerve roots of the cauda equina are unremarkable. No epidural abnormality is seen.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Loss of disc T2 signal with preserved disc height. No significant spinal canal or foraminal stenosis. L3-4: Mild facet arthropathy. Loss of disc T2 signal with preserved disc height and minimal lateral disc bulging. No significant spinal canal or foraminal stenosis. L4-5: Mild facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L5-L6: Mild facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L6-S1: Moderate facet arthropathy. No significant spinal canal or foraminal stenosis.", "output": "1.Compression deformities of the T12 and L1 vertebral bodies are seen. Please note that the presence of six lumbar type vertebral bodies accounts for the difference in level numbering relative to the history. Both compressed vertebrae show mild marrow edema which would suggest a late acute or subacute time course. Neither vertebra is significantly retropulsed, and the spinal canal and neural foramina are not compromised.2.No additional compression deformities or significant osseous lesions are seen. Relatively mild degenerative findings are noted in the lumbar spine, but without significant spinal canal or foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "History of malignant peripheral nerve sheath tumor, known left femoral diaphyseal tumor now here with increasing pain over the left femur tumor site. Assess for bony abnormality over proximal femur. Multiple soft tissue masses are compatible with the stated diagnosis of neurofibromatosis. There is a chronic fracture deformity of the distal femoral diaphysis resulting in posteromedial bowing. There is a defect of the proximal femur at the level of the lesser trochanter representing extrinsic erosion by an adjacent soft tissue mass seen on the prior MRI study. The femoral neck is thinned which may also reflect chronic extrinsic pressure erosion. A small round lucency in the distal femoral diaphysis may either be posttraumatic in etiology or due to the patient's underlying neurofibromatosis. Moderate osteoarthritis affects the knee.", "output": "Radiographic features of neurofibromatosis as described above with chronic pressure erosions of the proximal femur, and old fracture deformity of the distal femur."}
{"instruction": "Generate impression based on findings.", "input": "Vision loss L>R, concern for giant cell arteritis. Brain MRI: There appears to be a punctate focus of cortical restricted diffusion in the right parietal lobe with high T2 signal. There are otherwise several scattered foci of high T2 signal in the cerebral hemisphere white matter bilaterally. There is no evidence of intracranial hemorrhage or mass. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Indeed, there is no evidence of enhancement surrounding the scalp vessels.Brain MRA: The anterior branch of the left superficial temporal artery and left ophthalmic artery appear relatively diminutive. There is no evidence of significant cerebral steno-occlusive lesions or aneurysms.Orbits MRI: There are bilateral lens implants. The lacrimal glands, optic nerve, orbital fat, and extraocular muscles otherwise appear unremarkable bilaterally. There is no evidence of intraorbital tumors.", "output": "1. Apparent punctate acute infarct in the cortex of the right parietal lobe superimposed upon a background of probable chronic small vessel ischemic white matter disease.2. The anterior branch of the left superficial temporal artery and left ophthalmic artery appear relatively diminutive, which may represent manifestations of giant cell temporal arteritis, anatomic variants, and/or technical effects of the scan, which is not particularly optimal for evaluating such small caliber vessels. Furthermore, there is no discernible inflammation associated with the vessels. Doppler ultrasound may be useful for further interrogation."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Follow-up subdural hematoma. Signs and symptoms: History of subdural hematoma. CT of brain without the infusion:In comparison with the prior examination there is complete resolution of patient's bilateral subdural hematomas. The cortical sulci are better visualized on this study secondary to lack of mass effect by subdural. Patchy areas of periventricular and subcortical low attenuation are consistent with small vessel disease of indeterminate age. No hemorrhage is detected. A calcific density at the level of the left leaf of tentorium (axial image 10) is consistent with a small meningioma and was noted on prior MRI examination. This lesion measures 7.8-mm times 16-mm. Meningioma is in contact with the pons however with no mass effect or deviation.", "output": "1.No evidence of residual subdural or any new bleed.2.Small vessel disease of indeterminate age.3.Small meningioma along the edge of the left tentorial leaf with no change since prior MRI."}
{"instruction": "Generate impression based on findings.", "input": "History of brain tumors, exact pathology unknown, and a ventriculoperitoneal shunt now presenting with headaches. There are post surgical changes related to a prior right parieto-occipital craniotomy. Immediately subjacent to the craniotomy flap there is a cystic collection in the right occipital lobe measuring 16 x 16 x 20 mm presumably reflecting a surgical resection bed. There is no associated enhancement or solid componentIn addition there is a right frontal approach ventriculostomy catheter with tip approaching midline at the level of the third ventricle. There is a small volume of gliosis along the ventriculostomy catheter tract. The ventricles are decompressed and somewhat slitlike in appearance.No foci of abnormal enhancement or mass lesions are evident. There are scattered periventricular and subcortical white matter foci of increased T2 signal compatible with mild chronic small vessel ischemic disease.No evidence of acute ischemic infarct or acute hemorrhage.The expected intracranial vascular flow voids are present. There is opacification of the right ethmoid air cells as well as mucosal thickening in the bilateral maxillary sinuses. Trace fluid in the mastoid air cells bilaterally. The orbits are unremarkable.", "output": "1. Postsurgical findings from prior right parieto-occipital craniotomy. Immediately subjacent to the craniotomy flap is a cystic collection presumably reflecting the resection cavity. There is no definitive evidence of recurrent or residual tumor, but comparison with prior imaging would be helpful.2. Right frontal ventriculostomy catheter in appropriate position. The ventricles are decompressed and somewhat slitlike in appearance.3. Mild chronic small vessel ischemic changes in the periventricular and subcortical white matter.4. Scattered paranasal sinus opacification; correlate with symptoms of sinusitis."}
{"instruction": "Generate impression based on findings.", "input": "68 year old male with metastatic renal cell cancer and known mets to lung and liver. Rule out biliary tree obstruction. Jaundice, elevated LFTs This examination is limited by absence of IV contrast. CHEST:LUNGS AND PLEURA: Large right and moderate left pleural effusions with associated compressive atelectasis. Mild cardiomegaly. Pulmonary nodules are suspicious for diffuse metastases. MEDIASTINUM AND HILA: Cardiomegaly. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Questionable hypoechoic lesion in the inferior right hepatic lobe. The lesion measures 7.5 cm in diameter at axial image 103 of series 3. MRI, even an exam without contrast, may be helpful for further evaluation. Hepatomegaly. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Large amount of metal streak artifact in the left perirenal region due to numerous large surgical clips in that area obscures local details. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Bilateral pleural effusions. Lung nodules are suspicious for metastases. Ascites. Questionable large lesion in right hepatic lobe, may be further evaluated with MRI/MRCP, if indicated. "}
{"instruction": "Generate impression based on findings.", "input": " There is normal ventricular size with no evidence of mass effect or edema. There no evidence of bleed. No midline shift. There is normal gray-white white matter differentiation. There is no abnormal signal in the hippocampus bilaterally. On the susceptibility images there is branching linear low signal in the left cerebellar hemisphere, consistent with developmental venous anomaly. There is no restricted diffusion abnormality. The vascular flow voids are normal.There is asymmetric pneumatization of the right petrous apex.", "output": "Essentially unremarkable MRI of the brain. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval for tibial tubercle fx vs ocd History: knee pain for 1.5 years worse with sports; intermittent swelling MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: There is a focal T1 signal hypointensity in the posterior aspect of the medial femoral condyle which measures 6 x 6 x 14 mm, which is compatible with an osteochondral defect. There is no surrounding bone marrow edema, suggesting this injury is likely chronic. The overlying articular cartilage is mildly thinned. The articular cartilage elsewhere in the knee is normal.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is normal.ADDITIONAL", "output": "Grade IIB osteochondral defect along the posterior aspect of the medial femoral condyle. There is no associated bone or soft tissue edema, indicating the lesion is chronic."}
{"instruction": "Generate impression based on findings.", "input": "Anosmia x 9 months. There is mild mucosal thickening and secretions within the left ethmoid sinuses and left middle meatus. There is slight deviation of the nasal septum towards the right. There is a right concha bullosa. The olfactory bulbs appear to be grossly intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a nonspecific subcentimeter focus of T2 hyperintensity in the left superior frontal gyrus. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. Apparent mild mucosal thickening and secretions within the left ethmoid sinuses and left middle meatus. Further evaluation via a sinus CT may be useful if clinically indicated.2. The olfactory bulbs appear to be grossly intact, without evidence of mass lesions in the anterior cranial fossa.3. Nonspecific subcentimeter focus of signal abnormality in the left superior frontal gyrus."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female with pain and swelling in the right index finger. Evaluate for tenosynovitis versus chronic fluid collection or osteomyelitis There is nonspecific soft tissue edema involving the index finger with slight thickening of the skin. There is edema and enhancement of the underlying subcutaneous fat. There is also enhancement of the nail bed. There are small foci of low signal intensity within the soft tissues along the radial aspect of the distal phalanx which are nonspecific but could represent small foreign bodies, which were not seen recent radiographs. Mild enhancement of the synovium of the flexor tendon apparatus is suggestive of mild tenosynovitis. There is mild enhancement of the synovium of the PIP joint of the index finger suggestive of mild synovitis, although we see no frank fluid within the joint. We see no frank fluid collection nor do we see bone marrow signal abnormality to suggest osteomyelitis.", "output": "Nonspecific inflammatory changes of the finger as described above. Small foci of low signal intensity within the soft tissues adjacent to the phalanx could represent foreign bodies but were not seen on recent radiographs and could also represent small foci of gas or small foci of hemosiderin from prior bleeding. We see no abscess or osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Preop planning study. Signs and symptoms: Brain tumor. Preoperative planning study. Pre- and post enhanced Stealth brain MRI:Examination is performed utilizing surgical planning protocol and is not a true complete diagnostic study.Examination redemonstrates a partially solid and cystic enhancing intra-axial in the right anterior and mid temporal lobe. The well-demarcated superficial solid component of the mass demonstrate inhomogeneous enhancement and measuring maximum of 19 x 38 x 44 mm in size. Immediately medial to the solid component of the mass there is a large minimally septated cystic and nonenhancing component measuring at least at 47 x 40 mm in transaxial dimensions. There is resultant significant mass effect on the temporal horn of lateral ventricle. Posteriorly the mass reaches the trigone of right lateral ventricle and with bulge of the cystic component of tumor into the right trigone of the lateral ventricle which is best appreciated on prior noncontrast study. There is also subtle mass effect on the right lateral ventricle however without evaluation of midline and widely patent basal cisternsA punctate focus of enhancement noncontiguous with the tumor in the right temporal lobe (axial post enhanced series 501 image 103 coronal post enhanced series 701 image 20. Images through posterior fossa on post enhanced series demonstrate a multi branch vascular enhancement in the right cerebellum consistent with a developmental venous anomaly", "output": "1.Partially solid and enhancing with a large nonenhancing cystic component mass in the right anterior and mid temporal lobe as detailed above.2.There is bulge of the cystic component of tumor into the trigone of right lateral ventricle as detailed.3.Small developmental venous anomaly in the right cerebellum as detailed.4.A noncontiguous punctate focus of enhancement immediately anterior to the mass in the right anterior temporal lobe as mentioned."}
{"instruction": "Generate impression based on findings.", "input": "Male, 76 years old, with subdural hemorrhage. Evaluate for structural lesions. A T1 hyperintense, susceptibility inducing subdural collection is evident along the left parietal lobe with smaller quantities along the left occipital and temporal lobes as well. The collection measures up to 10 mm in thickness which is not significantly changed from prior CT. No new areas of hemorrhage are suspected.Extensive patchy periventricular T2 hyperintensity is seen. No edema or mass effect is detected. The sulci are prominent compatible with underlying parenchymal volume loss. The ventricles are within normal limits. Marrow signal of the calvarium is unremarkable.", "output": "Redemonstration of a subacute subdural hematoma predominantly located along the left parietal lobe with smaller quantities present along the left occipital and temporal lobes. No significant interval change in size is seen. No associated or underlying lesions are detected."}
{"instruction": "Generate impression based on findings.", "input": "Female, 55 years old, history of compression fracture of T11 of unclear etiology, assess for underlying malignancy. History of sarcoid. The thoracic kyphosis is perhaps mildly exaggerated, but the curvature is smooth and vertebral body alignment is within normal limits. Very slight anterior wedging of the lower thoracic vertebral bodies is seen, including the T11 vertebral body. The degree of wedging is mild and within the limits of normal variation. No evidence of marrow edema is seen to suggest an acute fracture.There are small right paracentral disk protrusions at T6-7 and T7-8. Mild disk bulging with a right foraminal and far lateral protrusion is seen at T11-12 with right-sided foraminal narrowing at this level. No significant spinal canal stenosis is seen.The spinal cord demonstrates normal morphology and signal characteristics throughout.Partially visualized soft tissue structure within the lower mediastinum may represent a hiatal hernia.", "output": "No evidence of vertebral body compression fracture is seen. Slight anterior wedging of several lower thoracic vertebral bodies, including the T11 vertebral body, is within the limits of normal variation. No marrow edema is detected."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old male with history of tumor resection presents with headache; evaluate for subarachnoid hemorrhage There is a periaqueductal mass, with lymphoplasmacytic histology, that shows interval enlargement from the previous CT on 9/11/2008 now measuring 33 x 30 mm (image 12, series 2) as compared to the previous measurement of 23 x 20 mm. However, there is no significant change compared to the MRI study on 10/12/2009. Again seen is a right ventriculostomy tube that extends to the body of the right lateral ventricle.There is no evidence of intracranial hemorrhage or acute hydrocephalus. The ventricles and basal cisterns are normal in size and configuration.Postsurgical changes from a right frontal craniotomy are again noted. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Periaqueductal mass whose pathology is suggestive of lymphoplasmocytic neoplasmventriculostomy as described above. No acute intracranial hemorrhage or hydrocephalus."}
{"instruction": "Generate impression based on findings.", "input": "Headaches. Chiari malformation. Low levels of thyrotropin. BRAIN:The cerebellar tonsils are peg-shaped and extend to 11 mm below the level of foramen magnum, resulting in crowding at this level with near complete obliteration of the CSF space at the level of the cervicomedullary junction. Of note, the odontoid process is mildly retroflexed.There is no dilatation of the ventricles. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a developmental venous anomaly in the left frontal lobe, which is a common incidental finding. Otherwise, the brain parenchyma is unremarkable and there is no abnormal intracranial enhancement. There is no midline shift. The major cerebral flow voids are intact. There is trace mucosal thickening in the maxillary and anterior ethmoid sinuses.CSF flow study shows preserved anterior but no posterior CSF flow at the level of foramen magnum. Immediately below the level of foramen magnum, there is preserved anterior and posterior CSF flow.PITUITARY:The pituitary gland is normal in size. It shows homogenous contrast enhancement without definite focal lesion. Pituitary infundibulum is normal thickness and midline. The optic chiasm and hypothalamus are unremarkable. The cavernous sinuses are symmetric and unremarkable as well.", "output": "1.Chiari I malformation with attenuated CSF flow dorsally at the level of foramen magnum as described above, but no ventricular dilatation. The odontoid process is mild retroflexed.2.Left frontal developmental venous anomaly, which is a common incidental finding. The brain is otherwise unremarkable.3.Normal pituitary MRI without definite focal lesion."}
{"instruction": "Generate impression based on findings.", "input": "Female 26 years old Reason: Crohns disease, evaluate small bowel for stenosis History: - 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: The patient is status post colectomy and right lower quadrant end ileostomy.Long segment multifocal bowel wall thickening, mucosal hyperenhancement, engorgement of the vasa recta and luminal narrowing, with associated prestenotic dilatation affecting the distal ileum. The area of wall thickening and luminal narrowing just proximal to the prestenotic dilatation (series 12/62) persists on all phases, raising concern for an underlying stenosis. There is adjacent fibrofatty proliferation suggesting acute on chronic inflammation. The entire length is difficult to determine but is estimated to be on the order of approximately 20 cm.There is an additional short segment of mucosal hyperenhancement and luminal narrowing in a more distal segment of ileum (series 13/65), consistent with active inflammation.Prominent mesenteric lymph nodes are again seen about the areas of active inflammation, which are presumably reactive.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.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": "1.Findings compatible with long segment multifocal acute on chronic inflammation of the ileum as detailed above, as well as an additional more remote short segment of active inflammation in the distal ileum. 2.Focal wall thickening and luminal narrowing resulting in prestenotic dilatation, which may be due to acute inflammation, although raising concern for an underlying stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 72 years old Reason: eval for possible right meniscus tear History: + McMurray with painful mechanical symptoms MENISCI: There is a complete degenerative tear of the lateral meniscus including the anterior horn, body and posterior horn. There is mild meniscal extrusion.The medial meniscus shows some intrasubstance degeneration in its posterior horn but no discrete tear is evident.ARTICULAR CARTILAGE AND BONE: Full-thickness cartilage loss involving the lateral compartment with subchondral marrow edema involving the lateral femoral condyle and lateral tibial plateau.In the medial compartment, there is diffuse chondral thinning and foci of full-thickness cartilage loss.Foci of cartilage loss involving the medial patellar facet.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The collateral ligaments and lateral collateral ligamentous complex are intact. EXTENSOR MECHANISM: There is mild prepatellar soft tissue swelling.ADDITIONAL", "output": "1.Degenerative tearing of the lateral meniscus with full-thickness cartilage loss in the lateral compartment.2.Joint effusion and synovitis."}
{"instruction": "Generate impression based on findings.", "input": "Neck pain and arm weakness, Spinal stenosis, cervical region [M48.02] Examination is limited by motion artifact.There is accentuated lordosis at the C7 level. The vertebral body heights are maintained. Heterogeneous marrow signal is demonstrated throughout the cervical spine, similar to prior examination. There is a 0.4 cm T2 hyperintense lesion involving the T2 spinous process, new since prior examination. The cervical spinal cord demonstrates normal caliber with normal signal intensity. No significant spinal canal stenosis is appreciated.C2-C3: Shallow disc-osteophyte complex and left more than right uncovertebral joint and facet arthropathy. There is mild left neural foramen narrowing. There is no significant spinal canal or right neural foraminal narrowing. These findings are unchanged.C3-C4: Disc osteophyte complex as well as uncovertebral and facet arthropathy result in moderate left and moderate to severe right progressive neural foraminal narrowing. There is also mild central canal narrowing.C4-C5: Disc osteophyte complex as well as uncovertebral and facet arthropathy result in moderate right and left neural foraminal narrowing. There is also mild central canal narrowing. These findings are unchanged.C5-C6: Disc osteophyte complex as well as uncovertebral and facet arthropathy result in moderate left and mild right neural foraminal narrowing. There is also mild central canal narrowing. These findings are unchanged.C6-C7: Shallow disc osteophyte complex as well as left more than right uncovertebral and facet arthropathy result in moderate-to-severe left and mild right neural foraminal narrowing. There is no significant central canal narrowing. These findings are unchanged.C7-T1: There is no significant disc herniation. There is uncovertebral and facet arthropathy resulting in moderate bilateral neural foraminal narrowing. There is also ligamenta flava thickening. These findings are unchanged.", "output": "1. Multilevel spondylosis of the cervical spine most severe at C3-C4 level where there is moderate left and moderate to severe right neuroforaminal stenosis, progressive since prior examination dated 10/2015.2. A new 0.4 cm lesion involving the T2 spinous process is suspicious for metastatic disease or myelogenous deposit."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female with history of leiomyoma of the uterus who presents for evaluation. PELVIS:UTERUS, ADNEXA: There are multiple large T2 heterogeneous, avidly enhancing subserosal and pedunculated lesions ranging from 1 cm to approximately 6 cm. The largest on the left measures 5.5 x 5.1 x 5.2 cm; findings compatible with leiomyomas.Bilateral adnexal T2 hyperintense foci are noted most compatible with physiologic cysts.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": "Multiple enhancing uterine leiomyomas."}
{"instruction": "Generate impression based on findings.", "input": "72 year old with history of coronary artery disease, dyslipidemia and apical hypertrophic cardiomyopathy presenting for evaluation for cardiac function and scar. Left VentricleThe left ventricle is normal in size and ventricular function. LV ejection fraction is 66%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 173 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 66 g/m2 (normal range 85+/-15), and the LV mass is 121 g (normal range 164+/-36). There is apical hypertrophy which results in obliteration of the apical 1/3 of the ventricle in systole. Associated enhancement of the hypertrophied segments.No intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVEDV is 189 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 75 ml (normal range 54+/-17). No right ventricular hypertrophy or enhancement.Right AtriumThe right atrium is mildly dilated.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 three vessel arch. 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 pericardial effusion.", "output": "1. Normal left ventricular size and function (LVEF 66%). There is apical hypertrophy with obliteration of the apical cavity at systole. Enhancement of the apical hypertrophic segments consistent with fibrosis. 2. Normal right ventricular size and function (RVEF 60%). No evidence of apical hypertrophy.3. Mild biatrial enlargement."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Demyelinating disease of central nervous system, unspecifiedClinical question: evaluate for demyelination The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular white matter lesions and subcortical white matter lesions. Many of the periventricular lesions are perpendicularly oriented to the lateral ventricles. These are stable when compared to the previous exam. No abnormal enhancing lesions are appreciated within the brain parenchyma. There is also lesion redemonstrated in the right middle cerebellar peduncle.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate distorted shape of a small size. There is a fluid fluid level in the right eye. The patient is status post ocular surgery.", "output": "1.There is a moderate degree of periventricular white matter lesions and subcortical white matter lesions as well as a right cerebellar lesion all of which were present on the prior exam and have not changed. There is no convincing evidence for acute plaque formation.2.The eyes are distorted in appearance and a small. Please correlate with clinical history."}
{"instruction": "Generate impression based on findings.", "input": "Male, 63 years old, with radiating right lower extremity pain and numbness. Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are heterogeneous. Signal abnormality and enhancement are seen along the L4 superior endplate compatible with a Schmorl's node. Scattered additional nonenhancing Schmorl's nodes are also seen. Small enhancing foci along the superior L2 endplate are nonspecific but likely benign.The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected. No pathologic intraspinal enhancement is seen.L1-2: Bulging disc. Mild generalized spinal canal narrowing. No significant foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing with slight crowding of the cauda equina. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Moderate to severe spinal canal narrowing with crowding of the cauda equina. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Severe generalized spinal canal narrowing with crowding and likely impingement of the cauda equina. Moderate bilateral foraminal narrowing. L5-S1: Facet arthropathy left worse than right, and ligamentum flavum thickening. Bulging disc asymmetric to the left. Effacement of the left lateral recess and moderate generalized spinal canal narrowing. Moderate left and mild right foraminal narrowing.", "output": "Multilevel disc and posterior element degeneration is seen. This results in a severe spinal canal stenosis at L4-5 and a moderate to severe stenosis at L3-4."}
{"instruction": "Generate impression based on findings.", "input": " There are extensive osseous metastases, some with soft tissue components extending into the epidural space and neural foramina, particularly involving the thoracic spine and at L4. There is severe central stenosis with cord compression at T5/6, T6/T7, and T8/9 without convincing evidence of cord edema.Moderate degenerative disease of the lower cervical spine with ventral effacement of the thecal sac and cord deformity. Questionable increased T2 signal in the anterior cord at C5/6 may reflect mild edema versus artifact. It is notable that at this level CSF is maintained posteriorly.Greater than 25% height loss of T8 vertebral body, present on chest x-ray two days prior.", "output": "1.There are extensive osseous metastases, some with soft tissue components extending into the epidural space and neural foramina.2.There is severe central stenosis with cord compression at T5/6, T6/T7, and T8/9 without convincing evidence of cord edema.3.Segment-specific MRI is recommended if symptomology localizes."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Status post untethering. Signs and symptoms: Status post untethering. Nonenhanced lumbar MRI:Examination was terminated after a severely motion artifact degraded sagittal T1-weighted series was obtained due to patient's severe pain and discomfort.Acquired suboptimal image demonstrate no acute finding when compared with prior.", "output": "Aborted exam due to patient's severe pain and discomfort. Only a nearly nondiagnostic sagittal T1-weighted series was obtained."}
{"instruction": "Generate impression based on findings.", "input": "Primary CNS lymphoma status post chemotherapy and radiation. There are findings related to right transfrontal biopsy. There is no evidence of abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged punctate foci of encephalomalacia in the right cerebellar hemisphere, which likely represent chronic infarcts. There are unchanged nonspecific patchy areas of T2 hyperintensity in the cerebral hemisphere white matter. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is a persistent left maxillary sinus retention cyst. There is also persistent minimal fluid and mucosal enhancement in the bilateral mastoid air cells.", "output": "Stable post-treatment findings without evidence of CNS lymphoma recurrence."}
{"instruction": "Generate impression based on findings.", "input": " The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There are numerous bilateral foci of T2/FLAIR hyperintensity in the subcortical and periventricular white matter as well as in the bilateral basal ganglia and left cerebellum, suggestive of moderate age-indeterminate small vessel ischemic disease, appearing similar to slightly increased compared to prior examination. 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": "1.No evidence of intracranial metastases.2.Moderate age-indeterminate small vessel ischemic disease appears similar to slightly increased compared to prior examination."}
{"instruction": "Generate impression based on findings.", "input": "20 year-old female with knee pain for one to two years MENISCI: The medial and lateral menisci are within normal limits.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears normal. Bone marrow signal is within normal limits throughout.LIGAMENTS: The cruciate and collateral ligaments are intact. Specifically, the lateral collateral ligament proper and iliotibial band appear normal.EXTENSOR MECHANISM: The quadriceps and patella tendons appear intact.", "output": "Normal knee without specific findings to explain the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Right lower extremity weakness and radiating pain. Evaluate nerve root and for lumbar stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening of the lumbar spinal curvature. Alignment is otherwise within normal limits. Bone marrow signal is heterogeneous which is nonspecific but without discrete suspicious osseous lesions. The conus medullaris is normal in position. No abnormal enhancement. Small sacral perineural cyst incidentally noted at the right S2 level. Individual levels 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: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Small dorsal annular fissure. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: Disc desiccation with small dorsal annular fissure and trace bulge eccentric to the right. There is minimal contact of the right S1 nerve root with the disc without clear evidence of impingement. No central canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Multiple bilateral renal cysts are partially imaged.", "output": "Minimal degenerative changes in the lumbar spine as described above. There is minimal contact of the right S1 nerve root related to trace disc bulge at the L5-S1 level without obvious impingement. There is otherwise no significant spinal canal or neural foraminal stenosis at any level. No abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out bleed. Signs and symptoms: History of mass. Non-enhanced CT of brain:Examination demonstrates a high density extra axial mass along the clivus and dorsum sella. This mass abuts the clivus however no definitive bony changes of the clivus. The mass is well-demarcated and measures 26-mm in cranial cephalad axis and 12.4-mm in AP axis on sagittal reformatted image 26. On axial image 9 the largest transaxial dimension of this tumor are 16.8 x 19.2-mm.superior A. the mass projects into the basal cistern and inferiorly in mid section of clivus. There is no evidence of any edema of brain parenchyma associated with this mass. Subtle mass effect on the pons and posterior displacement is noted. The exact etiology of this finding is not clear. The mass is not correctly state of any particular tumor. Differentials could include a hamartoma, mesenchymal type tumor, neuroepithelial cysts, aneurysm as well as less likely possibility of a meningioma. Follow-up with an enhanced MRI examination is recommended. There is normal density and morphology of brain parenchyma and no evidence of hemorrhage, edema, midline shift or hydrocephalus. The gray -- white matter differentiation is well preserved.", "output": "1.Nonspecific extra axial mass in the prepontine cistern extending along the clivus and superiorly terminates and is inseparable from the floor of the third ventricle. Follow-up with an MRI exam is recommended. There is no associated parenchymal edema.2.Unremarkable CT examination of brain otherwise."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old male with history of ulcerative colitis with primary sclerosing cholangitis/cirrhosis. Evaluate for stricture. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology with areas of T2 hyperintensity and heterogeneous arterial enhancement, which is increased in conspicuity compared to previous examination. This area near the caudate lobe demonstrating the T2 hyperintensity appears to be bulging the capsule mildly. However, the vasculature in this region courses through the abnormal signal and enhancement without attenuation.Again noted is multifocal irregular intra and extra hepatic biliary ductal strictures compatible with the stated history of PSC. The right and left intrahepatic ducts are again poorly seen proximal to the Klatskin point. Common bile duct is patent and noted to be attenuated proximally.SPLEEN: Splenomegaly with the spleen measuring approximately 20 cm, increased from 18 cm. Splenic varices are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Persistent nonspecific mild periportal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Stable findings compatible with primary sclerosing cholangitis without significant interval change in the biliary system.2.Heterogeneous T2 signal of the hepatic parenchyma as well as arterial contrast enhancement which is more conspicuous compared to previous examination as detailed. Differential considerations include cirrhotic changes from regenerating liver versus perfusional abnormality.3.Worsening splenomegaly, likely secondary to worsening cirrhosis related changes."}
{"instruction": "Generate impression based on findings.", "input": "55 year old man with paroxysmal atrial fibrillation, non ischemic cardiomyopathy, referred for further evaluation of inducible ischemia and pre atrial fibrillation ablation planning.MEDICATIONS: Lisinopril, Toprol XL, Xarelto, Multaq First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no obvious late gadolinium enhancement to suggest an underlying myocardial fibrosing, infiltrative, or inflammatory process. No evidence of prior myocardial infarction. The myocardial is viable. Left VentricleThe left ventricle is normal in size (when adjusted for body surface area) with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 131 ml (normal range 47+/-19), the LV mass index is 32 g/m2, and the LV mass is 85 g. LV dysfunction is global with regional variation.Left AtriumThe left atrium is 131ml (moderately dilated). No obvious left atrial appendage thrombus. Normal pulmonary venous anatomy.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 34%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 50 ml/m2 (normal range 31+/-9), and the RVESV is 131 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 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. No perfusion defects/ \"ischemia\" present during hyperemia.2. No evidence of myocardial infarction or other forms of myocardial fibrosis, inflammation, or infiltration. The myocardium is viable. 3. Normal LV size (when adjusted for body surface area) and moderately reduced systolic function (LVEF 34%).4. Normal RV size and moderately reduced systolic function (RVEF 34%).5. Moderate 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": "Reason: research History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3.8 x 2.4 x 3.8 cm.Peripheral Zone: There is a 4 x 7 mm right apical posterior lesion with restricted diffusion on image #24, series #1303 consistent with prostate cancer. In addition in the mid prostate there are small foci on the right and left side of the peripheral zone close to the midline best seen on image #124, series #1303 consistent with prostate cancer.Central Gland: Benign prostatic hypertrophy.Seminal Vesicles: Unremarkable.Extracapsular Extension: Not present.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.Right apical and bilateral mid peripheral zone cancer without evidence of extracapsular extension or seminal vesicle invasion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with history of thyroid nodules, subclinical hyperthyroidism RIGHT LOBE MEASUREMENTS: 5.2 x 2.1 x 2.0 cmLEFT LOBE MEASUREMENTS: 7.0 x 2.1 x 2.4 cmISTHMUS MEASUREMENTS: 1.0 cmRIGHT LOBE: Enlarged thyroid lobe with multiple solid thyroid nodules. A solid, inferior right thyroid lobe nodule without microcalcifications or increased vascularity measures 1.9 x 1.9 x 1.5 cm.LEFT LOBE: Enlarged thyroid lobe with multiple coalescent nodules without discrete measurable nodule.ISTHMUS: Enlarged isthmus with solid, slightly hyperechoic, inferior nodule measuring 2.2 x 2.1 x 1.6 cm. No microcalcifications or increased vascularity is identified.PARATHYROID GLANDS: Not noted.LYMPH NODES: Subcentimeter lymph nodes in bilateral neck. OTHER: No significant abnormality noted.", "output": "Enlarged and heterogeneous multinodular thyroid with measurements above. A nuclear medicine thyroid scan may be considered if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": " Spinal alignment is grossly within normal limits without sagittal spondylolisthesis. Vertebral body heights are grossly preserved without compression deformities. The spinal canal remains widely patent without evidence of acute cord compression. The spinal cord is grossly normal in signal and morphology. There are several mild posterior disc osteophyte complexes within the cervical spine most prominent at C4-C5, minimally progressed compared to 2007. At least mild disc bulges are present at L3-L4, L4-L5 and L5-S1 with mild spinal canal stenosis and scattered neuroforaminal narrowing at these levels. Incidental note is made of a small lipoma within the posterior soft tissues of the left back.", "output": "No acute cord compression. Mild degenerative changes as described above. Dedicated segment-specific MRI can be considered if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": " The large right intraparenchymal temporoparietal hematoma is not significantly changed along with areas of low and high T2 signal and predominantly low T2 signal and surrounding vasogenic edema. There is no discernible underlying nodule enhancement. There is persistent partial effacement of the right lateral ventricle, right uncal medialization, as well as approximately 5 mm of midline shift to the left. There is minimal right parietal subarachnoid hemorrhage and intraventricular hemorrhage. There are no new areas of intracranial hemorrhage or hydrocephalus. There are periventricular and subcortical T2 hyperintensities, which are nonspecific, but most compatible with chronic microvascular ischemic disease. However, there is no acute territorial infarct. There is mildly prominent leptomeningeal enhancement diffuse in the right cerebral hemisphere diffusely, which may be due to altered hemodynamics. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA HEAD", "output": "1.Redemonstration of large right intraparenchymal temporoparietal hematoma, with adjacent vasogenic edema and effacement of the right lateral ventricle. There is no midline shift or herniation.2.Unchanged minimal right parietal subarachnoid and intraventricular hemorrhage.No evidence of vascular malformation, aneurysm or significant steno-occlusive lesions within the limits of MRA."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female with back pain status post extensive lumbar fusion. Evaluate for spinal abscess/osteomyelitis. Wound infection per recent neurosurgery notes. Detailed evaluation of the previous surgical site is limited secondary to lack of contrast and distortion from adjacent surgical hardware.New since the previous MRI examination is extensive emphysema throughout the dorsal soft tissues, subcutaneous inflammatory change and adjacent skin thickening within the posterior soft tissues of the back. There is a is a small focal fluid collection posterior to surgical hardware, at approximately the L4 level, within the surgical site which measures approximately 25 x 20 7 mm, (axial T2 series 501, image 11).Inflammatory change, fluid density and foci are extends in craniocaudal dimension by approximately 17cm from the inferior aspect of L4 to the superior aspect of T12. There are multiple foci of air within the subcutaneous tissues at this level. This focal collection is concerning for inflammatory change versus infection. Evaluation of bony structures surrounding hardware is limited secondary to metallic artifact. No definitive evidence of osseous or hardware complication.Redemonstrated is a burst fracture present at L3 grossly unchanged compared with MRI dated 7/13/2011. There is posterior retropulsion of fragments into the central canal which causes crowding of the cauda equina and central stenosis, unchanged. Interval development of trace retrolisthesis of L2 on L4, not significantly changed.Compression deformity is central with compression noted of both the superior and inferior endplates of L3. Posterior retropulsion of cortex also affects both neural foramina causing severe stenosis. The visualized lower thoracic spine demonstrates multilevel degenerative endplate change.L1-2: no central neuroforaminal narrowing.L2-3: Mild disk bulge and mild bilateral neural foraminal stenosis, unchanged. L3-4: Compression deformity as described above. Interval postsurgical change of a posterior stabilization device with bilateral pedicular screws entering the vertebral bodies of L2 and L4, without foraminal involvement. Left L3 laminectomy with bony graft, unchanged. No new fracture or hardware compromise is identified. L4-5: Mild disc bulge without significant compromise to spinal canal or neural foramina, unchanged.L5-S1: Mild disc bulge without significant compromise to spinal canal or neural foramina, unchanged.Lung bases demonstrate multifocal linear areas of opacification which may be secondary to scarring, atelectasis or infection/inflammation, not significantly changed compared to the previous examination.", "output": "1. No evidence of diskitis or osteomyelitis.2. Interval development of subcutaneous stranding, focal fluid and soft tissue emphysema within the posterior soft tissues as described above, concerning for inflammatory change versus infection. 3. Postsurgical changes of a bilateral posterior stabilization device at L2 and L4 without definitive evidence of hardware or osseous complication.4. Unchanged appearance of an L3 compression fracture with posterior retropulsion of fragments into the central canal which causes crowding of the cauda equina, central stenosis and left greater than right bilateral neural foraminal narrowing."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o tear History: pain. Swelling MENISCI: There is globular increased signal abnormality within the anterior horn of the lateral meniscus indicating intrasubstance degeneration. We see no meniscal tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness loss of the articular cartilage along the medial facet and apex of the patella with underlying subchondral cyst formation. There is also near full-thickness cartilage loss along the femoral trochlea, inferiorly. There is a small partial-thickness defect of the articular cartilage along the posterior aspect of the medial femoral condyle as well as tricompartmental osteophyte formation.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a septated slightly heterogeneous near fluid signal intensity collection anterior to the patella and patellar tendon with mild edema within the adjacent subcutaneous fat, measuring approximately 4 cm in its greatest dimension. This likely represents a prepatellar bursitis, although this could represent a hematoma, particularly if there is a history of trauma.ADDITIONAL", "output": "1. Septated slightly heterogeneous collection of near fluid signal intensity in the prepatellar soft tissues likely representing a bursitis, but this could conceivably represent a hematoma if there is a history of trauma.2. Osteoarthritis, particularly affecting the patellofemoral joint, and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with right neck mass. Per prior requisition, history of craniopharyngioma status post resection. Head CT: Stable postoperative changes are noted status post resection of craniopharyngioma with surgical clips in the sellar region. If clinical suspicion for the recurrence of craniopharyngioma is high, MRI may be considered. There is a well corticated focal bony deformity located along the inner table of the right parietal convexity. Similar findings were noted on the MRI from 2003 and have not changed since then. These findings likely represent an atypical arachnoid granulation with cortical vasculature extending through it. Recommend routine MRI with SPGR sequence for evaluation of this lesion if clinically indicated.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Neck CT: There is diffuse contrast enhancing lymphadenopathy in the neck bilaterally, right greater than left. The largest lymph node measures approximately 2.3 x 2.1 cm and located at the level 2 of the right jugulodigastric chain. No evidence of airway obstruction or midline shift. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. Mild degenerative changes are noted in the vertebral bodies of the cervical spine. Otherwise, the osseous structures are unremarkable.", "output": "Extensive bilateral, right greater than left, neck lymphadenopathy without a discrete primary lesion. Although an inflammatory process with reactive lymphadenopathy is possible, a neoplastic lesion cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old male with a history of neurofibromatosis type I presents with lower back pain radiating to the left leg and sciatic distribution. Evaluate for pelvic/sciatic neurofibroma. Note is made of multiple foci of increased signal abnormality on fluid sensitive sequences within the cutaneous, subcutaneous tissue and musculature of the pelvis compatible with the stated history of neurofibromatosis, although these are incompletely characterized on this noncontrast examination. More specifically, the largest lesion in the region of the left gluteus medius muscle measures 2.0 x 1.2 cm (image 15; series 6) which is suggestive of a neurofibroma, although this is again incompletely characterized on this noncontrast examination. The sciatic nerve is normal in appearance, bilaterally. The imaged musculature of the hips is normal in appearance. No bone marrow signal abnormality is identified. Note is made of an apparent disc bulge at the level of L5/S1 with apparent annular fissure, although this is incompletely characterized on this examination.", "output": "Multiple foci of signal abnormality within the subcutaneous tissue and musculature of the pelvis consistent with the stated history of neurofibromatosis, although these are incompletely characterized on this noncontrast examination. The left sciatic nerve is normal in appearance. Disc bulge at the level of L5/S1. This could be better characterized with a dedicated lumbar spine MRI if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with pituitary adenoma A previously demonstrated T2 hyperintense, heterogeneously T1 hyperintense lesion in the inferior left aspect of the pituitary gland now measures 5 mm transverse x 2 mm height (previously 5 x 2 mm), as measured on the coronal T2 technique were its greatest conspicuity is visualized.The pituitary gland otherwise demonstrates normal size and signal characteristics. The pituitary stalk sits at midline and enhances normally. The suprasellar cistern is clear and the visualized optic apparatus is normal.", "output": "No significant interval change in size of a small lesion within the inferior left pituitary which is presumed to represent an adenoma."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old woman with headache and hypertension. Unresponsive evaluate for ICH. There is a parenchymal hemorrhage in the left parieto-occipital region. The hemorrhage measures 4.8 x 4.3 cm in the axial plane and extends to the cortical surface. No underlying lesion (such as an AVM) is visible on this study. A subdural hematoma measuring approximately 7 mm in thickness is present. The hemorrhage has a surrounding rim of edema and causes mass effect with near total effacement of the left lateral ventricle and approximately 12mm of midline shift at the level of the thalamus. There is partial effacement of the left aspect of the suprasellar cistern, suggesting left uncal herniation. The quadrigeminal cistern is partially effaced. In addition, the brainstem is shifted to the right, causing effacement of the right prepontine cistern. The cortical sulci of both cerebral hemispheres are effaced. Low attenuation with loss of gray-white differentiation is present in the white matter of the right cerebral hemisphere and is most pronounced in the right frontal lobe. This may represent ischemia or edema and could be better evaluated with MRI. Gray-white differentiation is otherwise preserved. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Water density fills the posterior nasopharynx -- possibly representing vomitus or secretions.", "output": "1. Left parieto-occipital parenchymal hemorrhage causing mass effect and about 12 mm of midline shift. No underlying lesion such as an AVM is visible on this study. Further evaluation for an underlying lesion is recommended as clinically appropriate.2. Findings of elevated intracranial pressure including effacement of cortical sulci, left uncal herniation, and partial effacement of the quadrigeminal cistern.3. Low attenuation in the white matter of the right cerebral hemisphere with loss of gray-white differentiation concerning for ischemia. This finding could be better evaluated with MRI.This report was discussed by telephone with the Dr. Eric and Dr. Shakur at 4:10 PM."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain. Evaluate for cholecystitis. ABDOMEN:LIVER, BILIARY TRACT: Giant hemangioma involving the posterior segment of the right hepatic lobe measuring 10.5 x 9.8 cm. Cholelithiasis with a gallstone at the gallbladder neck. Other scattered subcentimeter T2 hyperintesities, likely small cysts, but too small to characterize.The gallbladder is distended, hyperemic and with pericholecystic fluid superiorly compatible with acute cholecystitis. There is mild mass effect on the common hepatic duct resulting in mild intrahepatic ductal dilatation. The common hepatic duct is patent on MRCP images.No filling defect in the common bile duct is evident.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric mild perinephric fluid is likely chronic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative endplate changes.OTHER: Mild basilar atelectasis.", "output": "1.Large gallstone impacted in the gallbladder neck resulting in acute cholecystitis with gallbladder wall thickening and pericholecystic fluid. Mass effect from the gallstone results in mild common hepatic and intrahepatic bile duct dilatation (Mirizzi syndrome) - the CBD is patent, however.2.Giant cavernous hemangioma involving the posterior right hepatic segment.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "27 years, Female, Reason: 27 F p/w epigastric pain, hyperbilirubinemia and elevated liver enzymes. RUQ u/s showed mildly dilated bile duct without stone. History: as above. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Intrahepatic biliary ductal dilatation with dilated common bile duct to 8 mm. There is a stone in the distal common bile duct measuring 4 mm. No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: Normal appearing pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Distal common bile duct stone causing mild intrahepatic and extrahepatic biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "55 year-old female with fall, head trauma and possible seizure. BRAIN: There is no evidence of intracranial hemorrhage, mass or edema. Multifocal regions of patchy hypoattenuation are present in a subcortical and periventricular deep white matter distribution, nonspecific; however, most likely represent small vessel ischemic disease, age indeterminate. No acute cortical infarction. If there is clinical concern for acute ischemia, MRI may be considered.Area of hypoattenuation located in the left frontal region, most likely encephalomalacia secondary to prior infarction.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 except for a small retention cyst in the left frontal sinus.CERVICAL SPINE:The cervical spine alignment is anatomic. The vertebral bodies, dens, lateral masses, pedicles, lamina, facets, and posterior elements are intact with no evidence of fracture or subluxation. The pre-vertebral and paraspinal soft tissues are within normal limits. Limited view of the lung apices demonstrate bullous change and emphysema.Multilevel degenerative disk changes are noted as follows:C2-3: Disk osteophyte complex with central protrusion without central or neuroforaminal narrowing.C3-4: Disk osteophyte complex with diffuse disk bulge without central or neuroforaminal narrowing.C4-5: Disk osteophyte complex with right neuroforaminal narrowing. No central canal narrowing.C5-6: Disk osteophyte complex with severe right greater than left mild neuroforaminal narrowing. No central canal narrowing.C6-7: Uncovertebral joint hypertrophy, osteophyte spurring. No central or neuroforaminal narrowing.Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no evidence of significant spinal canal stenosis.", "output": "1. Diffuse intracranial parenchymal volume loss without acute abnormalities such as hemorrhage or acute cortical stroke.2. White matter disease as described above, nonspecific however most likely represent small vessel ischemic disease.3. Multilevel degenerative disease of the cervical and visualized upper thoracic spine, not significantly changed compared to the previous examination.4. No evidence of cervical spine fracture or subluxation, if spinal cord or ligamentous injury is suspected MRI is recommended."}
{"instruction": "Generate impression based on findings.", "input": "76 year-old female with right renal mass. Status post stroke. Hypertension. Suspected right upper pole renal mass seen on the recent ultrasound examination. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: Mild cardiomegaly. No acute infiltrates or effusions. Dense pleural-based posterior calcification at the right lung base appears benign. Precardiac lymph nodes measure up to 1.5 cm in length.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys show moderate atrophy bilaterally. In the right midpole region there is a 3-cm diameter cystic lesion with attenuation measuring approximately 11 Hounsfield units, indeterminate. Additional smaller cystic lesions are present in the right kidney. No associated lymphadenopathy. There is a 1.6-cm exophytic mass at the left lower renal pole with attenuation of 58 Hounsfield units. These lesions could be further characterized with dedicated contrast enhanced CT or MRI, but this may not be possible due to the patient's renal failure.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Contiguous thoracic spine bridging osteophytes compatible with diffuse idiopathic skeletal hyperostosis. Degenerative changes.OTHER: Fat containing umbilical hernia. PELVIS:UTERUS, ADNEXA: Atrophic uterus. BLADDER: Bladder is contracted with apparent mild wall thickening.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis. BONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis. Old fracture deformity with callous at a right hip intertrochanteric region.OTHER: No significant abnormality noted", "output": "Bilateral renal masses. The right midpole mass appears to be an atypical cyst. The left lower pole mass is indeterminate and may be solid. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 75 years old. Reason: r.o growth of nodules, adenopathy History: 2 year follow up US for multinodular goiter. left-sided nodules has increased a bit in size on physical examination RIGHT LOBE MEASUREMENTS: 4.6 x 1.2 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.9 x 1.8 x 1.6 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Heterogeneous echotexture. A hypoechoic nodular focus in the right inferior pole measures 1.4 x 2.5 x 1 .5 cm, nonvascular, unchanged.LEFT LOBE: Heterogeneous echotexture. A heterogeneous hypoechoic mixed cystic and solid nodule in the inferior pole measures 2.5 x 1.4 x 1.5 cm, noncalcified, minimal internal vascularity, unchanged.ISTHMUS: Heterogeneous echotexture. A heterogeneous hypoechoic nodule at the inferior aspect of the Isthmus measures 0.7 x 0.6 x 1 .0 cm, unchanged. An additional heterogeneous hypoechoic nodule at the mid right aspect of the Isthmus measures 0.7 x 0.6 x 0.7 cm, unchanged.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A right level 2 lymph node measures 0.7 x 0.3 x 1.3 cm.OTHER: No significant abnormality noted.", "output": "Stable thyroid nodules bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "History of optic neuritis: visual decline. Orbits: There is diffuse high T2 signal involving the intraorbital, canalicular, and cisternal segments of the left optic nerve. There is also enhancement along the cisternal segment of the left optic nerve. The right optic nerve is intact. There are bilateral lens implants. The bilateral globes and ocular adnexa are otherwise unremarkable. There is no evidence of intraorbital mass lesions.Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a 10 mm diameter pineal gland cyst. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral frontal and ethmoid sinuses.", "output": "1. Findings compatible with left optic neuritis.2. No evidence of acute intracranial hemorrhage or acute infarct."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other specified disorders of muscle Altered mental status, unspecified Other specified disorders of muscle Altered mental status, unspecifiedClinical question: patient w/ clonus of right foot, eval for spinal cord lesionSigns and Symptoms: clonus of foot Lumbar spine:Five lumbar type nonrib-bearing vertebral bodies are presumed to be present which are appropriate in overall height. The L5 vertebra is a transitional vertebra and is partially sacralized. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level associated with the narrowing of the neural foramina bilaterally and mild encroachment of the exiting nerve roots. Overall there is a mild degree of spinal stenosis at this level with some mild to moderate encroachment of exiting nerve roots. The fat surrounding the exiting nerve roots is mildly effaced.At L3-4 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated with marked bilateral facet and ligamentum flavum hypertrophy and mild anterior subluxation of L3 on L4. There is effacement of spinal fluid surrounding the nerve roots within the thecal sac at this level. Overall there is a moderate to severe degree of spinal stenosis at this level. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level. The fat surrounding the exiting nerve roots is effaced.At L2-3 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with the mild to moderate bilateral facet and ligamentum flavum hypertrophy. There is mild crowding of the nerve roots at this level. Overall there is a mild degree of spinal stenosis at this level. There is some narrowing of the neural foramina bilaterally at this level associated with some partial effacement of the fat surrounding the exiting nerve roots. Overall there is a mild to moderate degree of encroachment of the exiting nerve roots at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.Large osteophytes are present at the left sacroiliac joint.A small amount of fluid in the uterus is a nonspecific finding.", "output": "1.There is a transitional vertebra present which is labeled L5 for the purpose of this exam. Please note that this may affect enumeration of the lumbar vertebrae.2.There is moderate to severe spinal stenosis at L3-4 due to degenerative changes which is associated with encroachment of the exiting nerve roots at this level bilaterally and some mild subluxation.3.There is a mild to moderate degree of encroachment of exiting nerve roots bilaterally at L4-5 and L2-3.4.There is also mild degree of spinal stenosis at L2-3.5.A small amount of fluid in the uterus is a nonspecific finding. It is incompletely evaluated on this exam."}
{"instruction": "Generate impression based on findings.", "input": "Female, 52 years old, with history of chronic back pain and SLE, complaining of 3 days bilateral lower extremity weakness, pain, thigh numbness and urinary incontinence. The cervical lordosis is reversed secondary to degenerative disease. A mild thoracolumbar scoliotic curvature is seen along with a grade 1 anterolisthesis of L3 relative to the levels above and below.Vertebral body heights are preserved throughout. No evidence of worrisome marrow replacement is seen. No significant marrow edema is demonstrated apart from scattered degenerative endplate signal change.Disc osteophyte complexes are present at C3-4, C4-5 and C5-6 resulting in mild to moderate spinal canal stenoses at these levels. No significant cord impingement is suspected. Mild disc bulging is also evident in the lumbar spine without significant or high-grade spinal canal stenosis. Mild to moderate foraminal narrowing is evident at L2-3 through L4-5.No significant abnormalities of the spinal cord are suspected. No epidural fluid collections are seen.", "output": "1.No evidence of acute cord compression.2.Cervical spondylosis results in mild spinal canal narrowing at mid cervical levels without significant cord impingement.3.Mild degenerative disc disease is also evident in the lumbar region without significant spinal canal stenosis or impingement of the cauda equina."}
{"instruction": "Generate impression based on findings.", "input": "History of seizure, altered mental status Significant motion artifact degrading the exam quality especially for gradient echo and T1 sagittal scans which need to be repeated.There is no evidence of acute ischemic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The paranasal sinuses and mastoid air cells are clear.", "output": "No evidence of acute ischemic lesion on the scan.Repeat MR exam for T1 sagittal scan, gradient-echo and T1 axial scans."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Crawford is a 40-year-old female with recently diagnosed DCIS of the right breast. She presents for MR evaluation. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the right lateral breast, far posterior depth, there is an area of irregular enhancement identified measuring 0.9 x 1.4 x 0.8 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within the central aspect of this enhancement, compatible with biopsy-proven malignancy.There is no additional abnormal enhancement identified in the right breast. There is no abnormal enhancement identified in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "Unifocal malignancy of the right breast. No MRI evidence for malignancy of the left breast.If breast conservation therapy is desired, the biopsy marker clip in the right breast can be used as target for preoperative wire localization.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. "}
{"instruction": "Generate impression based on findings.", "input": "31-year-old with severe headache and dizziness. Please evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass, or edema. Subtle periventricular white matter hypoattenuation most prominent in the posterior parietal lobes that is of uncertain significance.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Small left sphenoid retention cyst, otherwise the visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1.No acute intracranial abnormality.2.Subtle periventricular white matter hypoattenuation most prominent in the posterior parietal lobes. This is of uncertain significance and is still within normal limits, however if patient symptoms persist, MR can be obtained to rule out white matter disease."}
{"instruction": "Generate impression based on findings.", "input": "History of urethral cancer status post cystectomy, evaluate for recurrence. 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: Postsurgical changes of right lower quadrant ileal conduit. No abnormally enhancing renal lesions or filling defects within the collecting systems. There is mild hydronephrosis on the right, not significantly changed.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal and mesenteric lymph nodes appear similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No specific evidence of tumor recurrence within the abdomen or pelvis."}
{"instruction": "Generate impression based on findings.", "input": "A 16 year old male, healthy and asymptomatic who was referred for EKG screening due to familiar history of arrythmia, the EKG showed negative T-wave in inferior leads and borderline criteria for hypertrophy, the echocardiography was normal. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle size is in the upper normal and the systolic function is low normal. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 106 ml/m2 (normal range: 74+/-15), the LVEDV is 198 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native T1 times were normal. No LVH.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 123 ml/m2 (normal range 82+/-16), the RVEDV is 229 ml (normal range 142+/-31), the RV end systolic volume index is 61 ml/m2 (normal range 31+/-9), and the RVESV is 114 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings 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. Low normalLV EF with normal RV EF2. Mild LV and RV enlargement3. No evidence for congenital structural abnormality.4. No evidence for delayed enhancement to suggest an inflammatory or infectious process.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: cervical cancer, radiation brachytherapy planningAdditional history per electronic medical record:Stage IIIB squamous cell carcinoma of cervix, s/p 6 cycles Carbo/Taxol/Avastin, and soon will complete EBRT with concurrent Cisplatin. PELVIS:UTERUS, ADNEXA: The uterine body is small in size, decreased from prior outside examination and which is favored to reflect atrophy in the absence of surgical history of supracervical hysterectomy.The ovaries are normal in size for age. No adnexal masses are identified.There is heterogeneous, abnormal soft tissue signal in the region of the cervix (series 3, image 32) measuring approximately 1.8 x 3.7 cm in the axial plane extending from approximately the level of the left UVJ inferiorly into the uterine body. There is associated heterogeneously increased enhancement. There is also restricted diffusion at the level of the cervix. The area of abnormal signal abuts the posterior wall of the bladder without frank evidence of invasion. The area of abnormal signal also surrounds the distal left ureter at the left ureterovesical junction.BLADDER: The distal tip of a nephroureteral stent is partially visualized in the bladder.LYMPH NODES: No pelvic lymphadenopathy is identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Abnormal signal intensity involving the cervix extending into the uterine body compatible with cervical neoplasm as described above. No pelvic lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "A 37 year old male with end stage renal disease on dialysis, hypertension, with repeated admission due to chest pain and pulmonary edema. An echocardiography (4/2015) showed hyperdynamic systolic function with severe left ventricular hypertrophy. Now hospitalized and referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is moderately dilated with hyperdynamic systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 116 ml/m2 (normal range: 74+/-15), the LVEDV is 208 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 58 ml (normal range 47+/-19), the LV mass index is 161 g/m2 (normal range 85+/-15), and the LV mass is 290 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Diffuse concentric left ventricular hypertrophy, maximal at basal septum up to 23mm. T1 time was above 1100ms at base, between 1050-1000ms at middle segments and between 1000-1050ms at the apex. These T1 time values represent most likely abnormal values at base, borderline at middle segments and probably normal at the apex. No myocardial iron overload is noted.No intracavitary thrombus is noted.In the context of this patient, these findings support the diagnosis of cardiac amyloid.Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 118 ml/m2 (normal range 82+/-16), the RVEDV is 212 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is dense calcification along the inferolateral mitral annulus with low density within the central portion of calcification which is demonstrated on recent CT. This is shown on MRI with low signal on the steady-state free precession sequences. This low density in the central calcification is suggestive of caseous necrosis. This contributes to slight decreased excursion of the basal posterior leaflet of the mitral valve. No significant mitral stenosis is visualized.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 pericardial effusion.Extracardiac FindingsIron overload is noted in the liver. Previous mediastinal lymphadenopathy from CT 7/15 does not appear as prominent on the current examination.", "output": "1. The left ventricle is moderately dilated with hyperdynamic systolic function, the LVEF is 72%. There are no regional wall motion abnormalities present. Diffuse concentric left ventricular hypertrophy, maximal at basal septum up to 23mm. T1 time was above 1100ms at base, between 1050-1000ms at middle segments and between 1000-1050ms at the apex. These T1 time values represent most likely abnormal values at base, borderline at middle segments and probably normal at the apex. In the context of this patient, these findings support the diagnosis of cardiac amyloid.2. The left and right atrium are dilated. 3. The right ventricle is mildly dilated with normal systolic function, the RVEF is 62%.4. Evidence of iron deposition in the liver and possibly in the spleen."}
{"instruction": "Generate impression based on findings.", "input": "53 year old female status post left lumpectomy for IDC in October 2013 , followed by radiation therapy presents today for routine follow up. Patient is currently on anastrozole. No current breast complaints. Three standard views of both breasts and 2 spot magnification views of left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scar marker overlies area of lumpectomy in the left upper inner quadrant with architectural distortion/scarring and surgical clips at that site. No suspicious calcifications seen on spot magnification views. 3 clips from prior benign biopsies identified in the right breast and 2 clips from prior benign biopsies identified in the left upper outer quadrant and a third clip identified in the left retroareolar region. Scattered benign calcifications seen in both breast. Few subcentimeter benign morphology masses in the right upper-outer quadrant are mostly unchanged from prior study and most likely correspond to cysts as seen on prior MRI dated 5/23/2013No dominant mass, suspicious microcalcifications or new areas of architectural distortion in either breast. Surgical clips identified in the left axillary region.", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: Metastatic urothelial cancer with brain meets, s/p resectionSigns and Symptoms: intermittent HA There is redemonstration of status post left frontal craniotomy. Since the prior exam a hemorrhagic lesion in left frontal lobe has regressed. There is significantly less perilesional signal change compared to the prior exam and less mass effect. There is some nodular enhancement present along the anterior and inferior aspect of the surgical bed. There is some susceptibility effect along the inferior aspect of the lesion.There is a 10 mm enhancing lesion in the left temporal lobe at the superior temporal gyrus adjacent to the superior temporal sulcus which previously measured 7 mm.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Since the previous exam the left temporal lobe mass has increased in size. This is compatible with metastatic disease.2.The patient status post left frontal craniotomy. Vasogenic edema associated with a left frontal lobe resection site for mass has regressed. The possibility of some residual or recurrent tumor cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Encephalopathy, unspecifiedClinical question: Encephalopathy The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of generalized brain atrophy present.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is redemonstration of a small cystic lesion just below the left cerebellar hemisphere measuring 16 x 6 mm in coronal dimensions which is stable when compared to the prior exam and most likely represents a small arachnoid cyst.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There is no evidence for any significant microhemorrhages in the brain parenchyma. There is no evidence for foci of diffusion restriction within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate opacification of the frontal sinuses, ethmoid air cells and sphenoids sinuses with an air-fluid level in the right maxillary sinus and mucosal thickening in the right maxillary sinus. There is a polypoid appearing lesion which extends into the right ostiomeatal complex unit from the right nasal cavity. This could also be identified on the prior exam from 7/12/2014. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There is opacification of the paranasal sinuses with a polypoid type lesion in the right nasal cavity extending into the right maxillary sinus. Please correlate with clinical evaluation for nasal polyposis and/or possible antrochoanal polyp.2.An air-fluid level in the right maxillary sinus could potentially represent acute sinusitis. Please correlate with clinical symptoms3.Findings suggest a mild degree of generalized brain atrophy but not significantly different than the prior exam.4.Small arachnoid cyst adjacent to the left cerebellar hemisphere. This is stable."}
{"instruction": "Generate impression based on findings.", "input": "36 week old infant with apnea; evaluate for bleed. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Subtle areas of questionable low attenuation within the subcortical white matter and bilateral frontal lobes that could represent prior hypoxic injury; recommend follow up MRI if clinically indicated.", "output": "Subtle areas of questionable low attenuation within the subcortical white matter in bilateral frontal lobes that could represent prior hypoxic injury; recommend follow up MRI if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "11 month old female with a cerebellar vermis lesion. Expected postoperative changes are again seen from the previous vermian mass biopsy through a small right paramedian occipital burr hole with resolution of the previous pneumocephalus and trace subdural blood products. Redemonstrated is a polypoid non-enhancing right cerebellar vermian lesion with normal T2/Flair signal intensity, which extends into the fourth ventricle and which is not significantly changed. The small hypothalamic lesion and subtle thickening of the tectal plate which narrows the cerebral aqueduct are also not significantly changed.Unchanged small focus of enhancement just above the tectal plate which is suspected to represent normal enhancing pineal tissue.There is a stable right frontal approach ventriculostomy catheter with tip in the midline on the anterior aspect of the septum pellucidum. The ventricles and sulci are within normal limits and there is no midline shift or mass effect. The major cerebral flow voids are intact. There is a fluid in the right greater than left mastoid air cells. There is patchy opacification of the ethmoid air cells bilaterally. The orbits, skull, and scalp soft tissues are grossly unremarkable.", "output": "No significant change in the hypothalamic lesion, polypoid cerebellar vermis lesion extending into the fourth ventricle, or the thickening of the tectal plate which narrows the cerebral aqueduct. These lesions may be hamartomatous/developmental especially given their absence of associated signal abnormality or enhancement but recommended continued follow-up."}
{"instruction": "Generate impression based on findings.", "input": "53 year old female with a history of left breast mastectomy and sentinel node biopsy in March 2009 for DCIS with immediate reconstruction (DIEP flap). No current breast complaints. Status post left mastectomy and autologous reconstruction.There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.Two susceptibility artifacts from biopsy clip in the right breast are again seen.A few enhancing foci in the right breast are unchanged.No abnormal enhancement is seen in right breast or reconstructed left breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old male with history of anterior shoulder pain status post fall. Evaluate for labral or other soft tissue pathology. ROTATOR CUFF: Intermediate signal intensity is noted of the supraspinatus tendon near the insertion site compatible with tendinopathy. Otherwise there is no evidence of full-thickness tear or other abnormality.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. Specifically no evidence of labral tear is noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "Findings compatible with tendinopathy of the supraspinatus tendon near the insertion site."}
{"instruction": "Generate impression based on findings.", "input": "Male, 83 years old. Back and leg pain. Exam is severely limited due to continued patient motion.Marked abnormal signal within both sacral wings is compatible with a known history of insufficiency fracture. Both iliac bones show additional areas of abnormal signal which may represent additional fractures. There is nonspecific edema/inflammation in subcutaneous soft tissues posterior to the sacrum.", "output": "Extremely limited study showing sacral insufficiency fractures and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": " There is left temporooccipital restricted diffusion with matching ADC hypointensity which is T1 hypointense centrally with gyral T1 hyperintensity, T2 hyperintensity, and enhancement.Elsewhere there are small foci of T2 hyperintensity within the white matter, splenium, and pons without restricted diffusion, susceptibility abnormality, mass effect, or enhancement.The ventricles and sulci are normal in size. 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. Flow voids are present within the major vessels indicating patency. Scattered foci mucosal thickening is present throughout the paranasal sinuses with a superimposed air-fluid level in the right sphenoid sinus. There is also fluid in bilateral mastoid air cells.", "output": "1.Subacute left temporooccipital infarct.2.Scattered foci mucosal thickening is present throughout the paranasal sinuses with a superimposed air-fluid level in the right sphenoid sinus. There is also fluid in bilateral mastoid air cells."}
{"instruction": "Generate impression based on findings.", "input": "Male, 15 years old, with new numbness and tingling in the bilateral legs, status post cervical spinal cord injury in June 2016 after wrestling. Cervical:Evidence of anterior and posterior instrumented fusion is seen at C5-6. Artifact from the instruments causes local image distortion. At the C5-6 level, a band of abnormal hyperintense T2 signal appears to traverse the spinal cord. Above this level, an inverted-V shaped column of abnormal T2 signal is seen involving the midline dorsal spinal cord. This abnormality extends superiorly to the cervico-medullary junction. Below the C5-6 level, abnormal spinal cord signal is seen more diffusely, but in particular, the lateral columns appear to be affected. This abnormality extends down to the level of the conus.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No areas of pathologic marrow replacement or edema are seen. Intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is seen.Spinal alignment is grossly anatomic. Vertebral body heights are preserved. No areas of pathologic marrow replacement or edema are seen.", "output": "Evidence of severe spinal cord injury is seen at the C5-6 level where there is a band of T2 hyperintensity spanning the cervical cord. This may represent partial transection or sequelae of prior contusion.Above the level of spinal cord injury, abnormal T2 signal is seen affecting the dorsal columns. Below the level of the spinal cord injury, abnormal T2 signal is seen more diffusely within the cord but particularly affecting the lateral columns. This pattern of findings is characteristic of Wallerian degeneration following spinal cord injury.No additional pathologic or unexpected findings are seen in the context of prior trauma."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for OCD versus interval resolution of Panner's disease There is bony edema involving the lateral epicondyle of the distal humerus but improved when compared to the prior study. There is a small elbow joint effusion. There is osteochondral defect at the articular surface of the lateral epicondyle measuring approximately 6 x 6 mm in size. No definite evidence of loose bodies within the joint space. There is minimal edema to the olecranon but improved from prior study. The flexor and extensor tendons and ligaments are normal.", "output": "Bony edema at the lateral epicondyle of the distal humerus but improved from prior study. There is a osteochondral defect at the articular surface of the lateral epicondyle as described above."}
{"instruction": "Generate impression based on findings.", "input": "High protein in CSF with headaches rated at 10/10. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unremarkable, aside from asymmetry of the occipital horns of the lateral ventricle, which can be a normal variant. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are probable secretions in the left petrous apex. There are secretions in the right frontal sinus.", "output": "1. No evidence of demyelinating lesions, mass, or acute infarct.2. Probable secretions in the left petrous apex. Assessment for petrous apicitis is otherwise limited without contrast."}
{"instruction": "Generate impression based on findings.", "input": "Left sensorineural hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is a cystic pineal gland that measures up to approximately 15 mm. There is diffuse volume loss of the imaged portions of the brain parenchyma.", "output": "1. No evidence of retrocochlear or inner ear lesions.2. A cystic pineal gland that measures up to approximately 15 mm likely represents benign cystic degeneration."}
{"instruction": "Generate impression based on findings.", "input": "Female, 18 years old, with exertional headaches. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.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. An incidental developmental venous anomaly is present in the right temporal lobe. No pathologic parenchymal or extra-axial enhancement is detected.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.", "output": "Unremarkable evaluation with no specific findings to account for the patient's headaches."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Marshall is a 49-year-old female with a personal history left breast skin sparing mastectomy in 2011 for DCIS. Family history of breast cancer in paternal grandmother, paternal great aunt, and paternal cousins. She has no current breast related complaints. Patient is status post left breast mastectomy with DIEP flap reconstruction. There is heterogeneous amount of fibroglandular tissue in the right breast.No abnormal enhancement is seen in the right breast or the reconstructed left breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Secondary GBM on Avastin. Signs and symptoms: GBM. Pre and post enhanced brain MRI:Examination demonstrated a large focus of FLAIR/T2 hyperintensity in the left anterior and mid temporal lobe with extension into left remaining inferior frontal lobe and extensive extension medially into the left basal ganglia and left periventricular white matter. Findings demonstrate regional mass effect and with very irregular configuration. Finding is consistent with patient's known GBM. There is no convincing evidence of any interval change in the signal intensity or extent/size of this lesion. On post enhanced images there is a focus of enhancement in the left inferior frontal component of above described finding which minimally extends into the left anterior temporal parenchyma similar to prior exam. All measurements of this focus of enhancement appear fairly similar to prior exam and without convincing evidence of change in size.There is an additional isolated small focus of enhancement in the left periventricular white matter component of this lesion measuring approximately 7 mm in transaxial dimensions which is less conspicuous compared to prior study however without definitive change in size.Above findings results in regional mass effect and effacement of adjacent cortical sulci, subtle mass effect in the left anterior aspect of the lateral ventricle similar to prior exam and without deviation of midline.Stable postoperative changes of left inferior frontal partial lobectomy for removal of tumor. Mild dilatation of the lateral ventricles similar to prior exam.Stable patchy and confluent FLAIR hyperintensity in the left hemisphere which is believed to represent post treatment changes. Possibility of overlapping chronic small vessel ischemic strokes cannot be excluded. No detectable new foci of signal abnormality or new foci of abnormal enhancement since prior exam.", "output": "1.No evidence of an acute or definitive evidence of new finding since prior exam.2.A large left hemispheric anterior temporal, left inferior frontal, left basal ganglia and left periventricular white matter mass with 2 internal noncontiguous foci of enhancement and its associated mass effect remains fairly similar to prior study. The larger focus of enhancement in the left inferior frontal lobe measures at 19.5 x 17 mm and a 7mm focus of isolated enhancement in the left periventricular white matter component of tumor similar to prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other specified disorders of muscleClinical question: fluctuating weakness r handSigns and Symptoms: stuttering hand weakness MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right A1 segment is smaller than the left A1 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally with small P1 segments.. The left vertebral artery is larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery.", "output": "1.There is no evidence for intracranial cerebrovascular occlusive disease.2.There is no evidence for extracranial cerebrovascular occlusive disease."}
{"instruction": "Generate impression based on findings.", "input": "History of multiple myeloma and breast and endometrial adenocarcinomas status post recent cervical spine tumor resection. There are postoperative findings related to recent C4 through C6 laminectomy with posterior rods and screws. There is a fluid collection with mildly convex margins and layering intermediate T1 and T2 components in the posterior extradural portion of the surgical bed in addition to what corresponds to floseal. The fluid collection measures approximately 20 AP x 25 RL x 50 SI mm. In conjunction with reversal of the usual lordosis, posterior disc-osteophyte complexes, and ossification of the posterior longitudinal ligament, there appears to be slight mass effect upon the spinal cord. There is diffuse high T2 signal in the spinal cord from C2 to C7. There is a small amount of residual intradural extramedullary tumor within the left aspect of the spinal canal at the C3-4 and C4-5 levels that measures up to 2 mm in thickness, as well as unchanged thickening and enhancement along the exiting left C4 and C5 nerve roots that extends beyond the neural foramina. There are multiple T2 hyperintense enhancing lesion in the imaged portions of the axial skeleton, including the T1 and T4 vertebrae and manubrium. The vertebral body heights appears to be preserved nevertheless. There is right axillary, supraclavicular, and parotid lymphadenopathy. There are bilateral maxillary sinus retention cysts.", "output": "1. Postoperative findings related to resection of a spinal cord tumor with a fluid collection containing a probable hematocrit level in the epidural compartment of the surgical bed contributes to slight mass effect upon the spinal cord at C4 through C7 in conjunction with reversal of the usual lordosis, posterior disc-osteophyte complexes, and ossification of the posterior longitudinal ligament. Nevertheless, the overall mass effect is markedly reduced compared to before surgery.2. A small amount of residual tumor is evident within the left aspect of the spinal canal at the C3-4 and C4-5 levels with extension along the exiting left C4 and C5 nerve roots beyond the neural foramina. 3. Diffuse signal abnormality in the cervical spinal cord may represent residual edema or sequela prior ischemic changes.4. Multiple lesions in the imaged axial skeleton are compatible with neoplasm.5. Right axillary, supraclavicular, and parotid lymphadenopathy likely represent neoplasm as well. Please refer to the prior neck CT report for additional details.Discussed with Dr. Lesniak on 4/24/2015 at 9:30 AM."}
{"instruction": "Generate impression based on findings.", "input": "History of non-Hodgkin's lymphoma status post rituximab and radiation. Follow-up imaging. History of thyroid cancer status post lobectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is mildly enlarged measuring 19.5 cm in the coronal plane. There is no intra or extrahepatic biliary ductal dilatation. The portal and hepatic veins are patent. Unchanged enhancing T2 hyperintense lesions within segment 6 and 5, probable hemangiomas.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.BONES, SOFT TISSUES: L1 vertebral body hemangioma, unchanged. PELVIS:PROSTATE/SEMINAL VESICLES: Right scrotal hydrocele partially imaged.BLADDER: No significant abnormality noted.LYMPH NODES: Unchanged representing a left inguinal lymph node measures 3.7 x 3.5 cm (series 19, image 46). Unchanged left external iliac lymph node measures 1.8 x 1.2 cm (series 19, image 24). Subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Edema within the left ilium. No suspicious abnormality.OTHER: No significant abnormality noted.", "output": "Unchanged left inguinal and left external iliac adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Dysarthria [784.51], Reason for Study: ^Reason: eval for vessel stenosis History: dysarthria, facial weakness? TIA work up There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Several scattered bihemispheric periventricular white matter high signal intensity lesions on FLAIR imaging indicating nonspecific minimal small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral posterior communicating arteries and anterior corticate and artery are patent.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. There is no intracranial arterial aneurysm.There is no evidence of significant arterial luminal stenosis on both extracranial and intracranial arterial system.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. Minimal nonspecific small vessel ischemic disease.3. Normal brain and neck MR angiogram. "}
{"instruction": "Generate impression based on findings.", "input": " Brain MRI:The ventricles and sulci are normal in size. 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.Brain MRA:There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis.", "output": "1.Negative MRI of the brain including gadolinium enhancement.2.Negative MRA of the brain. Specifically, there are no hemodynamically significant intracranial stenoses."}
{"instruction": "Generate impression based on findings.", "input": "Follow up of a pituitary lesion. There is a mildly hypoenhancing lesion in the left pituitary gland that measures up to 10 mm. There is no mass effect upon the optic apparatus or cavernous sinus. There is slight deviation of the pituitary infundibulum to the right. The cavernous carotid artery flow voids are intact.", "output": "An unchanged lesion in the left pituitary gland that measures up to 10 mm likely represents an adenoma."}
{"instruction": "Generate impression based on findings.", "input": "Head and neck cancer. Head CT:There is a vague area of enhancement in the left temporal lobe (image #11, series 10). This should be evaluated with MRI brain to exclude the possibility of a metastatic disease. No obvious mass is identified.Neck CT:Post-treatment changes with associated soft tissue thickening in the neck are unchanged. There is no evidence of mass, or adenopathy based on size criteria.The limited view of the upper lungs appear unremarkable.Degenerative disease of the cervical spine is again present, with mild neuroforaminal narrowing at C3 -- C4 and C4 -- C5 levels.", "output": "1. Vague enhancement in the left temporal lobe may be vascular in etiology. However, further evaluation with MRI brain without and with contrast is recommended to exclude the small possibility of a metastatic focus. 2. No evidence of recurrence or adenopathy in the neck."}
{"instruction": "Generate impression based on findings.", "input": "40 years Female (DOB:9/10/1975)Reason: transphenoidal hypo to be done today in the OR. Please do MRI Stealth for intraoperative image guidance during surgery. History: pituitary massPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 14 x 13 mm axial dimension cystic lesion suprasellar cistern.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities The visualized portions of the mastoid air cells demonstrate some scattered opacities in the left The visualized portions of the orbits are intact.", "output": "There is a cystic type lesion in the suprasellar cistern. The possibility that this represents a craniopharyngioma cannot be excluded. Please compare to the prior MRI exam for further comments."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female with a right ulnar wrist mass for 4 months. Evaluate for cyst versus solid mass. Incomplete examination secondary to the patient's inability to tolerate the examination as well as technical/mechanical issues. A dedicated wrist coil could not be utilized for this examination resulting in slightly suboptimal image quality.A marker was placed along the volar and ulnar aspect of the wrist denoting the site of the patient's mass. There is a lobulated mass of fluid signal intensity situated volar to the ulna and medial to the flexor tendons. The mass measures approximately 12 x 11 mm in the transverse dimension and just over 2 cm in the longitudinal dimension. Based on these nonenhanced images, this most likely represents a ganglion. Although the cyst does not directly communicate with the triangular fibrocartilage on this examination, there is a similar appearing but smaller cystic lesion, which appears to arise from the ulnar aspect of the disc and hence this ganglia and may represent an extension of mucoid material from the triangular fibrocartilage. There may be a tear within the more central/radial fibers of the triangular fibrocartilage, although this is difficult to ascertain due to patient motion artifact. We see no additional soft tissue masses. There is a small amount of fluid within the distal radioulnar joint. Although this study was not protocoled for detailed evaluation of the ligaments, there is mild heterogeneity of the scapholunate ligament which may represent partial thickness tearing. Mild osteoarthritis affects the basilar joint and trapezioscaphoid articulation with a small cyst within the trapezium that is likely degenerative in etiology. The tendons of the wrist appear normal. We see no findings to suggest nerve compression.", "output": "Incomplete study as described above showing a soft tissue mass volar to the ulna that likely represents a ganglion that we suspect arises from the articular disc of the triangular fibrocartilage. A malignant neoplasm is considered exceedingly unlikely given the morphology and homogeneity of this mass, however, the patient can return for a complete study following gadolinium administration if desired."}
{"instruction": "Generate impression based on findings.", "input": "Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: r/o stroke, evaluate for demyelination History: acute left sided weakness, questionable dx of MS Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There scattered tissue losses involving bilateral caudate nuclei, thalami, pons and centrum semiovale indicate chronic lacunar infarctions. Underlying brain shows multifocal patchy T2/FLAIR high signal intensity lesion on bilateral periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 40% of luminal stenosis at the level of proximal right MCA M1 segment. Due to vascular tortuosity, the MIP image of the MRA shows exaggerated the degree of stenosis. Otherwise unremarkable bilateral ACAs and left MCA. There is less than 10% of luminal narrowing at mid basilar artery. And the right distal vertebral artery is small which may indicate congenital hypoplastic artery. Right Pcom artery and Acom artery are patent. The left Pcom artery is not seen.There is no evidence of intracranial arterial luminal stenosis. No intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, and internal/external carotid arteries. The right vertebral artery is hypoplastic and the left vertebral artery is dominant.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal lacunar infarctions with underlying non specific small vessel ischemic disease.3. About 40% of luminal stenosis of the proximal right MCA M1 segment and less than 10% luminal stenosis at the mid basilar artery. No other intracranial and extracranial arterial luminal stenosis. No intracranial aneurysm. "}
{"instruction": "Generate impression based on findings.", "input": "28-year-old male with right shoulder pain and infraspinatus atrophy. ROTATOR CUFF: The rotator cuff appears intact. There is mild tendinopathy of the distal supraspinatus and infraspinatus tendons. The muscle bellies themselves appear without significant pathology, including fatty atrophy.SUPRASPINATUS OUTLET: The supraspinatus outlet appears well-maintained.GLENOHUMERAL JOINT AND GLENOID LABRUM: Articular cartilage remains intact along the glenohumeral joint and glenoid labrum. There is a complete tear of the posterior labrum.BICEPS TENDON: The biceps tendon appears well seated within the bicipital groove and no significant pathology is visualized at the coracoid origin. ADDITIONAL", "output": "1. Mild tendinopathy of the distal supraspinatus/infraspinatus tendons, however no tear. No significant infraspinatus atrophy as clinically queried.2. There is a complete tear of the posterior labrum, as outlined above."}
{"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 \u201ctime-out\u201d form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 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\u2019s 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: 34 seconds", "output": "Successful fluoroscopic left hip arthrogram injection."}
{"instruction": "Generate impression based on findings.", "input": "History of sarcoidosis. Evaluate for biliary obstruction or other abnormality. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size with a nodular contour compatible with chronic liver disease. Recanalized periumbilical vein.Note is made of bilateral percutaneous biliary drains with mild adjacent signal changes of the parenchyma. There is persistent irregular narrowing and moderate dilatation of the common bile duct and intrahepatic biliary tree. There is mild enhancement of the biliary tree centrally, unchanged and likely related to chronic mild inflammation. No new dominant stricture or discrete mass lesion. No suspicious arterial enhancing lesion.The main portal vein and intrahepatic portal branches are chronically occluded with extensive perigastric peripancreatic, intrapancreatic and splenic collaterals.SPLEEN: The spleen is normal in size morphology and signal intensity.PANCREAS: The main pancreatic duct appears to drain into the minor papilla compatible with pancreas divisum. No main pancreatic ductal dilatation or focal lesion. There are extensive intra and peri-pancreatic collateral vessels. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral cortical scarring is noted. Splenorenal shunt is again noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mild morphologic changes of cirrhosis, chronic portal vein occlusion and stable dilatation/stricturing of the common bile duct and intrahepatic biliary tree. No suspicious hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": " The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The right cerebellar tonsil is slightly low-lying, extending 5 mm below the level the foramen magnum. However, there is no crowding of structures at this level and the cerebellar tonsils remain rounded. Otherwise, the midline structures are within normal limits. There are scattered mucosal thickening in the ethmoid sinuses.", "output": "No MR evidence of demyelinating disease. No evidence of traumatic brain injury. Very minimal incidental right cerebellar tonsillar ectopia"}
{"instruction": "Generate impression based on findings.", "input": " BRAIN: Motion artifact slightly limits the study. A curvilinear area of enhancement in the anterior right cingulate gyrus is likely represents a developmental venous anomaly. The susceptibility weighted images are degraded due to motion artifact, however there is no definite evidence of mixed vascular malformation. 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. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. 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. There is no additional abnormal enhancement within the brain. There is mild diffuse mucosal thickening of the bilateral maxillary sinuses and ethmoid air cells. LUMBAR SPINE: Vertebral body and intervertebral disc heights are preserved. Alignment is anatomic. There are no fractures or subluxations. The marrow signal is normal. The conus is normal in signal and morphology and terminates at an appropriate level. There is no evidence of neural foraminal stenosis. There are no areas of abnormal enhancement. The visualized intra-abdominal and paraspinal contents are unremarkable.", "output": "1.No finding to explain the patient's symptoms in the brain or lumbar spine. 2.Diffuse mucosal inflammation of the paranasal sinuses."}
{"instruction": "Generate impression based on findings.", "input": "76 year old man with coronary artery disease s/p TECAB CABG in May 2015. He presents with persistent dyspnea on exertion and referred to evaluate for ischemia and viability.MEDICATIONS: aspirin, clopidogrel, atorvastatin, HCTZ, lisinopril, metoprolol, insulin First Pass PerfusionDuring hyperemia, a large, severe perfusion defect was seen involving the basal and inferolateral and anterolateral walls and also the apical lateral wall. The overall ischemia score is 9 out of 32 and 28% of the ventricle is ischemic.Viability/ Myocardial ScarThe possibility of a small transmural myocardial infarction (i.e. late gadolinium enhancement) involving the basal inferolateral wall can not be excluded. It is unclear if this segment is viable. However, the remainder of the heart is without late gadolinium enhancement and is very likely to be viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 48 ml/m2 (normal range: 74+/-15), the LVEDV is 97 ml (normal range 142+/-34), the LV end systolic volume index is 17 ml/m2 (normal range 25+/-9), the LVESV is 35 ml (normal range 47+/-19), the LV mass index is 46 g/m2, and the LV mass is 92 g. There is tardokinesis of the basal inferior wall. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 43 ml/m2 (normal range 82+/-16), the RVEDV is 86 ml (normal range 142+/-31), the RV end systolic volume index is 14 ml/m2 (normal range 31+/-9), and the RVESV is 28 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. Mild atherosclerosis is noted in the descending thoracic aorta.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. There is a large burden of pericardial fat.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. There is a large severe perfusion defect during hyperemia, as described above.2. The possibility of a small transmural myocardial infarction (i.e. late gadolinium enhancement) involving the basal inferolateral wall can not be excluded. It is unclear if this segment is viable. However, the remainder of the heart is without late gadolinium enhancement and is very likely to be viable. 3. Normal LV size and systolic function (LVEF 64%). There is tardokinesis of the basal inferior wall.4. Normal RV size and systolic function (RVEF 67%)."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic thyroid cancer, status post resection on April 20, 2014. There are postsurgical findings related to a right pterional craniotomy with unchanged enhancement in addition to mild intrinsic T1 hyperintensity and susceptibility effect along the margins of the right inferior frontal gyrus resection cavity, as well as unchanged surrounding confluent T2 hyperintensity. There is a new 2 mm diameter lesion at the grey-white matter interface with T1 hyperintensity and possibly contrast enhancement and susceptibility effect posterior medial to the treatment bed in the inferior right frontal gyrus. The 2 mm diameter enhancing lesion in the left superior cerebellar hemisphere is now much less conspicuous and there is no associated vasogenic edema. The punctate focus of susceptibility effect without associated enhancement in the right basal ganglia is unchanged. The ventricles and sulci are unchanged. There is no midline shift or mass effect. There is no evidence of acute infarction. There is an unchanged subcentimeter posterior nasopharynx retention or Thornwaldt cyst. There is minimal mucosal thickening in the inferior aspect of the right maxillary sinus.", "output": "1.Post-treatment findings related to resection of a right frontal lobe metastasis. 2.A new 2 mm diameter lesion medial to the treatment may represent a metastasis. However, the previously demonstrated 2 mm diameter lesion in the left superior cerebellar hemisphere is much less conspicuous. "}
{"instruction": "Generate impression based on findings.", "input": "Female 56 years old with tenderness palpation of the right foot. Assess soft tissue mass in right foot. There is a multilobulated lesion within the septations in the soft tissues overlying the talus and medial cuneiform bones and medial to the extensor digitorum tendon. The lesion measures 2.3 x 1.6 x 3.9 cm (series 1201, image 13 and series 1101, image 12). It is low in signal intensity on T1 and high on T2-weighted image. There is mild peripheral contrast enhancement but no enhancement of the septations. A 5 mm ossicle posterior to the talocalcaneal articulation compatible with an os trigonum. Bone marrow signal intensity is within normal limits. There is no fracture, dislocation tibiotalar joint effusion. The Achilles tendon is normal in appearance. The flexor and extensor tendons are intact. The ligamentous structures appear intact.", "output": "2.3 x 1.6 x 3.9 cm lesion in the anterior soft tissues of the ankle is most compatible with a ganglion cyst."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer with recurrences in the past, and now with increasing thyroglobulin level. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening.Neck: There are postoperative findings related to thyroidectomy, without measurable tumor or significant lymphadenopathy in the neck. There are scattered subcentimeter cervical lymph nodes that are not significantly enlarged. The salivary glands are unremarkable. The major cervical flow voids are intact. The osseous structures are unremarkable.", "output": "1. No evidence of intracranial metastases. 2. Postoperative findings related to thyroidectomy, without measurable tumor or significant lymphadenopathy in the neck. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 52 years old, history of thyroid cancer with metastases, compare to prior. Numbering is performed as per prior reports.Thoracic MRI: An enhancing lesion in the left anterior aspect of the T5 vertebral body measures is unchanged from the prior exam. The lesion is associated with mild superior endplate concavity, also unchanged.Lesions within the left transverse process and pars interarticularis of T5 and T6 also show no significant interval change.Instrumented fusion of T10 through T12 is again seen, and the T11 vertebral body remains compressed demonstrating diffusely abnormal signal characteristics compatible with metastatic involvement. Findings are stable.No new lesions are seen. No epidural disease extension is identified. As before, the spinal canal is not significantly narrowed. Mild kyphotic angulation centered at T11 is stable.T1 shortening in the thoracic and lumbar likely related to prior radiation. Increased signal within the T9 and L1 vertebral bodies on fat-suppressed T1 post contrast images is at least in part artifactual and due to metal related failure of fat suppression.Lumbar MRI:A lesion within the right L2 vertebral body is unchanged.A lesion within the left L3 vertebral body is unchanged.A small nonspecific lesion along the left inferior endplate of L4 is unchanged.A lesion in the left L5 vertebral body measures is unchanged.No new lesions are significant epidural disease extension is identified. No spinal canal encroachment or significant foraminal narrowing is detected.Mild degenerative changes are again seen without significant spinal canal or foraminal stenosis, stable in appearance.", "output": "1.No significant change in multiple osseous lesions in the thoracic and lumbar spine without significant interval change in size or morphology. 2.No new lesions are detected. 3.No significant epidural disease or spinal canal/foraminal narrowing."}
{"instruction": "Generate impression based on findings.", "input": "Deteriorating memory. Symptoms compatible with depression vs subacute cognitive decline. Screening tools as the NE and MMSE are normal. There is a punctate focus of susceptibility artifact in the pons to the right of midline which correlates with focal contrast enhancement and may reflect an incidental capillary telangiectasia. There is no other abnormal intracranial enhancement. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. For age, there is minimal global parenchymal volume loss but no hydrocephalus. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1.Mild global parenchymal volume loss but no focal lesion.2.No evidence of intracranial hemorrhage, mass, or acute infarct. 3.Small incidental pontine capillary telangiectasia is suspected."}
{"instruction": "Generate impression based on findings.", "input": "Other headache syndrome [G44.89], Reason for Study: ^Reason: r/o mass History: headache No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement. There are multiple scattered FLAIR/T2 high signal intensity lesions on periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass, 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": "Minimal nonspecific small vessel ischemic disease.Otherwise unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "67 year old man with history of HTN, HL, known RBBB on ECG and family history of sudden cardiac death who presented after a syncopal episode. He was referred for cardiac MRI to evaluate for structural heart disease and scar. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 84 ml/m2 (normal range: 74+/-15), the LVEDV is 167 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 55 ml (normal range 47+/-19), the LV mass index is 60 g/m2 (normal range 85+/-15), and the LV mass is 118 g (normal range 164+/-36). Wall thickness is normal (9-10mm in the basal septum). There are no regional wall motion abnormalities present. There were technical limitations for the late gadolinium imaging portion of this exam, but grossly there is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 980ms, which is normal. There is no myocardial iron overload. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 183 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 92 ml (normal range 54+/-17). There are no regional wall motion abnormalities. Right AtriumThe right atrium is mildly dilated.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 ascending aorta measures 37x 35mm. There is mild atherosclerosis.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly-moderately dilated.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. Normal size LV with normal systolic function (EF 67%). Wall thickness is normal. Technically difficult late gadolinium imaging, but there is no gross evidence of late gadolinium enhancement to suggest the presence of underlying myocardial infiltration, inflammation or fibrosis. 2. Normal size RV with normal systolic function (EF 50%). There are no regional wall motion abnormalities. 3. Biatrial enlargement. 4. Main pulmonary artery dilatation. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 36 years old, 21 weeks gestational age, with ventriculomegaly on prenatal ultrasound. The lateral ventricles are slightly enlarged measuring up to 11 mm at the level of the atria. The third and fourth ventricles are normal in size. The cerebral aqueduct is not adequately visualized to allow a confident assessment of patency. The cavum septum pellucidum is visualized and the corpus callosum is present. Cortical morphology and the degree of gyration are within expected limits for gestational age. The thalami and brainstem appear to be normally formed. The cerebellar vermis and hemispheres are likewise normally formed. The posterior fossa as a whole is normal in size.", "output": "Mild ventriculomegaly without clear evidence for an underlying etiology or any additional associated abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "51 years Male (DOB:3/12/1965)Reason: r/o cord compression History: right lower extremity weaknessPROVIDER/ATTENDING NAME: DAVID A HARTER DAVID A HARTER Cord compression protocol:The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.The patient is status post laminectomies at L3, L4 and L5 and there is soft tissue swelling and fluid collections at the surgical site.MRI lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.The patient is status post laminectomies at L3, L4 and L5 and discectomy at L4-5 and L5-S1.. There is a fluid collection present measuring 92 mm superior-inferior length extending at the laminectomy sites which bulges into the spinal canal. It measures 12 mm in thickness. It is associated with effacement of the spinal fluid surrounding the nerve roots within the thecal sac extending from L3 down to the L4-5 disc space. Below that level there is fluid surrounding the thecal sac extending down to the L5-S1 level. There is soft tissue swelling present along the left and right hemicanal at the L5-S1 level extending into the disc space and also bilaterally at L4-5 extending into the disc space. There are blood products present along the right hemicanal at L5-S1. This is associated with some encroachment of the nerve roots at the right lateral recess at L5-S1 and some partial effacement of the thecal sac at this level.There is an additional fluid collection present in the subcutaneous tissues adjacent to the perivertebral space which measures 43 x 19 mm axial dimensions and approximately 104 mm superior-inferior length.There is heterogeneous signal within the medial and posterior paravertebral musculature at the surgical sites.There is narrowing of the neural foramina due to disc bulge at L3-4 and L4-5 and to a lesser degree L5-S1 bilaterally. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. However, the cauda equina does appear to be potentially compressed. Please note that the postsurgical findings may mimic compression of the cauda equina, however, clinical correlation is needed to confirm this.2.The patient is status post laminectomies at L3, L4 and L5 with discectomy at L4-5 and L5-S1. 3.There is fluid collection at the laminectomy sites at L3 and L4 associated with findings suspicious for compression of the cauda equina. Please correlate clinical symptoms.4.There is soft tissue swelling surrounding the thecal sac at the L4-5 and L5-S1 levels extending from the L4-5 disc space down to the sacral spinal canal associated with some blood products in the right hemicanal at L5-S1. This results in some circumferential narrowing of the thecal sac and affects the nerve roots at the lateral recesses sees at these levels.5.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.6.Findings were discussed with Dr Constantine."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Right knee pain after \"ligament injury\" years ago; recent re-injury 1 month. History: right knee pain MENISCI: There is a radial tear through the posterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the central weightbearing component of the articular cartilage of the medial femoral condyle without focal defect. There is irregularity of the articular cartilage of the lateral femoral condyle with multiple small focal partial-thickness defects. There are several small partial thickness tears of the patellar cartilage at the junction between the medial and lateral facets.LIGAMENTS: The ACL is not visualized, consistent with complete tearing. There are no secondary signs of ligamentous injury and the bone marrow signal appears normal, indicating subacute or chronic injury. The PCL, LCL, and MCL are intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact.ADDITIONAL", "output": "1. Nonvisualization of the ACL, consistent with subacute or chronic tearing.2. Radial tear through the posterior horn of the medial meniscus.3. Articular cartilage degeneration as described above."}
{"instruction": "Generate impression based on findings.", "input": "Male 17 years old Reason: eval for meniscal pathology History: L knee pain/clicking MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is edema in the tibial plateau anteriorly with what appears to be slight depression of the overlying bone which may represent a mild depressed fracture if there is a history of trauma. Remainder of the marrow is unremarkable. The articular cartilage is normalLIGAMENTS: The ACL, PCL, MCL, and lateral collateral complex are intact. However, there is mild edema superficial to the iliotibial band at, and just proximal to its insertion on Gerdy's tubercle.EXTENSOR MECHANISM: Extensor mechanism is intact.", "output": "1.Minimally depressed fracture of the anterior tibial plateau.2.Mild edema superficial to the iliotibial band and just proximal to its insertion on the greater tubercle."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question:Rule out cord compression. Signs and symptoms: Bilateral lower extremity weakness, urinary/stool incontinence, paresthesias of large toes. Non-enhanced total spine MRI:Examination is performed utilizing cord compression protocol and without axial images.Examination of thoracic and lumbar spine demonstrate normal anatomic alignment the vertebral column. No evidence of spinal canal compromise or stenosis at any level. No detectable mass effect on the cord or thecal sac at any level. There is normal signal intensity and caliber of cord. There is no detectable perispinal soft tissue abnormalities.Nonenhanced cervical MRI:Examination demonstrate normal anatomical alignment the vertebral column.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 is unremarkable.C4 -- C5 demonstrate mild degenerative changes and unremarkable otherwise.C5 -- C6 demonstrate moderate disk disease, loss of disk height and mild facet and ligamentum flavum degenerative changes. There is resultant significant bilateral neural foraminal compromise and moderate central spinal stenosis. Mild flattening and posterior displacement of the cord secondary to degenerative changes is noted.C6 -- C7 demonstrate moderate disk disease and loss of disk height and mild bilateral facet and ligamentum flavum degenerative changes. There is no spinal stenosis however moderate right and mild to moderate the left neural foraminal compromise is noted.C7 -- T1 demonstrate mild right neural foraminal compromise and unremarkable otherwise.", "output": "1.Nonenhanced MRI of cervical spine demonstrates degenerative changes at C5 -- C6 with resultant significant neural foraminal compromise and moderate central spinal stenosis. At C6 -- C7 moderate right and mild to moderate left neural foraminal compromise is noted. Unremarkable exam otherwise.2.Nonenhanced total spine MRI demonstrate no evidence of cord compression. Unremarkable sagittal only images of thoracic and lumbosacral spine."}
{"instruction": "Generate impression based on findings.", "input": "Achilles pain TENDONS: There is perhaps minimal thickening and increased signal intensity of the Achilles which may reflect minimal tendinosis but this is equivocal. There is distention of the retrocalcaneal bursa with fluid indicating bursitis and there is associated reactive edema in the underlying calcaneus. The flexor, extensor, and peroneal tendons are intact.LIGAMENTS: The anterior talofibular ligament appears slightly thinned but is otherwise intact. The calcaneofibular, posterior talofibular, and ligaments of the distal tibiofibular syndesmotic complex as well as the visualized portion of the deltoid ligaments are intact. There is a tiny focus of fluid signal intensity adjacent to the posterior talofibular ligament which may reflect a small ganglion.ARTICULAR SURFACES AND BONE: Aside from the reactive edema within the posterior calcaneus, the remaining marrow signal of the ankle is normal. There is no osteochondral lesion.", "output": "Retrocalcaneal bursitis with other findings described above."}
{"instruction": "Generate impression based on findings.", "input": "Patient with two days history of headaches with frontal neurologic signs, vertigo, sensory deficit, bilateral hand tingling, right cranial nerves 6 palsy, vertical nystagmus. CT of brain without and with infusion:No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.Subtle foci of low-attenuation in the periventricular white matter of bilateral hemispheres are not specific and non-enhancing. The findings considering patient's age are concerning for demyelinating disease. Possibility of stroke cannot be entirely ruled out. Follow up with a dedicated MRI of brain is recommended. There is no evidence of parenchyma volume loss. Cortical sulci and ventricular system remain within normal. No evidence of any abnormality of cortex is detected.On post infusion images no abnormal enhancement of brain parenchyma or leptomeninges is detected.Calvarium is intact. Mastoid air cells and limited view of paranasal sinuses are unremarkable.100 cc of Omnipaque 350 was utilized for the above study.", "output": "1.Periventricular foci of low attenuation without enhancement is concerning for demyelinating disease considering patient's age. Ischemic stroke or other etiologies cannot be entirely ruled out and further follow-up with an MRI is recommended.2.There is no abnormal enhancement on post infusion images.3.Calvarium, paranasal sinuses and mastoid air cells are unremarkable."}
{"instruction": "Generate impression based on findings.", "input": " MRI Brain:The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. Moderate periventricular and subcortical T2/FLAIR hyperintense foci, nonspecific and probably reflecting chronic small vessel ischemic disease. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Patchy right mastoid air cell opacification noted.MRA neck:Phase contrast technique is limited in evaluation of tortuous segments of the vasculature. There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is mild atherosclerosis of the carotid bifurcations, left greater than right. The carotid arteries are normal in course without evidence of significant steno-occlusive lesion. Both vertebral artery origins are patent. The vertebral arteries are co-dominant. There is no evidence of stenosis or occlusion.", "output": "1.Chronic small vessel ischemic disease. No evidence of acute ischemia.2.Within the limitations of a noncontrast MRA, there is no gross vascular compromise in the major neck arteries."}
{"instruction": "Generate impression based on findings.", "input": "Female, 81 years old, with history of atypical meningioma status post resection, with recent progressive left leg dysfunction causing gait disorder. Assess for cause of left leg dysfunction. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Specifically, cortical activation related to foot movement is seen bilaterally at the high paramedian vertex of the precentral gyri. The degree of cortical activation is, if anything, somewhat greater on the right than on the left.All tested language paradigms produced reliable language related cortical activation. On the sentence completion paradigm, language is left dominant with Broca's area identified predominantly along the pars orbitalis, and Wernicke's area is identified along the posterior aspect of the left superior temporal sulcus. On the verb generation and word generation paradigms, Broca's area remains best visualized along the left pars orbitalis. Wernicke's area, however, is much more prominently seen along the posterior aspect of the right superior temporal sulcus with only mild Wernicke's area activity detected on the left.", "output": "Functional assessment of sensorimotor cortical activation identifies the motor strip in its customary location. Cortical activation related to lower extremity/foot motion is seen bilaterally along the high paramedian precentral gyri. Cortical activation is, if anything, more robust on the right than on the left. This discrepancy can be technical in origin, though it can also reflect increased effort related to left leg dysfunction. Given this finding, and the fact that no impinging or compressing lesions are seen at the foot motor area, the etiology of the patient's left leg dysfunction may be more distal.Functional assessment of language reveals Broca's and Wernicke's areas in their expected locations of the inferior frontal and posterior temporal lobes respectively. On one out of the three tested paradigms, language is left dominant. However, on two of the three paradigms, substantial contributions are seen from the right hemisphere, and in particular, Wernicke's area is far more robustly activated on the right than on the left. Findings would suggest that language processing is somewhat more distributed between both cerebral hemispheres than what is typically seen."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Is there evidence of bleed. Signs and symptoms: Headaches. Non-infused CT brain:Examination demonstrates no evidence of intracranial hemorrhage.Patchy foci of nonspecific low-attenuation in the periventricular and subcortical white matter are present. Although nonspecific the findings are suspected for small vessel disease of indeterminate age. Further follow-up with an MRI is recommended. There is no evidence of edema, mass effect, midline shift or hydrocephalus.High density mass in the sella with extension superiorly into the basal cistern is concerning for pituitary macroadenoma. Dedicated MRI examination of the sella is also recommended for further evaluation. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.", "output": "1.Pituitary macroadenoma.2.Small vessel disease of indeterminate age.3.Follow-up with an MRI is recommended for above findings.4.No evidence of acute intracranial process."}
{"instruction": "Generate impression based on findings.", "input": "Male 59 years old History: atypical meningioma. Grade II meningioma status post resection in 2010 and again in 2016, as well as SRS. There are post-treatment findings related to right parietal craniotomy and radiation therapy. There is interval increase of dural based tumor in the treatment bed region. For example, a lesion along the right lateral parietal convexity measures up to 9 mm in thickness, previously 5 mm, a nodular dural based tumor along the posterior occipital convexity measures up to 10 mm, previously 5 mm, and tumor along the lateral occipital convexity with infiltration of the calvarium measures up to 12 mm in thickness, previously 8 mm. There is persistent high T2 signal and scattered areas of gyriform enhancement in the posterior parietal lobes near the midline, which is not significantly changed. There is no evidence of acute cerebral infarction. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is a partially-empty sella. The skull and extracranial soft tissues are unchanged.", "output": "1.Postoperative findings in the right parietal region with increase in size of multiple foci of residual tumor in the treatment bed. 2.Unchanged treatment effects in the bilateral posterior cerebral hemispheres likely related to radiation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " MRI BRAIN: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are mild bilateral punctate T2/FLAIR hyperintense foci within the periventricular and subcortical white matter as well as the pons most compatible with chronic small vessel ischemic disease. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There are moderate secretions within the maxillary sinuses with air-fluid levels, right greater than left. The mastoid air cells are clear.MRI ORBITS: There is ectasia of the optic nerves and optic nerve root sheaths. The optic chiasm and optic tracts appear normal. There is flattening of the optic discs. The extraocular muscles are normal and symmetric. The globes appear normal. No retinal detachment or vitreous clouding. The lacrimal glands are symmetric and within normal limits for size. No orbital mass lesion. Note is made of a partially empty sella with CSF signal within the pituitary fossa.", "output": "1.Limited exam as only precontrast images were obtained due to patient intolerance.2.Partially empty sella with ectasia of the optic nerves and optic nerve root sheaths as well as flattening of the optic disks. This constellation of findings can be seen in idiopathic intracranial hypertension (aka pseudotumor cerebri) in the appropriate clinical setting.3.Chronic small vessel ischemic disease. 4.Bilateral maxillary sinus opacification with air-fluid levels, right greater than left, similar to recent CT."}
{"instruction": "Generate impression based on findings.", "input": "Pain In Right Leg [M79.604] / Dorsalgia, unspecified [M54.9], Reason for Study: ^Reason: R/O compressed or irritated nerve root History: Right lateral leg pain numbness, originally starting in the lower back now mostly involving the leg For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. There is about 6mm sized renal cyst on the right kidney.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: disc dessication, Schmorl's node on the inferior endplate of the L1 vertebral body. minimal to mild facet joint hypertrophy (left worse than right). no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: disc dessication, bilateral ligamentum flavum thickening, no neuroforaminal narrowing. L4-L5: grade 1 anterolisthesis of L4 on L5 with pseudobulging of disc with disc dessication results minimal to mild spinal canal stenosis. There is 4.4mm x 9.7mm sized fluid filled lesion on the lateral aspect of the right L45 facet joint which may indicate degenerative change related synovial cyst.L5-S1: disc dessication with exuberant osteophytes on bilateral facet joints indicating degenerative facets bilaterally.", "output": "1. Grade 1 anterolisthesis of L4 on L5 with minimal to mild spinal canal stenosis at the level.2. Multilevel various degree degenerative changes of intervertebral discs and facet joints as described above including L45 right side synovial cyst."}
{"instruction": "Generate impression based on findings.", "input": "Female, 45 years old, with epilepsy. fMRI requested for mapping of language and motor function. Sensorimotor cortical activation maps as expected along the pre- and postcentral gyri.All of the tested language paradigms produced reliable language related cortical activation. Language is left dominant.Broca's area activity is identified within the left inferior frontal lobe, specifically the pars opercularis and pars triangularis. Wernicke's area activity is identified along the left superior frontal sulcus.", "output": "Technically successful functional MRI for presurgical planning. Sensorimotor cortical activity maps as expected along the pre- and postcentral gyri. Language-related activity is left dominant. Broca's area is identified at its customary location in the left inferior frontal lobe. Wernicke's area is identified at its customary location along the left superior temporal sulcus."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old male with urinary retention, lower extremity weakness and bowel incontinence. Evaluate for cord compression. Exam is limited by motion degradation. The spine may be scoliotic or this may be positional. There are findings compatible with multilevel degenerative changes involving much of the cervical spine with disc osteophyte complexes and facet degenerative changes. This results in at most moderate to severe spinal canal stenosis involving the C4-5 level which is likely chronic in etiology. Note however that cord signal abnormality cannot be fully evaluated on this limited exam. There are additional degenerative changes in the lumbar spine most prominently involving the L4-5 level where there a disc bulge and facet degenerative changes contribute to moderate spinal canal stenosis.", "output": "Multilevel degenerative changes causing up to moderate to severe spinal canal stenosis at the C4-5 level and moderate spinal canal stenosis at the L4-5 level. These findings are felt to be chronic in nature. If there is further concern, dedicated cervical spine MRI and lumbar spine MRI may be obtained on a nonemergent basis."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old man with prostate cancer. Biopsy showed 3+3 prostate adenocarcinoma in the right lateral base, right medial apex and left medial mid gland; 3+4 in the right lateral apex and left medial apex. PELVIS:PROSTATE:Prostate Size: 3.9 x 2.4 x 2.1 centimeters.Peripheral Zone: There is diffuse biliary appearance of the peripheral zone on T2-weighted images and evidence of extensive hemorrhage from previous biopsy. There is an 8 x 5 mm focus of T2 and ADC hypointensity in the left mid gland (series 4 lung, image 51) is suspicious for adenocarcinoma. This lesion may be continuous with another lesion extending to the base and straddling the peripheral zone and transitional zone measuring 14 x 10 mm (series 503, image 284). An additional smaller lesion in the right mid gland (series 4, image 54) may be an additional site of adenocarcinoma.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension.BLADDER: The bladder is moderately distended and without focal lesion.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: Bone marrow signal intensity is within normal limits for the patient's age.OTHER: No significant abnormality noted.", "output": "Foci of signal abnormality in the left mid gland extending to the base are suspicious for prostate adenocarcinoma. A smaller lesion in the right mid gland is also suspicious. No extracapsular extension or pelvic lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "History of chronic suppurative otitis media now with dizziness and headaches in the setting of possible chronic Lyme disease. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a left temporal lobe developmental venous anomaly. The brain parenchyma otherwise 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.Internal Auditory Canals: There is mild high T2 signal in the right mastoid air cells region. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable.", "output": "1. Mild scattered foci of T2 hyperintensity in the right mastoid air cells, which may represent a sequela of prior infection. However, assessment of the middle ear is limited on MRI and a temporal bone CT may be useful for further evaluation.2. Left temporal lobe developmental venous anomaly."}
{"instruction": "Generate impression based on findings.", "input": " There are unchanged posttreatment findings including right temporal occipital craniotomy with underlying resection cavity, associated foci of susceptibility effect, minimal residual linear enhancement, and unchanged moderate confluent T2 hyperintensity surrounding the resection cavity. There is no increased relative CBV in the postoperative region. There are no separate/new areas of suspicious enhancement. There is an unchanged punctate focus of high diffusion signal with corresponding high ADC signal and small slightly more prominent focus of high T2 signal in the right brachium pontis on series 401 image 7; there is slightly greater prominence of the high T2 signal focus in the right brachium pontis felt to represent evolving encephalomalacia from old tiny infarct. There is no acute infarct. The ventricles are unchanged with ex vacuo dilatation of the right occipital horn. There is no midline shift or herniation. There is mild unchanged T2 hyperintense signal in the right mastoid air cells. There is mild bilateral maxillary sinus mucosal thickening. The skull and extracranial soft tissues are otherwise unremarkable.", "output": "Stable postoperative findings without evidence of tumor progression."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Dawson is a 42-year-old woman with newly detected left breast mass. History of benign left breast biopsy in 2015 and benign right breast biopsy in 1992. Family history of breast cancer (mother, maternal grandmother, three paternalaunts). She presents for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Scattered enhancing foci are seen bilaterally, compatible with moderate background parenchymal enhancement, limiting the sensitivity of this examination. None of these foci are more suspicious than the rest. LEFT BREAST: There is a lobulated enhancing mass in the left breast near 9:00 position, measuring approximately 3.2 x 2.5 x 2.6 cm (AP x ML x SI). This mass correlates with the mass seen on recent diagnostic workup, including mammogram and ultrasound. There are innumerable T2 hyperintense non-enhancing cysts present. No additional abnormal enhancement is seen in the left breast. RIGHT BREAST: There are innumerable T2 hyperintense non-enhancing cysts present. No abnormal enhancement is seen in the right breast.AXILLA: No abnormal lymph nodes are identified in either axillary region.", "output": "(1) 3.2 cm lobulated enhancing mass in the left breast, corresponding to the findings seen on recent diagnostic workup. An ultrasound-guided biopsy of this mass was subsequently performed and will be reported separately.(2) No MRI evidence for malignancy in the right breast. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": " There is asymmetric prominence of the right cavernous sinus with pre-T1 and T2 images showing soft tissue signal along the medial aspect of the right cavernous sinus with asymmetrically smaller right cavernous carotid artery as compared to the left. This soft tissue enhances postcontrast and measures up to 10 x 6 mm on series 601 image 10. The overall appearance is without significant change.The pituitary gland is not enlarged. There is no abnormal enhancement within the pituitary gland or focal lesion. There is no mass effect on the suprasellar cistern or optic chiasm. The Meckel's caves are symmetric and normal in appearance. The imaged brain parenchyma elsewhere appears unremarkable.There is mild asymmetric ill-defined diffuse enhancement in the left frontal calvarial marrow, incompletely imaged, but probably unchaged. There is no discrete osseous marrow lesion identified. The pre-contrast T1 images show no discrete lesion in the incompletely imaged left frontal calvarium marrow.", "output": "1.No significant change in enhancing soft tissue thickening along the medial aspect of the right cavernous sinus with asymmetrically narrowed right cavernous carotid artery. Differential diagnosis includes meningioma, less likely a pituitary tumor, or perhaps even an anatomic variation.2.No additional discrete pituitary mass identified.3.Stable diffuse enhancement in the left frontal calvarial marrow which is incompletely imaged, favored to represent a benign process such as fibrous dysplasia. This can be further imaged on CT as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Hand is a 41-year-old female with a strong family history of breast cancer including maternal grandmother, paternal grandmother, mother, sister and maternal great aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is revisualization of three circumscribed enhancing masses, consistent with multiple benign fibroadenomata of both breasts. The mass in the right breast 3:00 position now measures 1.1 x 0.7 x 1 cm, previously measured 1.2 x 0.7 x 0.9 cm. The mass in the right breast 12:00 position now measures 1.1 x 0.7 x 0.9 cm, previously measured 1.0 x 0.7 x 0.7 cm, and is also stable. The mass in the left breast 8:00 position now measures 1.4 x 1.1 x 1.2 cm, previously measured 1.5 x 1.0 x 0.9 cm, stable from prior exam. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. Stable benign fibroadenomata of both breasts BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Left sided neck mass below mandible along SCM. US showed solid heterogenous mass. There is diffuse swelling and patchy T2 hyperintensity and enhancement of the left sternocleidomastoid muscle. There is no evidence of significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The imaged intracranial structures and orbits are unremarkable.", "output": "Findings suggestive of left fibromatosis colli."}
{"instruction": "Generate impression based on findings.", "input": "74 year old with history hypertension, coronary artery disease and congestive heart failure presenting after a recent ventricular fibrillation arrest. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 143 ml/m2 (normal range: 65+/-11), the LVEDV is 284 ml (normal range 109+/-23), the LV end systolic volume index is 114 ml/m2 (normal range 18+/-5), the LVESV is 226 ml (normal range 31+/-10), the LV mass index is 65 g/m2 (normal range 67+/-11), and the LV mass is 129 g (normal range 114+/-24). There is global hypokinesis with additional thinning and akinesis of the basal to mid inferior and inferoseptal walls. There is transmural late gadolinium enhancement involving most of the inferior and inferoseptal walls in a pattern consistent with prior myocardial infarction. These segments are unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 64 ml/m2 (normal range 69+/-14), the RVEDV is 127 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 80 ml (normal range 35+/-13). 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 mild 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. There is mild protruding atheroma in the descending aorta. 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 FindingsThere is mild bilateral atelectasis or consolidation at the base of the lungs. 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. Severe LV dilation with severely reduced systolic function (LVEF 20%).2. There is a transmural myocardial infarction involving much of the usual territory of the right coronary artery. This territory is unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable. 3. Normal RV size with moderately reduced systolic function (RVEF 37%).4. Severe left atrial dilation. 5. Mild protruding atheroma in the descending aorta. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 62 years old, with newly diagnosed base of tongue cancer, compare to outside. A bulky enhancing mass is evident involving the tongue base bilaterally measuring up to 40 mm when assessed in the transverse plane (image 31 series 12). This lesion extends into the floor of mouth bilaterally as well as into the left oral tongue and perhaps a small portion of the right oral tongue as well. The exact boundaries of this infiltrative spread are difficult to assess though the lesion potentially occupies a majority of the tongue. Ulceration of the left oral tongue is demonstrated. The lesion effaces the vallecula and is inseparable from the free edge of the epiglottis. No definite involvement of the supraglottic larynx is seen.Two left level Ib lymph nodes are subjectively prominent but they do not meet imaging criteria for pathologic enlargement. No additional pathologic adenopathy is detected. The salivary glands and thyroid are unremarkable. Bone marrow signal characteristics are unremarkable.", "output": "1.A large mass is evident centered on the tongue base but with extensive infiltration of the floor of mouth and oral tongue.2.No pathologic adenopathy is identified by size criteria."}
{"instruction": "Generate impression based on findings.", "input": "History of high-grade obstruction in the ileum status post clinical improvement. Retrocaval ureter with percutaneous nephrostomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No focal lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is normal in size and morphology without a discrete lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval improvement of right-sided hydronephrosis with a percutaneous nephrostomy catheter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The ileum is adequately distended with oral contrast. The jejunum is suboptimally distended.The small bowel fold pattern is unremarkable.The bowel is normal in caliber without wall thickening, abnormal postcontrast enhancement, or restricted diffusion.There is no surrounding inflammatory changes or fibrofatty proliferation.There is no evidence of persistent luminal narrowing or prestenotic/upstream dilatation to suggest a flow-limiting stricture.Nonspecific small mesenteric lymph nodes are present.No evidence of sinus tract or fistula formation.The colon is normal in appearance.No significant free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence of significant active small or large bowel inflammation. No flow-limiting stricture. No evidence of obstruction.Interval improvement in right-sided hydronephrosis with placement of percutaneous nephrostomy."}
{"instruction": "Generate impression based on findings.", "input": " The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. At C2-C3, there is no significant spinal canal or neural foraminal stenosis.At C3-C4, there is no significant spinal canal or neural foraminal stenosis.At C4-C5, there is a tiny central disk protrusion with annular fissure causing no significant spinal canal or neural foraminal stenosis.At C5-C6, there is a tiny central disk protrusion with annular fissure causing no significant spinal canal or neural foraminal stenosis.At C6-C7, there is a small central disk protrusion with annular fissure causing no significant spinal canal or neural foraminal stenosis.At C7-T1, there is no significant spinal canal or neural foraminal stenosis.", "output": "Tiny central disk protrusions with annular fissures causing no significant spinal canal or neural foraminal stenosis. Unremarkable exam otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Male, 21 years old. Right knee pain. MENISCI: The medial meniscus is intact. There is blunting of the anterior horn of the lateral meniscus which is consistent with a tear. The posterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is no bone marrow edema. The articular cartilage appears intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "Blunting of the anterior horn of the lateral meniscus consistent with a meniscal tear."}
{"instruction": "Generate impression based on findings.", "input": "Former football player with multiple concussions and memory issues, evaluate for structural changes. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, predominantly in the right posterior frontal corona radiata and in the pons consistent with moderate chronic small vessel ischemic changes. There is a focus of susceptibility measuring approximately 4 mm in maximum diameter along the left lateral aspect of the inferior medulla consistent with chronic hemorrhage and nonspecific. The ventricles and basal cisterns are prominent, compatible with mild global parenchymal volume loss which is appropriate for patient's age. There is no midline shift or herniation. There is prominent mineralization involving the basal ganglia which is of uncertain significance in this age group. The major cerebral flow voids are intact. There is mild diffuse paranasal mucosal thickening . The orbits, skull, and scalp soft tissues are grossly unremarkable.", "output": "1. Moderate chronic small vessel ischemic disease.2. Focus of chronic microhemorrhage in the left lateral medulla which is nonspecific in etiology. No other areas of hemorrhage or traumatic encephalomalacia.3. Mild global parenchymal volume loss which appears age-appropriate."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with knee pain, evaluate for AVN MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears within normal limits.There is extensive red marrow replacement sparing only the epiphyses of the distal femur and proximal tibia. Partially visualized heterogeneous signal abnormalities in the distal diaphysis of the femur and proximal diaphysis of the tibia likely represent bone infarcts.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps tendon and patellar tendons are intact.ADDITIONAL", "output": "Extensive red marrow replacement sparing the epiphyses and likely bone infarcts in the tibial and femoral diaphyses, as described above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: scaphoid fracture History: pain LIGAMENTS: Give the limitations of a non-arthrogram study, the scapholunate and lunotriquetral ligaments appear intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The articular disc of the triangular fibrocartilage complex appears intact, although there is increased signal intensity within the lamina of the triangular ligament at their ulnar styloid attachments which may reflect degeneration or degenerative tearing.TENDONS: There is mild thickening and increased signal intensity within the extensor carpi ulnaris tendon as it courses along the ulnar styloid suggesting mild tendinosis. The flexor and extensor tendons appear intact. BONES: There are small cysts within the dorsal portion of the lunate bone as well as within the capitate, likely degenerative in etiology.ADDITIONAL", "output": "1. No evidence of scaphoid fracture.2. Ganglion volar to the radioscaphoid articulation as described above.3. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "33 year old male with IBS, palpitations, PVCs and recent fatigue and RV dysfunction. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%. The LVEDV is 134 ml (normal range 142+/-34), the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVESV is 70 ml (normal range 47+/-19) and the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9). The LV mass is 96 g (normal range 164+/-36) and the LV mass index is 56 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%. The RVEDV is 144 ml (normal range 142+/-31), RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVESV is 72 ml (normal range 54+/-17), and the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9). No focal RV aneurysm or wall motion abnormality. No evidence of fibro-fatty infiltration. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, 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 imaging indicated, a separate dedicated evaluation should be considered.", "output": "1. Normal left ventricular size with mildly reduced systolic function (LVEF 48%). No evidence of underlying myocardial fibrosis inflammation or infiltration.2. Normal right ventricular size and systolic function (RVEF 50%) without evidence focal aneurysm or wall motion abnormality. No evidence of underlying right ventricular fibrofatty infiltration. No CMR evidence of arrhythmogenic right ventricular dysplasia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Seizure and recent resection of a brain metastasis. There has been recent resection of the right temporal lobe mass with intrinsically T1 hyperintense blood products within the resection cavity, but no residual enhancing tumor. There is persistent extensive surrounding vasogenic edema. There is no significant change in the hemorrhagic heterogeneously enhancing mass in the left parietal lobe that measures up to 32 mm with extensive vasogenic edema. There slight midline shift to the left. The ventricles are unchanged in size and configuration. There are a few scattered punctate nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute infarction. There is trace fluid signal within the mastoid air cells. There are subcentimeter cystic lesions in the skin of the right temporal scalp and bilateral cheeks, which may represent epidermoids.", "output": "1. Recent resection of the right temporal lobe mass without evidence of residual enhancing tumor, although there is persistent extensive surrounding vasogenic edema.2. Unchanged hemorrhagic mass in the left parietal lobe with extensive vasogenic edema. "}
{"instruction": "Generate impression based on findings.", "input": "Male 56 years old Reason: Outside scan shows 4 cm lesion in left lobe near falciform ligament, 1 cm lesion near gallbladder History: HCV and ETOH cirrhosis ABDOMEN:LIVER, BILIARY TRACT: The liver has an advanced cirrhotic morphology with widened fissures and hypertrophy of the caudate. 1.1 cm hypervascular lesion in segment 5 of the liver on image 153/series 3 is stable. The lesion does not show washout on delayed imaging. However, the lesion shows abnormal signal characteristics on diffusion-weighted imaging.Within the left lateral segment of the liver there is a hypervascular lesion measuring 3.0 cm on image 154/series 13. This lesion also does not show washout. There is a prominent vessel within this lesion. Hepatic and portal veins are patent. Gallbladder contains multiple stones.SPLEEN: Spleen is enlargedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst.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": "1.1.1 cm segment 5 lesion which shows enhancement but no washout. It does not meet the criteria for HCC but remains suspicious.2.Left hepatic lobe lesion is hypervascular without washout. There is prominent vessel within the lesion and the lesion may be due to the shunt. This can be followed on subsequent imaging to evaluate for change.3.Cholelithiasis"}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male patient with history of pancreatic neuroendocrine tumor status post resection and subsequent peripancreatic fluid collection formation. Evaluate collections. ABDOMEN:LIVER, BILIARY TRACT: There is a segment 6/7 hemangioma.SPLEEN: There are multiple splenic cysts. PANCREAS: The lesser sac peripancreatic fluid collection measures approximately 6.9 x 4.4 cm, previously 7.8 x 4.4 cm when compared to the 12/16/2015 CT (image 17, series 9). The collection is changed slightly in orientation now along the more distal and lateral aspect of the pancreas. No suspicious enhancing pancreatic lesion is identified. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A left parapelvic cyst is increased in size measuring 8.1 x 5.6 cm.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": "Slightly decreased size of a lesser sac peripancreatic fluid collection compared to the most recent CT."}
{"instruction": "Generate impression based on findings.", "input": "Male 16 years old Reason: f/u OCD lesion s/p microfracture History: pain MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There are postsurgical changes related to prior microfracture within the articular cartilage of the lateral femoral condyle, above the anterior horn of the lateral meniscus, with associated new cartilage formation.LIGAMENTS: The posterior and anterior cruciate ligaments are intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "Postoperative findings related to prior microfracture for an osteochondral defect in the lateral femoral condyle as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male patient with HCC. Assess liver lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable. The hepatic vasculature is patent.The right hepatic dome lesion measures approximately 1.9 x 1.4 cm (image 31, series 11) and contains heterogeneous proteinaceous/hemorrhagic products. An adjacent peripheral wedge-shaped area of T2 hyperintensity which enhances without washout is likely post treatment related, unchanged.The segment six lesion cavity measures 3.7 x 2.7 cm (image 250, series 11) and contains heterogeneous proteinaceous/hemorrhagic products. There is no suspicious marginal enhancement.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral cysts are unchanged. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left superior lumbar fat-containing hernia.OTHER: No significant abnormality noted.", "output": "1.Post-ablation changes of the right hepatic dome and segment 6 without evidence of marginal recurrent or residual disease.2.Cirrhotic liver morphology without new suspicious lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Poorly differentiated lung adenocarcinoma with a solitary brain metastasis resected on 7/20/2011. There are post-treatment findings in the left frontal lobe region. There is unchanged patchy T2 hyperintensity surrounding the treatment bed and diffusely elsewhere in the cerebral and pontine white matter without associated abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles 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 unchanged.", "output": "Stable post-treatment findings without evidence of tumor recurrence."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with periosteal bone formation seen on recent radiograph No evidence of fracture is visualized. There is patchy red marrow signal within the proximal femurs and pelvis. A lobulated fluid collection extends within the iliopsoas bursa. A small amount of fluid is also present within the joint. There is moderate joint space narrowing, consistent with moderate osteoarthritis. Foci of subchondral signal abnormality in the femoral head are considered likely degenerative in etiology. There is no evidence of avascular necrosis. The labrum is poorly visualized on this non-arthrographic exam.", "output": "1. Moderate degenerative changes as described above without fracture or dislocation.2. Left iliopsoas bursa fluid collection and small amount of fluid within the hip joint. Note that in approximately 15% of asymptomatic patients the iliopsoas bursa communicates with the joint. "}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with history of malignant neoplasm of the prostate. PELVIS:PROSTATE:Prostate Size: 4.5 x 3.5 x 4 cm (TR x AP x CC)Peripheral Zone: Extensive lobulated decreased T2 signal intensity within the left peripheral zone. Crossing the midline at the mid gland apex, there is a 2.8 x 1.5 cm T2 hypointense lesion (axial series 901 images of 14-15). This broad-based lesion abuts the capsule, and neurovascular invasion is suggested (axial series 901 image 17). Postcontrast imaging is noncontributory.The right mid peripheral zone demonstrates amorphous linear appearing T2 hypointense signal intensity, and posterolateral capsular invasion is also suspected.Central Gland: No significant abnormality.Seminal Vesicles: Suspicious low T2 signal intensity of the left seminal vesicle.Extracapsular Extension: As above.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent inguinal and sidewall lymph nodes, nonspecific. A left inguinal lymph node measures 1.6 cm (axial series 1601 image 387), and a left external iliac measures 0.9 cm (axial series 1601 image 398).BONES, SOFT TISSUES: Mottled marrow signal intensity that is low on T1 and T2 of the pelvis that is most evident in the bilateral inferior pubic rami (axial series 801 image 4; axial series 901 image 4) and bilateral iliac wings (coronal series 701 image 24).OTHER: No significant abnormality noted.", "output": "1.MRI findings compatible with extensive disease in the mid peripheral zone as described above.2.Mottled low signal intensity of the bone marrow on both T1 and T2. A review of the medical record indicates a history of thalassemia, which is compatible with these findings. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out structural cause for gait instability and nystagmus. Signs and symptoms: As above. Nonenhanced brain MRI:Diffusion-weighted images are severely limited due to extensive left-sided paramagnetic artifact obscuring significant portion of the hemisphere. Beyond the region of artifact no evidence of restricted diffusion. There is also partial effacement of the images on flair and susceptibility MRI series due to left-sided metallic artifact (patient known to have a shrapnel in the face).Examination demonstrates a tiny single focus of nonspecific flair hyperintensity in the right frontal centrum semiovale without enhancement. The finding has questionable clinical significance.The anatomical morphology and signal intensity to brain remains otherwise entirely within normal on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of all major intracranial arterial branches are well visualized and unremarkable. The signal intensity of intracranial venous sinuses are beginning normal.Visualized calvarium and soft tissues of the scalp as well as orbits are unremarkable. Partially visualized paranasal sinuses demonstrate normal pneumatization signal pattern.", "output": "1.Metallic fragment/shrapnel in the left facial region results in diffuse artifact obscuring part of the left hemisphere as detailed.2.Within this limitation this examination is unremarkable. Please see above comments. If there are prior studies available and submitted to radiology department an addendum to this report could be submitted after comparison."}
{"instruction": "Generate impression based on findings.", "input": "Foot pain, possible mass Ankle/hindfoot: TENDONS: There is mild increased signal within the peroneus brevis tendon as it courses below the tip of the fibula likely suggesting mild tendinosis and perhaps interstitial tearing. However there is no surrounding tenosynovitis and these findings may not necessarily be of any current clinical significance. The remaining tendons of the ankle are intact.LIGAMENTS: Calcaneofibular ligament appears thickened, possibly from prior sprain. The posterior talofibular ligament also appears slightly thickened which may also reflect prior injury. There is a small lobulated collection of fluid adjacent to the posterior fibers of the posterior talofibular ligament which may represent a small ganglion. The remaining visualized ligamentous structures of the ankle are unremarkable.ARTICULAR SURFACES AND BONE: A small lobulated focus of abnormal signal intensity is noted within the distal fibula and may represent a small cartilaginous rest. There is mild osteoarthritis of the tibiotalar joint with focal cartilage degeneration along the medial aspect of the joint. Increased marrow signal within the medial talar dome may represent a subchondral cyst. ADDITIONAL", "output": "1. Healing fracture of the base of the fifth metatarsal.2. Fourth metatarsal lesion further detailed above may represent an enchondroma now with resolution of the surrounding marrow edema seen on the prior exam.3. No evidence of soft tissue mass within the hindfoot or forefoot.4. Mild tibiotalar osteoarthritis and other ankle findings described above."}
{"instruction": "Generate impression based on findings.", "input": "78-year-old male with a gait disorder and traumatic SAH and question of NPH. MRI brain: There is susceptibility effect along the right anterior lateral temporal convexity and frontotemporal operculum compatible with prior subarachnoid hemorrhage as seen on CT. There is also evidence of trace subdural hematoma along the right frontotemporal convexity without mass effect and probably present on prior CT although difficult to appreciate due to its size.Again demonstrated is moderate periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. No evidence of acute infarct. There is lateral ventricular and focal areas of sulcal prominence which appear slightly disproportional to the degree of volume loss and could indicate a communicating hydrocephalus/NPH pattern. There is no abnormal parenchymal or meningeal enhancement aside from along the right cerebral convexity which may be reactive to the trace subdural hematoma. No intracranial mass or mass effect. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal scattered paranasal sinus mucosal thickening and a right maxillary sinus mucus retention cyst.MRI C-spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Interspace observations:C2-3: Mild right greater than left facet hypertrophy. No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex which contacts the ventral cord. Mild facet arthropathy with mild left neuroforaminal narrowing. No right neuroforaminal narrowing or spinal canal stenosis.C4-5: Small disc osteophyte complex which contacts the ventral cord. Mild facet arthropathy. Mild left neuroforaminal narrowing. No right neuroforaminal narrowing or significant spinal canal stenosis.C5-6: Disc osteophyte complex which mildly indents the ventral cord and ligamentum flavum thickening contributing to minimal spinal canal narrowing. Mild left greater than right facet and uncovertebral hypertrophy. Mild/moderate left neural foraminal narrowing. No right neural foraminal narrowing.C6-7: Mild facet hypertrophy and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.", "output": "1.Trace subarachnoid and subdural hemorrhage along the right frontotemporal convexity grossly similar to prior CT allowing for slight differences in technique. No intracranial mass or abnormal enhancing lesions.2.Ventricular enlargement which appears slightly disproportional to the degree of volume loss and raises possibility of communicating hydrocephalus/NPH in the appropriate clinical setting.3.Moderate chronic small vessel ischemic disease.4.No cord signal abnormality or significant spinal canal stenosis in the cervical spine at any level.5.Multilevel degenerative changes in the cervical spine with small disc osteophyte complexes at multiple levels which contact the ventral cord. There is however no significant spinal canal stenosis overall at any level or cord signal abnormality. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Medial joint pain MENISCI: There is attenuation of the posterior horn of the medial meniscus which may reflect changes of prior partial meniscectomy versus chronic attritional tearing. There is branching intermediate signal of the posterior horn of the medial meniscus which extends to both the tibial and femoral articular surfaces compatible with tear although this could also represent residual intrasubstance degenerative signal following meniscectomy. We suspect there is at least undersurface tearing of the posterior horn, however. There is mild medial extrusion of the body of the medial meniscus which also appears attenuated. The anterior horn of the medial meniscus is intact.There is attenuation of the posterior horn of the lateral meniscus which again may reflect changes of prior partial meniscectomy or chronic attritional tearing. There is obliquely and vertically oriented intermediate signal within the posterior horn which extends to the tibial articular surface which we suspect represents undersurface tearing although could represent residual intrasubstance degenerative signal following partial meniscectomy.ARTICULAR CARTILAGE AND BONE: There is moderate to severe degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle posteriorly with areas of full-thickness cartilage loss. A small focus of degenerative subchondral signal intensity is seen within the medial tibial plateau with mild degeneration of the overlying articular cartilage. There is moderate degeneration of the articular cartilage of the lateral compartment with full-thickness cartilage loss along the lateral femoral condyle and lateral tibial plateau adjacent to the posterior horn of the lateral meniscus. There is moderate degeneration of the articular cartilage of the patellofemoral joint. There are tricompartmental osteophytes.LIGAMENTS: The patient has undergone ACL reconstruction. Graft fibers can be traced from the femoral interference screw to the tibial interference screw and the graft itself is slightly ill-defined with intermediate signal intensity representing degeneration. Additional adjacent intermediate-low signal intensity is thought to represent scarring. Degenerative signal intensity is also seen within the lateral collateral ligament proximally with the remaining major ligaments intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Medial and lateral meniscus abnormalities as described above likely represent a combination of postmeniscectomy changes and degenerative tearing.2. Surgical changes of ACL reconstruction with intact graft showing features of degeneration and adjacent scarring.3. Osteoarthritis further detailed above; loose body noted within a Baker's cyst."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male with a history of orthotopic liver transplant 11/05 with prior hepatic abscess, and biliary anastomotic stricture. Follow up evaluation of biliary stricture and hepatic abscess. ABDOMEN:LIVER, BILIARY TRACT: Note is made of diffuse low T2 signal abnormality affecting the liver and spleen with associated loss of signal intensity on in phase sequences, consistent with secondary hemosiderosis. There is moderate dilation of the right posterior segmental branch of the intrahepatic biliary system. The remainder of the intra-and extrahepatic biliary system is normal in appearance. Percutaneous biliary drain in place.No focal mass lesions are identified, however, lack of intravenous contrast limits evaluation of solid organs.SPLEEN: Note is made of diffuse low T2 signal abnormality affecting the liver and spleen with associated loss of signal intensity on in phase sequences, consistent with secondary hemosiderosis. 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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Focal biliary ductal dilation of the right posterior segmental branch of the intrahepatic biliary system.2.Findings consistent with hemosiderosis of the liver and spleen."}
{"instruction": "Generate impression based on findings.", "input": "Right lower quadrant pain in a pregnant patient. 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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Gravid uterus with 3 fetuses noted. Please note that this study was not performed for the detailed evaluation of the fetuses. Oval soft tissue structure in the region of the right adnexa with several follicles likely represents a normal ovary measuring approximately 3.8 cm. There is minimal fluid in the right lower quadrant. On the coronal series #3 there appears to be a blind-ending tubular structure originating from the cecum which likely corresponds to the appendix which is normal in caliber without adjacent inflammatory changes.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": "No specific findings to account for the patient's right lower quadrant pain. Please note that this study was not performed for the detailed evaluation of the fetuses."}
{"instruction": "Generate impression based on findings.", "input": "Female 29 years old; Reason: Pt Pregnant. R/O appendicitis History: abd pain, N/V ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. No biliary ductal dilatation. Gallbladder is not distended.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. The appendix is not identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Cystic area within the uterus likely represents the gestational sac. Exophytic fibroid noted in the right uterine body.Right ovary is enlarged measuring 6.4 x 5.9 cm with a large cyst measuring 3.5 cm and multiple peripherally located follicles. Vascular pedicle is thickened.There is fluid adjacent to the right ovary. The left ovary is normal in size with multiple small scattered follicles.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": "1.Findings suspicious for right ovarian torsion. Correlate with pelvic sonography."}
{"instruction": "Generate impression based on findings.", "input": "Confusion, evaluate for progression or recurrence of cerebellar cavernoma. There are post-surgical changes of a prior suboccipital craniotomy with underlying resection of a left anteromedial cerebellar cavernous malformation. There is a mild amount of residual hemosiderin staining at the resection cavity. Redemonstrated is a prominent adjacent developmental venous anomaly. The remainder of the brain demonstrates no new cavernous malformations, or other mass or mass effect. There is mild hypoplasia involving the inferior cerebellar vermis. Brain parenchyma is otherwise unremarkable for age. There is no restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Sella and orbits are within normal limits. The paranasal sinuses and mastoid air cells are clear.", "output": "Post-surgical findings of suboccipital craniotomy for resection of a left anteromedial cerebellar cavernous malformation are again seen. Small resection cavity demonstrates slight evolution but is otherwise unchanged including mild amount of adjacent parenchymal hemosiderin staining. No new cavernous malformations."}
{"instruction": "Generate impression based on findings.", "input": "Male, 29 years old, history of neurofibromatosis type I with intermittent severe pain in the right arm. Extensive plexiform neurofibroma formation is seen along all of the cervical nerve roots including throughout the brachial plexi. The right brachial plexus is more extensively involved than the left. Bilateral heterogeneous masses are present within the apical thoraces with resultant inferior displacement of the lung apices. The mass on the left measures up to 60 mm, and the mass on the right measures up to 42 mm. A scoliotic deformity of the cervicothoracic junction is evident at the level of the apical masses.Numerous additional small tumors are evident within the mediastinum, deep spaces of the neck, and even perhaps the left laryngeal folds. The trachea is deviated to the left and mildly narrowed secondary to paratracheal tumor at the level of the thoracic inlet. Numerous cutaneous and subcutaneous nodules are evident.", "output": "Extensive plexiform neurofibroma formation throughout the brachial plexi affecting the right side more than the left.Large bilateral apical thorax masses are seen. Given their heterogeneous appearance and disproportionate size relative to the other visualized neurofibromas, the possibility of malignant degeneration should be considered. Correlation with prior imaging if available would be helpful.Numerous additional small neurofibromas are evident within the cutaneous and subcutaneous tissues as well as the deep spaces of the neck."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old male with chronic pancreatitis and new onset right lower quadrant pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Numerous calcifications are scattered throughout the pancreas, compatible with chronic pancreatitis.A 14 x 9 cm cystic lesion is seen at the junction of the body/tail of the pancreas (series 3, image 41) with possible associated calcifications, unchanged from recent MRI.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is not definitively visualized. No right lower quadrant inflammatory changes are visualized.A tubular, blind ending structure (series 3, image 114) arises off the distal ileum, compatible with a Meckel's diverticulum. No adjacent inflammatory changes are visualized.Mild diffuse haziness of the mesentery is seen, not significantly changed.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace free fluid in the pelvis, unchanged.", "output": "Meckel's diverticulum without adjacent inflammatory changes. Nonvisualized appendix without inflammatory changes in the ileocecal region to suggest appendicitis.Cystic lesion in the pancreas, unchanged from MRI from 7/15/09. In retrospect, this is compatible with a side branch IMPN. Follow-up MRI may beneficial."}
{"instruction": "Generate impression based on findings.", "input": "Knee pain. Heard popping this morning Severe degenerative changes are observed largely the medial compartment however changes are tricompartmental. On bone narrowing, sclerosis and osteophytes with subchondral cyst are noted. A large suprapatellar calcification and moderate effusion are also observed suggesting free loose body within the joint, this ovoid finding measures over 3 cm in length. No immediate superimposed acute abnormality, however MRI may be needed if internal derangement is now suspected.", "output": "Severe osteoarthritic changes with suspected loose body and effusion, however no superimposed acute osseous abnormality observed"}
{"instruction": "Generate impression based on findings.", "input": " For numbering purposes, there are total of 5 lumbar type vertebral bodies. There is minimal anterolisthesis of L4 on L5. Otherwise the alignment is anatomic. Foci of T1 and T2 hyperintensity in the L3 and L4 vertebral bodies are suggestive of hemangiomas. Vertebral body heights are preserved.The conus is normal in signal and morphology and terminates at L1-L2 level. The visualized intra-abdominal and paraspinal contents are unremarkable.There is mild desiccation of L2-L3, L3-L4, and L4-L5 intervertebral discs with no significant loss of height.T12/L1: No significant spinal canal or neural foraminal stenosis.L1/2: No significant spinal canal or neural foraminal stenosis.L2/3: There is a small right paracentral disc protrusion with no significant spinal canal or neural foramina stenoses.L3/4: There is a moderately sized left foraminal disc protrusion, resulting in severe left neural foraminal stenosis and probable impingement of the exiting nerve root. Additionally, there is mild facet joint hypertrophy bilaterally resulting in mild right neural foraminal stenosis. No significant spinal canal stenosis present.L4/5: There is a central disc protrusion and bilateral facet joint arthropathy and edema resulting in moderate spinal canal stenosis and severe left neural foraminal stenosis with possible nerve impingement and moderate-to-severe right neural foraminal stenosis.L5/S1: Mild facet joint hypertrophy, left greater than the right, resulting in mild left neural foraminal narrowing with no significant spinal canal stenosis.SI Joints: No significant abnormalities.", "output": "1.Left foraminal disc protrusion at the L3-L4 level, resulting in severe left neural foraminal stenosis and possible nerve impingement at this level.2.Central disc protrusion at L4-L5 which, with posterior element degeneration, contributes to a moderate generalized spinal canal stenosis. Facet arthropathy contributes to significant left foraminal narrowing at this level with possible nerve root impingement."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent breast cancer with headache/blurring of vision. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is left maxillary sinus mucosal thickening.", "output": "No evidence of intracranial metastases."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with heel pain and overlying violaceous skin discoloration and rash. Question of fat necrosis following cortisone injection. Evaluate calcaneal fat pad and plantar fascia. TENDONS: The flexor and 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 are normal in appearance.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. ADDITIONAL", "output": "Increased signal abnormality and thickening within the medial plantar aponeurosis suggesting a plantar fasciitis, although superimposed infection cannot been excluded by this examination. Nonspecific soft tissue edema along the plantar aspect of the calcaneus."}
{"instruction": "Generate impression based on findings.", "input": "History of elevated liver function tests. Evaluation limited by patient motion, body habitus, and lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly. There are a myriad rounded as well as geographic sites of increased T2 signal throughout the liver with interposed reticular or linear relatively decreased T2 signal, uncertain . The largest of the lesions do not appear to show restricted diffusion (no low ADC signal corresponding to the increased DWI signal observed) but difficult to exclude smaller sites of restricted diffusion. The gallbladder is collapsed. No gross biliary ductal dilatation, though MRCP images are heavily degraded by motion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is a nonspecific left adrenal nodule measuring 2.0 x 2.1 cm which is incompletely characterized due to lack of T1 in/out of phase and postcontrast imaging.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse signal abnormality of the visualized osseous structures compatible with metastases. There is apparent associated narrowing of the spinal canal in the lumbar spine. Scattered body wall edema.OTHER: Scattered mild abdominal pelvic ascites.", "output": "1.Limited and truncated examination.2.Hepatomegaly with diffuse hepatic signal abnormality as described above, appearance may be due in part to prior receipt of treatment (correlation with patient's clinical history recommended), difficult to include active metastatic disease. PET and/or contrast-enhanced CT using liver protocol may be considered for additional evaluation.3.Widespread osseous metastatic disease. Associated narrowing of the spinal canal in the lumbar spine which could be further evaluated with dedicated imaging if clinically warranted.4.Incompletely characterized left adrenal nodule.5.Small abdominopelvic ascites."}
{"instruction": "Generate impression based on findings.", "input": "Fall. History of stroke. The study is limited by patient motion.Cervical spinal alignment is notable for partial straightening which may relate to patient positioning. The vertebral bodies are preserved in height. There is mild multilevel degenerative marrow signal abnormality subjacent to the endplates, most pronounced at C3-C4, but no suspicious marrow abnormality. This is associated with multilevel loss of disc height and T2 signal, most pronounced at C5-C6 and C7-T1, where it is moderate. Multilevel shallow ventral indentations of the thecal sac are also present as described below, but there is no significant spinal canal stenosis. The cervical spinal cord shows normal morphology and signal, accounting for motion. There are secretions along the posterior nasopharyngeal/oropharyngeal wall but no abnormal soft tissue signal in the prevertebral soft tissues. There is also a small catheter extending from the esophagus below reaching superiorly to the lower most nasopharynx along posterior pharyngeal wall to the right of midline. It is not visible above this level but this may relate to the lack of fluid within the catheter lumen.C2-C3: No significant degenerative disc disease or spinal canal stenosis. Minimal left neural foraminal stenosis by uncovertebral arthropathy.C3-C4, C4-C5, C5-C6: Flattening of the anterior thecal sac by disc-osteophyte complex but no significant spinal canal stenosis. Mild bilateral neural foraminal stenosis by uncovertebral and facet arthropathy.C6-C7: No significant additional disc disease or spinal canal stenosis. No significant neural foraminal stenosis.C7-T1: Flattening of the anterior thecal sac by disc-osteophyte complex. Left more than right uncovertebral and facet arthropathy and moderate left neural foraminal stenosis.", "output": "1.Multilevel degenerative cervical spondylosis is relatively mild and results in no significant spinal canal stenosis. 2.There is moderate left C7-T1 foraminal stenosis. There is no or mild foraminal stenosis at the other levels as described above.3.The catheter in the esophagus is not visible by MRI above the soft palate which may be related to the lack of fluid within the catheter lumen. The possibility of malposition or retained tube across the oropharynx to upper esophagus would be better assessed clinically. Dr. Monther Qandeel discussed the above findings and recommendations with the NeuroICU residents (including Dr. Robin A Buerki) over the phone on 1/7/2016 at 1400 hours."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up regarding neck abscesses. Please evaluate soft tissues of the neck for fistulous tracks. There postoperative findings related to prior incision and drainage in the left neck soft tissues. There is no evidence of residual fluid collections in the neck. There is asymmetric effacement of the left piriform sinus. There is now normal alignment of the cervical spine. There is no significant lymphadenopathy. The major salivary glands are unremarkable. The imaged intracranial structures are unremarkable. The imaged portions of the mediastinum and lungs are unremarkable.", "output": "Postoperative findings related to left neck incision and drainage of an abscess, without evidence of residual fluid collections. However, a collapsed fistula related to an underlying branchial cleft anomaly cannot be entirely excluded. Therefore, an image-guided fistulogram may be useful for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent CNS lymphoma with headache and lethargy. There are postoperative findings in the left cerebellar hemisphere. The limited sequences suggest the presence of mass lesions with relatively restricted diffusion within the anterior right temporal lobe, right posterior corpus callosum, and perhaps the right corona radiata, with extensive surrounding vasogenic edema. There appears to be mild right uncal herniation, but no significant midline shift.", "output": "The limited exam shows evidence of central nervous system lymphoma involving the anterior right temporal lobe, right posterior corpus callosum, and perhaps the right corona radiata, with extensive surrounding vasogenic edema."}
{"instruction": "Generate impression based on findings.", "input": "66 year old man referred to evaluate aorta, aortic valve, and to rule out ischemia as a cause of his shortness of breath and chest pain. First Pass PerfusionDuring hyperemia, there is a nearly circumferential perfusion defect involving the basal, mid-ventricular, and apical slices. During resting conditions, no perfusion defect is noted. These findings are consistent with either multivessel coronary artery disease or microvascular dysfunction. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 66 ml/m2 (normal range: 74+/-15), the LVEDV is 150 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 62 ml (normal range 47+/-19), the LV mass index is 56 g/m2, and the LV mass is 131 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 173 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 87 ml (normal range 54+/-17).Right AtriumThe right atrium is moderate dilated.Aortic ValveThe aortic valve is anatomically trileaflet; however, the right and non-coronary cusps are partially fused together and heavily calcified. There is evidence of poor leaflet excursion and flow acceleration through the aortic valve consistent, with aortic valve stenosis. Correlation with echocardiography is suggested to better quantify the severity. There is mild aortic regurgitation (RF 5%).Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. No thoracic aortic aneurysm, dissection, or coarctation is noted. Sinus of Valsalva: 36x37x38mmST Junction: 32x34mmAscending Aorta: 33x34mmPulmonary 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 FindingsBilateral renal cysts are noted. 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. There is a global circumferential perfusion defect present during stress consistent with either multivessel coronary disease or extensive microvascular disease.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 59%).4. Normal RV size and systolic function (RVEF 50%).5. The aortic valve is anatomically trileaflet; however, the right and non-coronary cusps are partially fused together and heavily calcified. There is evidence of poor leaflet excursion and flow acceleration through the aortic valve consistent, with aortic valve stenosis. Correlation with echocardiography is suggested to better quantify the severity. 6. No evidence of aortic dilation, dissection, or coarctation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "History of L3-L4, L4-L5 fusion. L1-L2 cyst. Evaluate for change in cyst size or abnormality. Right-sided low back pain. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment is grossly within normal limits, aside from perhaps minimal L4 on L5 anterolisthesis. Bone marrow signal is benign. The conus medullaris is normal in position. Postoperative changes of prior surgical fusion from L3 to L5 are again seen. Bilateral paraspinous rods, pedicle screws, and interbody grafts were better assessed on recent CT, which showed bony bridging.Susceptibility artifact from hardware slightly limits exam. Mild multilevel degenerative changes are seen including disc desiccation. Individual levels as below: L1-L2: There is approximately 5 x 6 x 7 mm lesion with T2 hyperintensity and peripheral enhancement involving the dorsal epidural soft tissues to the right of the midline abutting the ligamentum flavum. The lesion projects anteriorly with mild mild effacement of the dorsal thecal sac. Mild facet arthropathy with surrounding enhancement. There is also mild edema involving the right pedicle/transverse process junction.Disc desiccation and mild disc bulge also seen. Overall no significant central canal stenosis. Neural foramina are patent.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. Moderate bilateral facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Advanced bilateral facet arthropathy. Artifact related to hardware limits assessment; however previously seen synovial cysts on the left are not clearly appreciated and presumably have decreased in size.Mild degenerative changes at the sacroiliac joints also noted.", "output": "1. Subcentimeter benign-appearing cystic structure involving the right dorsal epidural space at the L1-L2 level which is not seen on preoperative imaging from 2/14/2015. Finding is favored to represent a synovial cyst. There is mild facet arthropathy at this level with enhancement which is likely on a degenerative basis. Ligamentum flavum cyst or perhaps residual chronic blood products related to prior intervention are other less likely differentials. There is mild indentation of the right dorsal aspect of the thecal sac without significant central canal stenosis overall at this level.2. No significant spinal canal or neural foraminal stenosis. Multilevel facet arthropathy, advanced at the bilateral L5-S1 level."}
{"instruction": "Generate impression based on findings.", "input": "37 years Male (DOB:7/22/1978)Reason: evaluate for progression of NMO History: tingling of the feet bilaterally PROVIDER/ATTENDING NAME: DAVID A HARTER RIMAS V LUKAS MRI thoracic spine:An enhancing T2 hyperintense lesion is present within the thoracic spinal cord. The T2 hyperintensity extends from the T1-T2 level to the T6 vertebral level. The enhancing component extends from the T2-3 disc space level to the T4-5 disc space level. It is located centrally within the spinal cord.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is disc desiccation at T7-8 and T8-9.Sagittal images of the cervical spine demonstrate a broad-based central disc protrusion at C3-4.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.There is enhancing lesion present within the central portion of the upper thoracic spinal cord with adjacent edema. There are no other lesions appreciated within the spinal cord. Differential considerations include neoplasm and inflammatory lesion. Given the clinical history of NMO demyelinating plaque is certainly in the differential diagnosis."}
{"instruction": "Generate impression based on findings.", "input": "Assess for abscess versus hematoma of tongue: Left-sided tongue pain and swelling; ESBL E coli of buccal mucosa treated with 3 wks IV ertapenem (9/2015). There is now diffuse T2 hyperintensity and swelling with areas of relatively lower T2 signal within the left oral tongue and tongue base with extension into the submandibular space, floor of the mouth and buccal mucosa region. The mandible bone marrow signal appears to be unremarkable. There does not appear to be significant lymphadenopathy in the upper neck and the imaged portions of the major cervical flow voids appear to be intact. There is left retinal hemorrhage with a hematocrit level. There is a right lens implant. There is scattered mild paranasal sinus mucosal thickening. The imaged intracranial structures are grossly unremarkable.", "output": "1. Findings suggestive of left oral cavity and tongue base inflammation, such as a form of Ludwig angina, without definite abscess formation, although the assessment is limited due to the lack of intravenous contrast, versus hemorrhage with associated edema.2. Left intraocular hemorrhage."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Iannitelli is a 44-year-old female with a personal history of left breast lumpectomy in 2008 for IDC with nodal involvement treated with radiation and chemotherapy. Personal history of benign right breast biopsy in 2011. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact from biopsy marker clip is identified in the right lower breast, at site of prior benign breast biopsy. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "MVC with back pain. Assess for acute process. Per the on call radiology resident memo, the patient also has a history of breast cancer with diffuse osseous lesions. Thoracic spine: There are multiple poorly defined lucent lesions involving the thoracic spine and ribs compatible with the stated history of metastatic breast cancer. There are multiple vertebral body compression fractures which I presume to be pathologic in nature, most notably affecting T4, T7, and T9-T12. While I suspect that most if not all of these are chronic, I cannot ascertain whether or not any individual compression fracture might be due to the patient's recent MVC. In addition to numerous rib lesions, multiple sites of rib deformity represent healing or healed fractures. Although the cervical spine is not optimally evaluated on these thoracic spine radiographs, on the swimmer's view there is suggestion of loss of height of the C4 and C5 vertebral bodies, which I suspect is pathologic in nature; please refer to the subsequent cervical spine MRI report for additional information. Poorly defined left lung basilar opacity is nonspecific and would be better evaluated with dedicated chest radiographs if clinically warranted. There is a right-sided central venous access device with its tip in the right atrium.Lumbar spine: Diffuse metastatic disease affects the lumbar spine. There is severe compression deformity of L3 and moderate compression deformities of L1 and L2, which I suspect are chronic. Facet joint osteoarthritis affects the lower lumbar spine.Pelvis: There is diffuse metastatic disease involving the bones of the pelvis with additional lucent lesions involving the proximal femora. Deformity of the right ischiopubic junction likely represents an old healed fracture; however, I see no acute fracture on this study.", "output": "Widespread metastatic disease to bone with multiple cervical, thoracic, and lumbar spine compression fractures as described above."}
{"instruction": "Generate impression based on findings.", "input": "Secondary malignant neoplasm of unspecified site [C79.9], Reason for Study: ^Reason: h/o metastatic melanoma with brain metastases and increased seizures/psychosis; eval for interval change of metastases/edema/hemorrhage History: see above Redemonstration of multiple peripheral enhancing intra axial lesions on bilateral hemispheres and bilateral cerebellar hemispheres indicating metastatic lesions, however, each enhancing lesions show overall decrease in maximum diameter as well as the extent of surrounding edema since prior scan.On gradient echo images, several of those lesions show increased extent of susceptibility artifacts indicating increased intra-lesional blood products such as interval intra-lesional hemorrhages.There is no new abnormal enhancing lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "1. Interval decrease of multifocal intra axial metastatic lesions and the extent of surrounding edema since prior scan.2. Interval increase of intra lesional blood products since prior scan.3. No new abnormal enhancing lesion is seen.4. No evidence of acute ischemic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Left upper extremity paresthesias, and prior neck injury. There is multilevel degenerative spondylosis. At C3-4, there is a posterior disc-osteophyte complex that abuts the spinal cord and there is moderate to severe bilateral neural foraminal narrowing. At C4-5, there is a posterior disc-osteophyte complex that also abuts the spinal cord and there is moderate left and mild right neural foraminal narrowing. At C5-6, there is a posterior disc-osteophyte complex that mildly narrows the spinal canal and there is at least moderate bilateral neural foraminal narrowing. At C5-6, there is a posterior disc-osteophyte complex that effaces the anterior thecal sac in the spinal canal and there is at least mild bilateral neural foraminal narrowing. There is no significant degenerative disease at C2-3 and C7-T1. There is lack of the usual cervical kyphosis, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.", "output": "Multilevel degenerative cervical spondylosis with variable degrees of spinal canal and neural foraminal narrowing."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status, evaluate for brain metastases. There is no restricted diffusion to suggest acute infarction. There are scattered foci of increased T2/FLAIR signal within the bilateral cerebral white matter which do not appear significantly changed compared to the 8/20/2016 examination allowing for differences in technique. Previously seen signal abnormality on 8/8/2016 exam predominantly involving the bilateral posterior cerebral hemispheres likely related to PRES no longer seen. There is no evidence of acute intracranial hemorrhage or mass. There is an unchanged punctate focus of susceptibility in the left frontal lobe, which is nonspecific, but likely related to trace mineralization or chronic hemosiderin. No pathologic enhancement is identified. The ventricles and sulci are unchanged including a normal variant cavum septum pellucidum. There is no midline shift or herniation. The major cerebral flow voids are intact. There is diffusely decreased T1 signal within the bone marrow with a few scattered areas of preserved increased T1 signal which is nonspecific and may be related to chronic anemia.", "output": "1.No evidence of acute infarct or other acute intracranial abnormality.2.Few scattered areas of signal abnormality within the cerebral white matter which are nonspecific and not significantly changed compared to 8/20/2016. These may represent chronic small vessel ischemic changes or sequela of other injury.3.No evidence of intracranial metastases as questioned. "}
{"instruction": "Generate impression based on findings.", "input": "Right knee pain after dancing Saturday. Check for ligamentous tear MENISCI: No significant abnormality noted. Specifically menisci appear intact.ARTICULAR CARTILAGE AND BONE: Minimal signal or malunion the subpatellar cartilage more pronounced underlying the medial facet. No distinct definite tear, however mild irregularity along the surface is suggested. Mild-to-moderate chondromalacia patellae. Medial and lateral compartment cartilage is otherwise unremarkableMild contusion is observed in the lateral tibial plateauLIGAMENTS: Minimal fluid in signal and amount is observed in the MCL towards the proximal origin. The remaining ligaments are otherwise intact and well visualizedEXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Combination of findings correlating with an moderate MCL sprain with an associated contusion of the tibial plateau, chondromalacia patellae and suprapatellar soft tissue edema. Specifically no underlying acute meniscal or retinaculum injury."}
{"instruction": "Generate impression based on findings.", "input": "Male, 36 years old, history of grade 2 astrocytoma status post biopsy and third ventriculostomy. Surveillance scan. A T2 hyperintense, well-circumscribed mass is demonstrated involving the tegmentum of the midbrain, slightly asymmetric to the right. This lesion is predominantly nonenhancing with the exception of one or two very small vessels which seem to penetrate it. There has been no significant change in size or morphology with the lesion continuing to measure approximately 19 x 18 mm in the axial plane. Mass effect upon the cerebral aqueduct is unchanged.Again seen is a tract running through the right frontal lobe to the level of the right lateral ventricle likely related to prior instrumentation. No new intracranial lesions are seen. Ventricle size and morphology are unchanged and normal.", "output": "Stable midbrain mass."}
{"instruction": "Generate impression based on findings.", "input": "3-year-old male with seizure disorder and history of grade 4 IVH. Evaluate for acute changes Low attenuation of left cerebellar hemisphere consistent with encephalomalacia. Regions of encephalomalacia are also seen in the periventricular areas consistent with findings on prior MRIThere is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. No acute intracranial abnormality. 2. Left cerebellar and periventricular encephalomalacia as described in prior MRI."}
{"instruction": "Generate impression based on findings.", "input": "28 year old woman with history of atrial septal defect who presents for further evaluation by cardiac MRI Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), the LVEDV is 130 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 71 g/m2 (normal range 67+/-11), and the LV mass is 130 g (normal range 114+/-24). There is diastolic flattening of the interventricular septum suggesting RV volume overload. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Atrial SeptumA sinus venosus type atrial septal defect is noted (i.e. a communication between right superior pulmonary vein, right superior vena cava, right atrium, and left atrium). The Qp:Qs is 2.6:1. The septum bows from right to left.Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 231 ml/m2 (normal range 69+/-14), the RVEDV is 423 ml (normal range 110+/-24), the RV end systolic volume index is 104 ml/m2 (normal range 22+/-8), and the RVESV is 190 ml (normal range 35+/-13). 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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsThe right inferior, left superior, and left inferior pulmonary veins drain normally into the left atrium. The right superior pulmonary vein is involved with the above mentioned sinus venosus type atrial septal defect.Pulmonary ArteryThe main pulmonary artery is moderately dilated in size measuring 35 mm.Venous AnatomyThe IVC drains normally into the right atrium. The right-superior vena cava is involved with the above mentioned sinus venosus type atrial septal defect. There is a persistent left-superior vena cava which drains into the coronary sinus. The coronary sinus is dilated.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. The left ventricle is normal in size with systolic function (LVEF 55%)2. The right ventricle is severely dilated with normal systolic function (RVEF 57%)3. The is a sinus venosus-type atrial septal defect (i.e. a communication between right superior pulmonary vein, right superior vena cava, right atrium, and left atrium). The QP:QS is 2.6:1.4. Anomalous right superior pulmonary venous drainage.5. Persistent left sided SVC draining into the coronary sinus.6. Severe right atrial dilation7. Main PA with moderate dilation8. Moderate tricuspid regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Follow up from 2011. Had partial patellar tendon rupture. Pt without follow up, now increased pain. Evaluate for further rupture. MENISCI: There is increased internal signal within the posterior horn of the medial meniscus; this does not appear to reach the surface and there is no definite evidence of a tear. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is a full thickness defect measuring up to 4-5 mm in width of the lateral facet of the patellar cartilage with underlying increased T2 bone marrow signal compatible with edema. LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The patellar tendon is intact. ADDITIONAL", "output": "1. Focal chondral defect of the patellar articular cartilage with underlying bone edema.2. Intact patellar tendons and cruciate ligaments.3. Abnormal internal signal within the posterior horn of the medial meniscus without definite tear. "}
{"instruction": "Generate impression based on findings.", "input": "Female 56 years old Reason: 56 yo F hx of cystic pancreatic lesion s/p distal pancreatectomy in 8/2013,EUS 5/2015 showed residual pancreas with chronic pancreatitis changes and a cystic lesion in uncinate process. 1 year f/u MRI to assess for growth, also eval for chronic pancreatic History: cystic lesion of pancreas, chronic pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.Status post cholecystectomy. Intrahepatic bile ducts and common bile duct are normal in caliber.SPLEEN: Status post colectomy. Probable residual splenic tissue adjacent to the left kidneyPANCREAS: Status post resection of the pancreatic tail. There is a subcentimeter cystic focus in the head of the pancreas measuring 9 mm that appears to communicate with the pancreatic duct and represents a small branch type IPMN.There is mild fatty atrophy of the pancreas.There is mild ductal irregularity of the pancreatic duct in the head of the pancreas in the region of calcifications previously noted.Upon administration of secretin, response is mildly blunted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: In the left kidney, there is a 9 mm partially exophytic lesion as seen on image 25/series 7. The lesion has questionable subtle enhancement. No hydronephrosis in either kidney.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.Status post pancreatic tail resection and splenectomy. Small cystic lesion (9mm) in the pancreatic head with imaging features suggestive of a IPMN. Allowing for differences in modality the lesion is not significantly changed.2.Slightly blunted response to secretin in the setting of mild pancreatic atrophy.3.Cystic lesion in the left kidney has slightly suspicious features. The lesion is too small to fully characterize and a follow-up imaging study in 12 months can be performed."}
{"instruction": "Generate impression based on findings.", "input": "Other specified types of non-hodgkin lymphoma, extranodal and solid organ sites [C85.89], Reason for Study: ^Reason: evaluate for etiology of double vision History: concern for recurrence of orbital lymphoma Orbit MRINo evidence of recurrence mass within the orbit. There is no evidence of abnormal enhancement.The globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement.  Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Focal encephalomalacia on the left frontal lobe is again seen, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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 mastoid air cells are clear.Mucosal thickening are seen within the frontal sinus and ethmoid sinus. Empty sella is noted.Lumbar spine MRIFor the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is evidence of left side laminectomy at the level of L34, L4-5 and L5-S1.Soft tissue fluid collections are seen from L23 to L45 which likely represent postoperative changes.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal.The conus medullaris terminates at the L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L1-L2: Broad-based disc protrusion central to left which abuts thecal sac. However, no significant neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation with diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis. L3-L4: Left sided total laminectomy status. Diffuse bulging of disc with bilateral ligamentum flavum thickening results mild to moderate spinal canal stenosis. L4-L5: Left sided total laminectomy status. Diffuse bulging of disc with bilateral ligamentum flavum thickening results moderate to severe spinal canal stenosis. L5-S1: Left sided total laminectomy status. Diffuse bulging of disc with left side lateral recess stenosis.", "output": "1. No evidence of recurrence orbital tumor or abnormal enhancement within the orbit.2. No evidence of acute ischemic or hemorrhagic lesion or abnormal enhancement of the brain.3. Unchanged left frontal encephalomalacia since prior scan.4. Postoperative status, left side laminectomy from L3-4 to L5-S1.5. Degenerative changes of lumbar spine including various degree spinal canal stenosis at the level of L3-4, L4-5 and left lateral recess stenosis at L5-S1.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "History of metastatic renal cancer, status post retroperitoneal resection, evaluate for recurrence ABDOMEN: Examination limited by lack of intravenous contrast.LIVER, BILIARY TRACT: Stable bilobar T2 hyperintense hepatic lesions may represent cavernous hemangiomas. No intra or extrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy. The right adrenal gland is normal.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrence within the left nephrectomy bed. Status post partial right nephrectomy. There is a complex septated lesion in the inferior pole of the right kidney measuring up to 1.5 x 1.0 cm (series 4, image 28), previously 1.4 x 0.9 cm. Additionally, there is a complex cystic lesion in the midpole of the right kidney, unchanged for 2 years, measuring 1.4 x 1.0 cm (series 4, image 42).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes affect the lumbar spine.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "1.No evidence of recurrent or metastatic disease on this limited exam. 2.Complex cystic mass in the right midpole, unchanged for 2 years. RCC can not be excluded.3.Stable reference complex cystic right inferior pole lesion, likely represents postsurgical changes."}
{"instruction": "Generate impression based on findings.", "input": "Female, 74 years old, with right-sided weakness. Corresponding to the area of abnormality noted on prior CT, there is restricted diffusion involving the left operculum and insula, as well as the left frontoparietal junction, with smaller scattered foci of diffusion restriction in the left anterior frontal lobe, the temporal lobe and the occipital lobe. Mild T2 hyperintensity is seen corresponding to these areas of restricted diffusion. No significant generalized mass effect is detected. There may be minimal petechial blood product in the infarct region but no frank hemorrhagic conversion is seen.Elsewhere, scattered foci of T2 hyperintensity are seen within the cerebral hemispheres appearing similar to those noted on prior MRI. No abnormal fluid collections are detected. The ventricular system is normal in size and morphology.Abrupt occlusion of the inferior division of the left MCA is seen within the sylvian fissure. No other significant intracranial stenosis is suspected. No aneurysms are detected within the limitations of technique. The region of the ACOM artery is unremarkable. Prominent bilateral PCOM arteries are seen.In the neck, there is moderate narrowing of the right carotid bifurcation but no significant stenosis by NASCET criteria. The carotid system is otherwise unremarkable. The vertebral vessels of the neck are likewise free of significant vascular stenosis.", "output": "1.Findings compatible with acute left MCA stroke. No significant generalized mass effect or frank hemorrhagic conversion is seen.2.Abrupt occlusion of the inferior division of the left MCA is seen. Elsewhere, no significant intracranial vascular stenosis is detected.3.No significant vascular stenosis is seen in the neck."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female with right knee pain, evaluate for medial meniscal tear MENISCI: Blunting of the free edge of the body of the medial meniscus is slightly more pronounced on the current study than the prior study, suggestive of free edge tearing. A small focus of low signal intensity just lateral to the free edge may represent a small meniscal fragment, but this is equivocal. Intrasubstance degeneration is seen within the body and posterior horn of the medial meniscus. A small linear focus of intermediate signal intensity involving the inner one third of the body of the lateral meniscus was not present on the prior study and may represent a small undersurface tear.ARTICULAR CARTILAGE AND BONE: There is subjective thinning of the articular cartilage within the medial femoral compartment which appears similar to the prior exam. There is near full thickness degeneration of the articular cartilage along the lateral femoral condyle immediately adjacent to the posterior horn of the lateral meniscus with a cartilage flap which is new from the prior exam. There is a focal full-thickness defect of the articular cartilage along the lateral tibial plateau at the base of the intercondylar eminence which appears to have progressed slightly since the prior exam. There is also degeneration of the articular cartilage along the posterior and anterior aspects of the lateral femoral condyle which is similar to the prior exam. There are osteophytes along the medial aspect of the femoral trochlea with thinning of the overlying cartilage, similar to the prior exam. Degeneration of the articular cartilage of the patella is unchanged. Tricompartmental osteophytes are present. A lesion in the distal femoral metaphysis measuring 1.6 cm likely represents a benign enchondroma, similar to the prior exam.LIGAMENTS: The ACL and PCL are intact. The MCL and lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The quadriceps tendon is intact. The patellar tendon is intact, although there is an additional band of low signal intensity extending from the inferior patella to proximal tibia which presumably represents scar tissue.ADDITIONAL", "output": "1.Blunting of the free edge of the body of the medial meniscus is slightly more pronounced than on the prior exam and is suggestive of free edge tearing. A small focus of low signal intensity just lateral to the free edge may represent a small meniscal fragment, but this is equivocal.2.Findings suggestive of a small tear involving the inner third of the body of the lateral meniscus, which is of questionable clinical significance.3.Osteoarthritis as described above with progression of cartilage defects involving the lateral compartment.4.Postoperative findings from prior arthroscopy and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Male, 48 years old. Reason: right knee medial meniscus tear History: knee pain MENISCI: There is a bucket-handle tear of the medial meniscus with displacement of the bucket-handle fragment along the medial tibial spine. Additional branching signal abnormality within the posterior horn of the medial meniscus is seen extending to the femoral and tibial articular surfaces representing complex tearing. Overall, the appearance is similar to that seen on the prior study. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Subjectively the articular cartilage of the medial compartment appears thinned, particularly along the tibial plateau beneath the posterior horn of the meniscus and along the weightbearing surface of the medial femoral condyle. There is also a small full-thickness defect anteriorly along the medial femoral condyle. The articular cartilage of the lateral compartment appears relatively normal. There is a partial-thickness cleft of the articular cartilage of the medial articular surface of the patella and mild blistering of the articular cartilage of the lateral articular surface of the patella. Overall, these findings appear similar to those seen on the prior study. Bone marrow signal intensity is within normal limits.LIGAMENTS: The ligaments of the knee appear normal. EXTENSOR MECHANISM: The extensor mechanism is intact. There is scarring along the anterior capsular structures of the knee which presumably reflects prior surgery.ADDITIONAL", "output": "Bucket-handle tear of the medial meniscus and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Left renal mass status post cryotherapy ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in the liver. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The left upper pole renal lesion is unchanged in size at 2.1 x 2.1 cm (series 3, image 23) and without change in signal characteristics. Post-ablation changes are again identified. Lack of intravenous contrast limits assessment for enhancing/suspicious components. No definite restricted diffusion is seen. Multiple additional simple appearing cysts are noted bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No retroperitoneal or abdominal lymphadenopathy.BOWEL, MESENTERY: Partially imaged large hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites. Small right and trace left pleural effusions.", "output": "1.Stable appearance of the ablated left upper pole renal lesion. Lack of intravenous contrast limits assessment for solid neoplasm, and continued follow-up is recommended given the patient's history of papillary renal cell carcinoma.2.No abdominal or retroperitoneal lymphadenopathy.3.Small amount of non-specific ascites, small right greater than left pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: No acute intracranial abnormality. Bleed, metastases. Signs and symptoms: history of metastatic prostate cancer. New onset of headaches for one week associated with eye pain and balance problems Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. A very subtle area of low-attenuation with apparent involvement of cortex and subcortical white matter of left frontal lobe is present. The exact etiology of this finding is not clear however the finding could represent small ischemic stroke. The age of this is stroke cannot be determined due to small size. On this non-infused exam there is no evidence of metastatic disease. Recommend an MRI for further evaluation. Calvarium is intact. Mastoid air cells and paranasal sinuses are unremarkable.", "output": "1.Small focus of low-attenuation in the left frontal lobe likely result of ischemic stroke. Recommend further follow-up with MRI since the small size of this lesion makes precise determination of its age difficult.2.No evidence of metastatic disease on this non-infused study.3.Calvarium is intact."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Unspecified disorder of the pituitary gland and its hypothalamic controlClinical question: s/p pituitary adenoma resection on 7/16/15Signs and Symptoms: Post-op surveillance, visual symptoms MRI brain:The patient is status post right frontal craniotomy. There is an extra-axial collection redemonstrated at the craniotomy site which measures up to 5 mm in thickness and previously measured approximately the same.There are punctate foci of diffusion restriction present in the right occipital lobe gray matter and along the left medial thalamus.The right vertebral artery flow-void appears to be diminished. There is a prior MRA exam from 7/11/2015 which indicates potential occlusion of the extracranial distal right vertebral arteryThere is a small focus of encephalomalacia involving the medial aspect of the right orbital gyrus and the gyrus rectus with associated T2 signal hyperintensity and FLAIR signal hyperintensity but without any significant contrast enhancement.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are multiple punctate T2 and FLAIR hyperintense foci within the brain stemThere is susceptibility effect along the surface of the cerebellum and the brainstemThere is redemonstration of subdural effusion bilaterally and in the posterior fossa.The patient is status post pituitary fossa and suprasellar mass resection.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are demonstrated mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRI pituitary:The patient status post pituitary fossa surgery. There is a residual lesion present within the pituitary fossa which measures approximately 17 x 25 mm in coronal dimensions. It has heterogeneous signal on both T1 and T2. It displays a thin rim of enhancement along its periphery as well as some mild heterogeneous enhancement centrally. Coronal dimensions on the prior exam were approximately 27 x 25 mm. The mass bulges into the inferior aspects of the cavernous sinus bilaterally", "output": "1.Since the prior exam postoperative changes located within the pituitary fossa have mildly regressed. The possibility that there may be some residual tumor within the pituitary fossa is suspected. A follow-up exam may help further assess this.2.There are couple punctate foci suspicious for acute or subacute microinfarcts located in the right occipital lobe and the left thalamus.3.Findings suggesting steno-occlusive disease the right distal vertebral artery.4.A focus of encephalomalacia in the right frontal lobe is stable.5.There are subdural effusions present which are stable compared to the prior exam6.There is superficial siderosis present probably related to prior subarachnoid blood7.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Compression of brain [G93.5] / Low back pain [M54.5], Reason for Study: ^Reason: chiari malformation, lower back pain, evaluate for tethered cord or syrinx. Please do with tethered cord protocol History: Chiari , lower back pain evaluate for tethered cor There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. There is no evidence of syrinx.The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the T12-L1 level. The filum terminale is normal in size and signal intensity. There is no evidence of syrinx, tethered cord or spinal dysraphism. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Diffuse bulging of disc which results bilateral lateral recess minimal stenosis. No neuroforaminal narrowing or spinal stenosis. L5-S1: Diffuse bulging of disc which results bilateral lateral recess minimal stenosis. No neuroforaminal narrowing or spinal stenosis.", "output": "1. No evidence of syrinx. No evidence of tethered cord.2. Diffuse bulging of discs with minimal bilateral lateral recess stenosis at the level of L45 and L5S1."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: Head ct showing interval scattered areas of hypoattenuation involving right frontal and parietal lobes History: altered mental status Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.There are chronic ischemic infarction with tissue loss on the right MCA territory, in particular right inferior parietal lobule and right frontal lobe. Underlying brain shows multifocal patch high signal intensity on FLAIR/T2 images indicating nonspecific small vessel ischemic disease.There are focal susceptibility areas on the course of right MCA, in particular, both are located along the sylvian fissure. These findings may indicate possibility of MCA branch wall calcification or remained intravascular thrombus without complete occlusion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear.Bilateral mastoid air cells show opacification.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 6 mm x 4.2 mm relatively wide neck basilar tip aneurysm. There is also focal luminal stenosis on the left ACA distal A2 segment before the pericallosal-callosomarginal bifurcation. Bilateral P-comm arteries are patent and Acom artery is patent.No other intracranial arterial aneurysm is seen.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate non-visualization of the left subclavian artery and right subclavian artery beyond thyrocervical trunk but otherwise patent brachiocephalic trunk, bilateral CCAs, bilateral VAs and bilateral extracranial ICAs without evidence of significant (more than 50%) luminal stenosis.", "output": "1. No acute ischemic or hemorrhagic lesion.2. 4mm x 6mm sized basilar aneurysm.3. Focal luminal stenosis on the left ACA distal A2. 4. Non visualization of right mid to distal subclavian artery and the proximal left subclavian artery indicating atherosclerotic occlusion."}
{"instruction": "Generate impression based on findings.", "input": "60 year-old female, with peripheral vascular disease status post left above-the-knee amputation with open wound and left leg edema. Evaluate for fluid collection, tracking air.IMAGE ACQUISITIONS: Non-IV contrast enhanced CT of the pelvis and both thighs. Lack of IV contrast decreases the ability to detect small abscesses.Patient is status post left above-the-knee amputation. Irregularity of the soft tissues of the distal end of the remaining left thigh is compatible with the stated history of open wound, and there several small pockets of gas density seen within the soft tissues surrounding and adjacent to the amputated distal left femur. There are no specific features of osteomyelitis on this study, although MRI would provide a more sensitive assessment for osteomyelitis. No abscess is identified within the left thigh. Air does not extend into the proximal thigh.There is moderate bilateral stranding of the subcutaneous fat of the thighs compatible with edema, which extends into the subcutaneous fat of the pelvis and lower abdomen. An intramedullary rod is present in the right femur and results in metallic artifact that slightly limits the exam of the surrounding anatomic structures. There are atherosclerotic calcifications seen within the pelvis and both thighs as well as a femoral artery stent on the right.", "output": "Status post left above-the-knee amputation with stump wound and small foci of air immediately adjacent to the distal left femur. No abscess evident."}
{"instruction": "Generate impression based on findings.", "input": "Status epilepticus with intracranial hemorrhage. Suspicion of nonaccidental trauma. Rule out spinal spine fracture or other injuries. The posterior infratentorial subdural hematoma does extend along the posterior aspect of the foramen magnum though without significant narrowing of the foramen. There is also minimal, predominantly right-sided subdural hemorrhage posterior to the vertebral bodies in the upper cervical spine, reaching to mid/lower C3 level, which has a maximum thickness of less than 2 mm and causes no significant spinal canal narrowing. Otherwise, there is no significant hemorrhage in the cervical or included upper thoracic spinal canal. The vertebral bodies show no gross morphologic abnormality or marrow edema. The intervertebral disks are preserved in height and T2 signal. The cervical spinal cord shows no significant abnormality.Opacification in the posterior, dependent lungs is probably atelectasis. There is no significant prevertebral effusion or soft tissue swelling. There is no convincing STIR T2 signal in the paraspinal soft tissues.", "output": "1.Minimal subdural hemorrhage along the upper cervical spine but without significant spinal canal stenosis, which given the prominent amount of subdural blood products in the posterior fossa and along the foramen magnum likely represents blood products tracking caudally.2.There is also no definite sign of fracture or significant soft tissue injury in the cervical spine or the included upper thoracic spine.3.The intracranial subdural hemorrhages are described in detail on the report of the brain MRI from the same day."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with prostate cancer. Evaluate for extraprostatic disease spread. Pathology dated 8/4/2016 showed right-sided adenocarcinoma (Gleason 3+3) and left-sided adenocarcinoma (Gleason 3+4). PELVIS:PROSTATE:Prostate Size: The prostate measures 5.9 cm in transverse, 3.6 cm in AP, and 5.3 cm in craniocaudal diameter.Peripheral Zone: Linear T2 hypointense foci throughout the peripheral zone are suggestive of chronic prostatitis versus scarring. In the left mid gland, there is a focal T2 and ADC hypointense region measuring 1.2 x 0.8 cm (axial series 501 image 20) (axial series 608 image 324) concerning for a dominant nodule.Central Gland: Heterogenous appearance compatible with BPH. There is an asymmetric enlarged hyperplastic nodule distorting the adjacent right peripheral zone (axial series 501 image 18), which partially limits evaluation of the exam.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: Nonspecific intramuscular enhancement adjacent to the bilateral femoral necks (left greater than right) is of uncertain clinical significance (axial series 2001 image 89).OTHER: No significant abnormality noted.", "output": "1.Dominant nodule in the left mid gland as described above. Right gland particularly peripheral zone suboptimally assessed as above.2.Linear T2 hypointense foci of the background peripheral zone bilaterally suggestive of chronic prostatitis versus scarring."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Chernawsky is a 33 year old female with known left breast cancer. She presents today for MRI to evaluate extent of disease. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.In the left upper inner breast, 11:00 location, there is an irregular enhancing mass measuring 2.5 x 2.2 x 2.8 cm. Susceptibility artifact from biopsy marker clip is seen within the central aspect of this lesion, compatible with biopsy-proven malignancy. The MRI measurement of this mass approximates the mammographically visualized abnormality (spiculated asymmetry + pleomorphic calcifications of approximately 2.6 cm).There is no additional abnormal enhancement seen in the left breast. There is no abnormal enhancement in the right breast. No abnormal lymph nodes are identified in either axillary region.", "output": "Unifocal malignancy in the left upper outer breast. Normal axillary lymph nodes. If patient desires breast conservation therapy, a single wire localization needle targeting the biopsy clip vs bracketed wire localization for the entire span of calcifications (approximately 2.5 cm) can be performed based on clinical preference. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for ischemia. Signs and symptoms: Right facial droop of right leg weakness. Nonenhanced brain MRI:Examination demonstrates small focus of restricted diffusion in the right lateral aspect of medulla measuring at 11.7 times 7-mm. No evidence of hemorrhagic changes or any appreciable mass effect.Examination in addition demonstrate extensive chronic strokes in the vertebral vascular system and including total PCA territory chronic stroke as well as multiple small bilateral cerebellar ischemic strokes and several chronic nonhemorrhagic pontine lacunar infarct.Images through supratentorial space in addition demonstrate findings of mild to moderate small vessel ischemic strokes in the subcortical and periventricular white matter of cerebral hemispheres.Midline is maintained and the cortical sulci appear normal for patient stated age.Signal void the major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells as well as calvarium and soft tissues of the scalp.", "output": "1.Focus of restricted diffusion in the right lateral medulla measuring at 7 times 11.7-mm.2.several chronic bilateral cerebellar ischemic stroke as well as large chronic nonhemorrhagic ischemic stroke involving the entire left PCA territory.3.Findings consistent with mild to moderate chronic nonhemorrhagic small vessel ischemic strokes."}
{"instruction": "Generate impression based on findings.", "input": "49 years Female (DOB:7/23/1967)Reason: stenosis? History: L4-L5 spondylolisthesis proximal to L5-S1 PSFPROVIDER/ATTENDING NAME: JAMES M MOK JAMES M MOK Five lumbar type vertebral bodies are presumed to be present. The patient is status post posterior lumbar fusion with pedicle screws and interconnecting rods at L5-S1 1. This creates a significant amount of artifact which obscures visualization of the lumbar spine from L3 down to S1. Within the left half of the L1 vertebral body there is a 21 x 16 mm sagittal dimension well-circumscribed lesion which is high signal on T1 and T2 which most likely represents a vertebral body hemangioma.There are cystic lesions present within the kidneys bilaterallyAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "Examination is compromised due to metal artifact. The patient status post lower lumbar spine fusion. There is no spinal stenosis or compromise to the exiting nerve roots at the L2-3 or L1-2 levels."}
{"instruction": "Generate impression based on findings.", "input": "80-year-old male disoriented for one day. Evaluate for stroke. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity in a periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Coarse hyperdensities within the tentorium represent calcifications of no current clinical significance. Focal areas of well delineated CSF attenuation within the region of the anterior left temporal lobe consistent with arachnoid cyst.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": "Suspected small vessel disease, otherwise unremarkable. If there is clinical concern for acute ischemia, an MRI may be considered."}
{"instruction": "Generate impression based on findings.", "input": "Patient AMS and unable to provide history. Possible internal hardware on CXRReason: Stroke? Subacute changes seen on CTA. History: AMS, not triggering vent effectively, unwitnessed fall3/29/195263 yearsFemale MRI of the brainNo diffusion weighted abnormalities are appreciated. The exam is somewhat compromised due to patient motion which may obscure more subtle abnormalities.A small focus of encephalomalacia is present along the lateral posterior aspect of the right orbital gyrus, the right insular cortex and right frontal lobe and a small region measuring approximately 2 cm in size.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate air-fluid levels in the maxillary sinuses, sphenoid sinuses and ethmoid air cells and mucosal thickening in the frontal sinuses. The visualized portions of the mastoid air cells are partially opacified. The patient status post intubation. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 6 mm x 4 mm aneurysm present at the right M1 segment which has a small neck. A branch of the superior division of the right middle cerebral artery originates from the base of this aneurysm. This particular branch also supplies the small focus of encephalomalacia.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. There is fenestration of the anterior communicating artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The vertebral arteries are not well imaged proximally in part related patient motion. It is suspected that there is occlusion of the right vertebral artery at its origin. The right vertebral artery appears to be reconstituted distally most likely from collaterals", "output": "1.There is a 6 mm x 4 mm aneurysm present at the right M1 segment which has a small neck. A branch of the superior division of the right middle cerebral artery originates from the base of this aneurysm. This particular branch also supplies the small focus of encephalomalacia. CT angiography be helpful in further assessing this.2.Findings suggest occlusion of the right vertebral artery at its origin with distal reconstitution via collaterals. Please note that the vertebral arteries are not adequately imaged proximally due to patient motion. CT angiography be helpful in further assessing this.3.There is no evidence for acute ischemic cerebral infarction. 4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.A small focus of encephalomalacia is centered in the right frontal lobe which involves small portions of the right orbital gyrus, insular cortex and inferior frontal gyrus.6.The exam is somewhat compromised due to patient motion which may obscure more subtle abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female patient with history of thalamic hemorrhage and microvascular disease presents with head fullness. There is mild continued evolution of chronic blood products related to left thalamic hemorrhage with residual susceptibility artifact. Again seen is susceptibility artifact compatible with hemosiderin scar in the right external capsule, appearing similar compared to prior exam. Bilateral punctate foci of susceptibility artifact in the bilateral frontal and occipital lobes as well as the basal ganglia appear similar compared to prior examination and are consistent with prior microhemorrhages. There is extensive pons and periventricular and subcortical white matter T2/FLAIR increased signal intensity without associated restricted diffusion that is not significantly changed compared to prior exam and consistent with moderate chronic small vessel ischemic disease. There is no abnormal enhancement on postcontrast images.There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The paranasal sinuses, mastoid air cells and orbits are unremarkable. The skull and extracranial soft tissues are unremarkable.", "output": "1.No acute infarct, hemorrhage, mass or mass effect.2.Mild continued evolution of chronic left thalamic hemorrhage. Stable hemosiderin scar within the right external capsule from remote hemorrhage. No significant change in multiple additional parenchymal microhemorrhages on background of advanced chronic small vessel ischemic disease. These findings are suggestive of chronic hypertensive encephalopathy and/or amyloid angiopathy."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old woman with history of HCV cirrhosis, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour and the fissures are widened. An approximately 1 x 1 cm lesion in the dome of the liver (series 3, image 5) is hyperintense on T2 and diffusion-weighted sequences, but there is no contrast washout on delayed phase images. The gallbladder appears normal.SPLEEN: The spleen is enlarged at 13 cm. Splenic varices are noted.PANCREAS: The pancreatic parenchyma is severely atrophied and the remaining pancreatic duct is irregularly dilated measuring up to 15 mm in the pancreatic head. No obstructing lesion is identified.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal.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.Small enhancing lesion in the hepatic dome which can be followed if clinically appropriate.2.Stable dilation of the pancreatic duct which may represent chronic pancreatitis or main duct type IPMN."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old female patient with autoimmune hepatitis presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Again seen is a T2 hyperintense subcentimeter focus that demonstrates arterial enhancement in the hepatic dome that does not demonstrate washout. It is unchanged in size compared to prior examination, compatible with a hemangioma. No suspicious arterial enhancing lesions with washout are identified.Focal outpouching of the gallbladder fundus is unchanged compared to prior examination and may represent focal adenomyomatosis (series 9 image 37).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Multilevel thoracic neuroforamina perineural cysts noted. Adjacent to the left T11-T12 (when counting from below) neuroforamina, there is a T2 hyperintense enhancing lesion that measures 1.5 x 1.0 cm (series 6 image 12). This lesion can be identified retrospectively and appears to be slow growing. For reference, on 09/26/2011 this lesion measured 0.9 x 0.8 cm and measured 1.0 x 1.2 cm on 09/04/2013.OTHER: No significant abnormality noted.", "output": "1.No suspicious hepatic lesions.2.Stable subcentimeter hemangioma at the hepatic dome.3.Slow growing lesion adjacent to the left T11/T12 neuroforamina is nonspecific and may be of neural origin, such as a schwannoma. Dedicated imaging with thoracic spine MRI can be obtained as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Proximal femur lesion. Centered within the anterior cortex of the proximal femoral diaphysis is a lucent lesion with internal septations. The lesion measures 8 mm x 12 mm in maximal axial dimensions, and approximately 2.2 cm in maximal craniocaudal dimensions. The lesion does not appear to contain internal fat, or chondroid matrix. A small portion of the lesion appears to extend beyond the cortex of the femur, and into the quadriceps musculature as demonstrated on outside MRI. This is seen for example on series 5, image 48. There are no enhancing components of this lesion. The lesion does not extend into the medullary cavity. Surrounding soft tissues are otherwise normal.The right hip joint is grossly normal.There is normal intravascular enhancement.Muscles and soft tissues are otherwise normal. No fractures.", "output": "Lucent lesion with sclerotic borders and internal septation centered within the anterior cortex of the proximal right femoral diaphysis as above, with a component apparently extending beyond the cortex. Nonossifying fibroma is suspected, but this is nonspecific. Although this lesion has some imaging characteristics of a chondromyxoid fibroma, osteofibrous dysplasia or an adamantinoma, the location of this lesion within the femoral diaphysis makes these differential possibilities less likely. Additionally, chronic infection is disfavored. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 66 years old, with altered mental status. Innumerable scattered foci of restricted diffusion are seen involving the watershed regions of the cerebral hemispheres, the basal ganglia, left thalamus, and the posterior fossa. The most conspicuous areas of restricted diffusion are in the bilateral parietal and occipital lobes and the cerebellum. A relatively large area of mild restricted diffusion without correlating T2 signal abnormality is seen involving the right parietotemporal junction.Most of the above-mentioned areas are associated with non-masslike gyriform enhancement. The right parietal and bilateral occipital lesions show evidence of gyriform T1 hyperintensity suggesting laminar necrosis. No evidence of basal cistern or cranial nerve enhancement is seen.Apart from those lesions which are diffusion restricting, there are numerous additional areas of periventricular and subcortical T2 hyperintensity which do not diffusion restrict. No evidence of significant generalized mass effect is seen. No brain herniation is demonstrated. The ventricles and sulci are proportionately prominent compatible with volume loss. No abnormal fluid collections are detected.", "output": "Innumerable areas of restricted diffusion are seen indicating cytotoxic edema or a mixture of cytotoxic and vasogenic edema both supratentorially and infratentorially. There is a marked predominance of lesions in the cerebral watershed zones, the parietal and occipital lobes, and in the cerebellum. One rather large and ill-defined area at the right parietotemporal junction demonstrates a curious pattern of mild restricted diffusion with no correlating T2 signal abnormality. Most of the lesions demonstrate non-masslike gyriform enhancement indicating blood brain barrier breakdown.The distribution of the lesions noted above, with a preference for the watershed zones and posterior circulation, is very suggestive of a PRES-like phenomenon. Lesions related to PRES do not typically diffusion restrict to this degree, but it has been reported in severe cases. The rather curious pattern of mild restricted diffusion without T2 signal abnormality at the right parietotemporal junction is also supportive of an atypical vascular process such as PRES.Other differential considerations, including embolic ischemic disease and metastatic/neoplastic disease, are considered much less likely based on the imaging characteristics. "}
{"instruction": "Generate impression based on findings.", "input": "Shoulder instability ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is deformity and multiple defects of the posterolateral humeral head reflecting a Hill-Sachs deformity however there is no underlying edema to suggest this is acute in nature. There is tearing and detachment of the labrum from the anterior to inferior. Additionally, there are ares where the cartilage is absent from the inferior glenoid with areas of calcification and granulation along the inferior margin. The superior labrum is intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "1. Tearing and detachment of the anterior to inferior labrum.2. Chronic deformities of the humeral head and inferior glenoid reflecting Hill-Sachs and bony Bankart lesions. There is callus formation and granulation noted along the inferior margin of the glenoid with the areas of articular cartilage absent.3. Mild synovitis."}
{"instruction": "Generate impression based on findings.", "input": " MRI Brain: Cerebellar tonsils are ectopic with inferior displacement of the tonsils by approximately 6 mm below the foramen magnum. There is minimal if any crowding of the CSF spaces at the foramen magnum. There is preserved bidirectional pulsatile CSF flow ventral and dorsal to the cord.FLAIR images are motion degraded but demonstrate no significant signal abnormality in the brain. Stable 8 mm pineal cyst is again seen. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is minimal mucosal thickening involving the maxillary sinuses with small mucous retention cysts. MRI Cervical spine: The cervical cord is normal in caliber and signal. There is no evidence of syrinx. Vertebral bodies are well aligned. There is no neural foraminal or spinal canal narrowing. Alignment of the vertebral bodies is unremarkable. There is mild straightening of the cervical spine which may positional in nature. The paravertebral tissues are unremarkable.", "output": "1.Stable mild cerebellar tonsillar ectopia/Chiari 1 malformation. CSF spaces and bidirectional CSF flow at the foramen magnum are preserved. No evidence of syrinx in the cervical cord.2.Stable small cystic lesion in the pineal gland."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female patient with concern for pancreatic ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: There are multiple simple cysts in the liver. There is no significant biliary ductal dilatation, mild ductal intrahepatic and extrahepatic ductal prominence noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct measures upper limits of normal diffusely without evidence of an obstructing lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Pancreatic duct diameter upper limits of normal diffusely and mild biliary ductal prominence seen without evidence of an obstructing masslesion; findings may reflect an element of sphincter of Oddi dysfunction. Unremarkable study otherwise."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male to assess for central sleep apnea. Again seen are multiple punctate foci of susceptibility effect scattered in the subcortical white matter of the supratentorial brain as well as multiple foci in the cerebellum. There is also a punctate focus of susceptibility effect that appears to be along the anterior aspect of the medulla and also seen previously. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are a few scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. These are not significantly changed from the prior examination.Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.", "output": "1. Multiple scattered foci of susceptibility effect in the bilateral cerebral hemispheres, cerebellum, as well as one in the medulla. Findings are consistent with chronic microhemorrhages and similar to recent MRI from 8/8/2016. Distribution of these microhemorrhages is nonspecific but may be related to amyloid angiopathy and/or chronic hypertension.2. Mild chronic small vessel ischemic changes. 3. Brain parenchyma is otherwise unremarkable with no acute findings."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with history of renal cysts. 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: Multiple cystic lesions are present bilaterally.Left kidney:Left mid pole posterior partially exophytic cystic lesion with thin septations and layering high T1 signal measuring 3.9 x 3.5 cm (image 26 of series 9). No enhancement. This may represent a proteinaceous or hemorrhagic cyst.Left midpole anterior exophytic cystic lesion without septations or nodularity measuring 4.7 x 6.9 cm (image 31 of series 9). No enhancement. This likely represents a simple cyst.Exophytic left inferior pole T2 intermediate lesion without enhancement significantly decreased in size now measuring 4.0 x 3.9 cm (image 46 of series 9). No enhancement. This likely represents a resolving cyst.Right kidney:Multiple small complex and simple cysts. For reference, a right lower pole complex lesion has not significantly changed from prior and measures 1.9 x 1.2 cm (imaged 62 of series 110)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. Right cystic renal lesions, some of which have decreased in size, likely benign.2. Multiple simple and complex left renal cystic lesions for which followup is recommended. "}
{"instruction": "Generate impression based on findings.", "input": "Encephalomyelitis. Evaluate for change of the inflammatory CNS lesions. Also headache and back pain.Additional clinical history from electronic medical records: 14 year old girl with a complex past medical history including a multi-system autoimmune disease which is thought to be caused by a mutation of the CTLA4 pathway who presented with brain and spine lesions on previous MRI. BRAIN:The few contrast-enhancing left frontal lobe lesions on the prior examination have resolved. Associated T2-hyperintensity is significantly improved to resolved. T2-hyperintense lesion in the left parietal white-matter with associated volume loss remains unchanged. The other smaller foci of T2-hyperintensity in the occipital lobes and in the right frontal lobe as well as the posterior corpus callosal body are also unchanged. These lesions are noncontrast enhancing. There is apparent faint focal contrast enhancement in the right frontal white-matter but no definite correlate on the coronal postcontrast imaging or T2/FLAIR, and may be artifactual. Otherwise, there is no new brain lesion and no abnormal intracranial contrast enhancement. Focus of susceptibility effect overlying the left frontal lobe is unchanged, related to previous biopsy. Otherwise, there is no acute intracranial hemorrhage. There is no acute infarct.Accounting for mild ex vacuo ventricular and sulcal enlargement in the left parietal region, the ventricles and other CSF-containing spaces are fairly symmetric. There is no mass-effect or midline shift. The major intracranial vascular flow voids are preserved.The orbits, skull and scalp are grossly unremarkable accounting for expected findings of previous left frontal lobe lesion biopsy. There is mild mucosal thickening in the maxillary and ethmoid sinuses.COMPLETE SPINE:There has been remarkable improvement of the expansile T2-hyperintense lesion involving the lower cervical/upper thoracic spinal cord. Residual abnormality is located predominantly on the left side at at T1-T2 level and is faint and subtle. The associated cord expansion is almost resolved. Associated contrast enhancement is remarkably improved.The remainder of the spinal cord is unremarkable. The sagittal spinal alignment is anatomic. There is a mild broad-based right convex curvature which can be positional. The vertebral bodies are preserved in height. The marrow signal is also unremarkable.Small lymph nodes in both sides of the neck are not enlarged by size criteria. The patient is intubated. Lungs show dependent abnormality likely reflecting atelectasis.", "output": "1.Left frontal lobe brain contrast enhancing lesions have resolved with improvement of the associated T2-hyperintensity. Other T2-hyperintense lesions remain unchanged, most pronounced in the left parietal lobe, with associated volume loss but no contrast enhancement or diffusion restriction, probably represent gliosis/chronic sequela of the previous, resolved inflammatory lesions. 2.Faint focal contrast enhancement in the right frontal white-matter on axial imaging does not correlate with abnormality on the other sequences or on the coronal postcontrast imaging and is likely artifactual. Otherwise, there is no definite new brain lesion.3.There is also marked decrease in size and enhancement of the upper thoracic spinal cord lesion."}
{"instruction": "Generate impression based on findings.", "input": "Male, 63 years old, with fasciculations of the left hand and forearm, status post foraminotomy on the left 1.5 years ago because of weakness. Postoperative findings are seen along the posterior elements on the left at C6-7 suggesting at least partial laminectomy and facetectomy.Mild reversal of the normal cervical lordosis is seen, likely degenerative in nature. Sagittal alignment is otherwise unremarkable. Vertebral body heights are grossly preserved. Degenerative endplate signal abnormality is seen at C4, C5 and C6. No worrisome marrow replacement or evidence of significant marrow edema is observed.The visualized spinal cord is free of pathologic signal abnormality. Level specific findings are detailed as follows:C2-3: Left greater than right facet hypertrophy. Right paracentral and foraminal disc osteophyte formation resulting in effacement of the right lateral recess, but no significant generalized canal stenosis and no cord impingement. The right neural foramen is severely narrowed. The left neural foramen is patent. C3-4: Left facet hypertrophy. Right paracentral and foraminal disc osteophyte formation which effaces the right ventral thecal sac and mildly deforms the ventral spinal cord. Mild generalized spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. C4-5: Mild facet hypertrophy. Broad disc osteophyte formation slightly asymmetric to the right. Effacement of the ventral thecal sac with slight flattening of the ventral cord. Mild generalized spinal canal narrowing. Severe right and moderate left foraminal narrowing. C5-6: Right facet hypertrophy. Broad posterior disc osteophyte formation. No cord impingement or significant spinal canal narrowing. Severe left and moderate to severe right foraminal narrowing. C6-7: Disc osteophyte formation asymmetric to the left and particularly along the left uncovertebral joint. Superimposed PLL thickening is also seen below the disc space level. These findings contribute to produce a mild to moderate spinal canal stenosis with very slight impingement of the spinal cord. Severe left and moderate right foraminal narrowing. Postoperative findings as discussed above. C7-T1: Bilateral facet hypertrophy. Left subarticular and foraminal zone disc osteophyte formation. No significant generalized spinal canal stenosis. Severe left and mild right foraminal narrowing.", "output": "1.Postoperative findings on the left at C6-7 compatible with the stated history of prior foraminotomy. The left, the left neural foramen at C6-7 remains severely narrowed due to disc osteophyte formation and left uncovertebral hypertrophy.2.Significant foraminal narrowing is also evident at most of the additional cervical levels as detailed above.3.Degenerative spinal canal stenosis is seen at multiple levels, most severely affecting the C6-7 level where there is a mild to moderate stenosis and slight impingement of the spinal cord. At no level is there any spinal cord signal abnormality to suggest cord edema."}
{"instruction": "Generate impression based on findings.", "input": "Male, 31 years old, with stiff legs and dizziness. Evaluate for multiple sclerosis. Brain:Numerous periventricular and, to a lesser degree, juxtacortical T2 hyperintense, T1 hypointense lesions are evident, many of which are oriented radially with respect to the ventricles. Some involve the corpus callosum or contact the callososeptal junction. Scattered lesions are also seen within the brainstem and cerebellum.No edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra axial fluid collection is detected. Ventricular size and morphology are within normal limits. Brain parenchymal volume is grossly preserved.Cervical spine:Multiple patchy and ill-defined areas of abnormal spinal cord T2 hyperintensity are seen. The lesions are primarily evident beginning at C3 and continuing through C6.Spinal alignment is grossly anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen.C2-3: Left facet arthropathy. Mild left foraminal narrowing. C3-4: Facet arthropathy. Mild bilateral foraminal narrowing. C4-5: Facet arthropathy. Small left paracentral disc protrusion. No significant spinal canal or foraminal compromise. C5-6: Facet arthropathy. Tiny central disc protrusion. Moderate right foraminal narrowing. C6-7: Facet arthropathy. Mild generalized posterior disc-osteophyte complex formation. No significant spinal canal compromise. Mild bilateral foraminal narrowing. C7-T1: No significant spinal canal or foraminal compromise.", "output": "1.Multiple lesions are evident within the cerebral hemispheres, brainstem and cerebellum suggestive of demyelinating disease.2.Multiple lesions are also seen within the visualized spinal cord also suggestive of demyelinating disease.3.Mild multilevel degenerative findings are evident in the cervical spine as discussed above."}
{"instruction": "Generate impression based on findings.", "input": "76 year old female with IPH. Evaluate for cervical fracture. Brain:There are postoperative findings related to left craniotomy. There is residual subdural blood product along the left hemisphere which is hyperintense on T1 and T2 weighted images and which was isoattenuating on the prior CT. This collection, likely representing subacute subdural blood, measures up to 10 mm in thickness similar to prior study. A more recent subdural hematoma along the left interhemispheric falx which demonstrates intermediate T1 signal and hypointense T2 signal measuring a maximum of 16 mm in thickness in the left occipital region is also unchanged from recent CT. Accounting for differences in technique, the left temporal parenchymal hematomas appear essentially identical to recent CT and the degree of vasogenic edema seems to be similar as well. There is generalized mass effect with effacement of the left lateral ventricle and right midline shift of approximately 5 mm, all unchanged. There is probably a small amount of layering blood product in the right occipital horn of the lateral ventricle which appears to have been present on prior study although was not as conspicuous at that time. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is persistent opacification of the right maxillary sinus with an air-fluid level. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Cervical Spine:Susceptibility artifact is seen related to orthopedic instrumentation which appears to be centered at C5/6 and C6/7 disk spaces. The spine alignment is straightened. The bone marrow signal is unremarkable. There is mild STIR hyperintensity within the soft tissues of the upper neck along the nuchal ligament. There is fluid along the oral cavity and hypopharynx which is likely related to ET tube placement. A congenital narrowness of the spinal canal is seen, with level specific degenerative changes as listed below: At C2-C3, there is no significant compromise to the spinal cord or neural foramina. At C3-C4, there is likely thickening of the posterior longitudinal ligament and suggestion of a central disk protrusion with no significant cord impingement. The neural foramina are patent bilaterally. At C4-C5, there appears to be thickening of the posterior longitudinal ligament or disk osteophyte formation and ligamentum flavum hypertrophy associated with significant narrowing of the spinal canal and what appears to be a chronic thinning of the cord. There is mild left neural foraminal narrowing.At C5-C6, there also appears to be thickening of the posterior longitudinal ligament or disk osteophyte formation which causes generalized spinal canal narrowing and also what appears to be chronic thinning of the cord. There is mild neural foraminal narrowing bilaterally. At C6-C7, there is mild generalized spinal canal and neural foraminal narrowing. At C7-T1, there is no significant compromise to the spinal cord or neural foramina.", "output": "1. Stable left temporal lobe parenchymal hematomas which are probably relatively acute given the MRI signal characteristics. 2. Stable acute to early subacute parafalcine subdural hematoma on the left. 3. Stable somewhat older likely subacute subdural hematoma along the left lateral temporal lobe. 4. There is stable generalized mass effect and midline shift. 5. There is minimal layering blood product within the right occipital horn. 6. There is evidence of prior surgery in the cervical spine. 7. There is congenital narrowing of the spinal canal which is exacerbated at several levels by either posterior longitudinal ligament thickening, disk protrusion, or la combination of both. The cord seems to be thinned chronically at these levels. 8. No definite trauma of the cervical spine. "}
{"instruction": "Generate impression based on findings.", "input": "Female 29 years old; Reason: right knee anterior pain, multiple patellar realignment procedures. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: No abnormal bone marrow signal. There is marked thinning of the articular cartilage of the patellofemoral joint. the cartilage of the femorotibial compartments are intact.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL", "output": "1.Marked chondromalacia of the patellofemoral cartilage.2.Postsurgical changes within the prepatellar subcutaneous tissues likely from the multiple patellar realignment procedures."}
{"instruction": "Generate impression based on findings.", "input": "69 year-old female with altered mental status, dysarthria, pronator drift. Evaluate for acute stroke. There is no CT evidence of acute territorial ischemia. There are patchy areas of hypodensity within the subcortical, deep, and periventricular white matter that are nonspecific, however most commonly small vessel ischemic disease of indeterminate age. If there is a high index of suspicion for acute infarct, MRI would be more sensitive.The ventricles and sulci are mildly prominent, likely due to age-related volume loss. There is no acute intracranial hemorrhage or extraaxial collection. There is no midline shift or basal cistern effacement.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are clear.There is moderate atherosclerotic calcification of the intracranial vessels.", "output": "1.No CT evidence of acute territorial ischemia. MRI would be more sensitive for acute infarction if there is strong clinical suspicion for acute infarct. 2.Moderate chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": " Cervical spine:There is slight reversal of upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The left thyroid lobe is only partially imaged, yet appears signal heterogeneous and enlarged with slight displacement of the airway right laterally. This most likely represents goiter which could be more thoroughly evaluated with a neck CT.C2/3: Posterior osteophyte disc complex and bilateral facet hypertrophy. There is mild bilateral neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, uncinate hypertrophy, and facet hypertrophy. There is mild central and moderate to severe bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex with an extruded disc component (extending superiorly). There is also bilateral uncinate hypertrophy and facet hypertrophy. There is mild-to-moderate central and moderate to severe bilateral neural foraminal stenosis. There is subtle T2 cord hyperintensity suggestive of myelopathy.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and facet hypertrophy. There is mild left neural foraminal and severe right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex without stenosis.C7/T1: Minimal disc bulge without stenosis.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. T1/2 demonstrates facet hypertrophy and mild bilateral neural foraminal stenosis.T2/3 demonstrates left facet hypertrophy and mild left neural foraminal stenosis.T3/4 demonstrates facet hypertrophy with moderate left and severe right neural foraminal stenosis.T4/5 demonstrates left facet hypertrophy with moderate to severe left neural foraminal stenosis.T5/6 demonstrates left facet hypertrophy with moderate left neural foraminal stenosis.T6/7 demonstrates left facet hypertrophy with mild to moderate left neural foraminal stenosis. There is also a small central disc protrusion causing anterior cord flattening without intrinsic cord signal abnormality.T7/8 demonstrates a small right paracentral disc protrusion causing slight anterior hemicord flattening without intrinsic cord signal abnormality.T8/9 demonstrates disc bulge and facet hypertrophy. There is slight anterior hemicord flattening without intrinsic cord signal abnormality. There is severe bilateral neural foraminal stenosis.T9/10 demonstrates a small right paracentral disc protrusion causing minimal anterior right hemicord flattening without intrinsic cord signal abnormality. There is also facet hypertrophy. There is mild bilateral neural foraminal stenosis.T10/11 demonstrates disc bulge and herniation causing deformation of the spinal cord with associated intrinsic T2 cord signal abnormality suggestive of myelopathy. There is also facet hypertrophy. There is severe central and mild bilateral neural foraminal stenosis.T11/12 demonstrates asymmetric bulge to the right causing mild left and moderate right neural foraminal stenosis.T12/L1 demonstrates disc bulge and bilateral facet hypertrophy. There is mild bilateral neural foraminal stenosis.", "output": "1.The left thyroid lobe is only partially imaged, yet appears signal heterogeneous and enlarged with slight displacement of the airway right laterally. This most likely represents goiter which could be more thoroughly evaluated with a neck CT.2.Multilevel cervical spine stenoses, worse at C4/5 where there is posterior osteophyte disc complex including an extruded disc component (extending superiorly). There is mild-to-moderate central and moderate to severe bilateral neural foraminal stenosis. There is subtle T2 cord hyperintensity suggestive of myelopathy.3. Multilevel thoracic spine stenoses, worse at T10/11 where disc bulge and herniation cause deformation of the spinal cord with associated intrinsic T2 cord signal abnormality suggestive of myelopathy. There is severe central and mild bilateral neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out tethered cord. Signs and symptoms: Constipation. Nonenhanced lumbar MRI:There is normal anatomical development of lumbosacral spine and the normal anatomical alignment.No evidence of spinal stenosis or neural foraminal compromise at any level. There is normal signal intensity and caliber of the lowest most visualized thoracic cord and, conus and the cauda equina. There is normal anatomical termination of the cord at L1-L2 level.There is normal anterior movement of the lower cord, conus and proximal cauda equina on prone sagittal T2-weighted series.Perispinal soft tissues are unremarkable. The bladder is full and expanded and with evidence of mild generalized thickening of the bladder wall.", "output": "1.Unremarkable nonenhanced lumbar MRI and in particular no evidence of tethered cord.2.Bladder is full and expanded and demonstrate mild diffuse wall thickening."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male with history of neuroendocrine carcinoid now experiencing flushing and hot flashes. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Loss of signal on opposed phased images diffusely, compatible with hepatic steatosis. No biliary ductal dilation.SPLEEN: Small splenules redemonstrated. Occlusion of the splenic vein is redemonstrated.PANCREAS: 13 x 18 mm T2 hyperintense lesion at the posterior aspect of the pancreatic tail demonstrating restricted diffusion and enhancement, suspicious for neuroendocrine tumor given the provided history (series 901/223 and 701/343). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No pathologically enlarged lymph nodes by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "13 x 18 mm lesion in the pancreatic tail as described, suspicious for neuroendocrine tumor given the provided history."}
{"instruction": "Generate impression based on findings.", "input": "Male, 16 years old, history of neurofibromatosis type II with acoustic neuroma and intracranial meningiomas, spinal cord lesions, status post cervical tumor debulking. Brain:Sequela of multiple prior craniotomies are again seen. Scattered areas of encephalomalacia in both frontal lobes are unchanged. The CSF space along the left lateral cerebellar hemisphere remains widened similar to prior.No restricted diffusion or parenchymal edema is suspected. No new intracranial hemorrhage or extra-axial collections are seen. Scattered areas of susceptibility artifact are unchanged and likely reflect a combination of calcification and chronic blood product. Ventricular size and morphology are stable.Multiple intracranial masses are demonstrated with details as follows:1. A bulky right CP angle/IAC tumor seems to slightly increased in size, at least along its inferior aspect, where it measures 34 x 22 mm (image 8 series 201) previously 32 x 20 mm.2. A left CP angle tumor also seems to have increased slightly in size measuring 16 x 10 mm (image 9 series 2 on), previously 12 x 8 mm.3. Residual enhancing tumor along the surgically altered left IAC and within the temporal bone centered at the geniculate ganglion may be slightly more prominent than on the prior examination, but comparison is difficult due to differences in technique.4. Tumor along the bilateral cisternal trigeminal nerves, with probable involvement of the cavernous sinuses, is unchanged.5. A small intraconal mass along the left lateral rectus muscle has probably not significantly changed.6. A tumor along the planum sphenoidale is at most minimally enlarged measuring 18 x 14 mm (image 34 series 302), previously 17 x 12 mm.7. Enhancing lesions in the left parietal scalp and right suboccipital scalp are not convincingly changed.8. A cystic and solid lesion with mild associated enhancement in the left brachium pontis is minimally increased in size with slightly more prominent enhancement.Spine:Postop findings are again seen with evidence of multilevel cervical laminectomy and partial resection of a cervical spinal cord tumor. Since the prior examination, postoperative findings including fluid and air within the soft tissue resection bed have resolved. T2 hyperintensity extending through the cervical cord has also significantly improved with only mild residual scattered T2 hyperintensity.Nodular intramedullary tumor at the cervicomedullary junction has slightly increased in size now measuring 20 x 16 mm in cross-sectional dimensions, previously 19 x 14 mm.Numerous enhancing tumors are seen along the cervical nerve roots including small lesions along the intradural portions of the nerves, for example at the C3 level on the left, at the C1-2 level bilaterally and along the foramen magnum on the left. These lesions were present on the prior examination but are better seen on today's study which could reflect differences in technique or very slight increased size.Also redemonstrated are bulky foraminal tumors which expand the neural foramina bilaterally beginning with the C5-6 neural foramina and continuing down. The lesion on the left at C5-6 projects from the foramen into the intradural space. All these lesions appears slightly larger than on the prior exam.In the thoracic region, a very bulky foraminal and extraforaminal tumor on the right at T2-3 has increased in size now measuring 54 x 33 mm (image 20 on series 4101) previously 47 x 32 mm. An intramedullary tumor at the T6 level has increased slightly in size. Two or three small extramedullary intradural nodules on the left at the T6 level have not convincingly changed. Additional small intradural nodules at lower thoracic levels have not significantly changed.Innumerable small nodules along the nerve roots of the cauda equina are seen. Some of these may be mildly increased in size relative to the prior examination, but overall, there has been no substantial change. A nodule along the lumbar plexus on the right at the L4 level is probably mildly increased in size measuring up to 14 mm in thickness, previously 12 mm.", "output": "1. Multiple intra-cranial masses are redemonstrated representing a mixture of presumed schwannomas and meningiomas. Most of these lesions demonstrate a mild interval increase in size. 2. An intramedullary lesion within the left brachium pontis may be minimally larger with slightly more prominent enhancement. 3. Redemonstration of findings related to partial resection of a tumor from the upper spinal cord. Residual nodular tumor at the cervicomedullary junction has increased in size.4. Scattered innumerable intradural, foraminal and extraforaminal tumors are redemonstrated throughout the spine, many of which have increased slightly in size.5. An intramedullary lesion at the T6 level has also increased in size."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old man with history of acute cholecystitis status post cholecystostomy 9/27, continued increase in bilirubinemia. ABDOMEN:LIVER, BILIARY TRACT: There is a subcentimeter cyst in segment 4, otherwise no focal hepatic lesion. The liver is otherwise normal in signal and morphology.Patient is status post cholecystostomy with decompressed gallbladder. The gallbladder wall still thickened and edematous measuring up to 1 cm. There is no intra or extrahepatic biliary ductal dilatation. The ducts are smooth without intraluminal filling defect or evidence of extrinsic compression.SPLEEN: Multiple round mildly T1 hyperintense, T2 isointense lesions with mild enhancement compatible with known history of lymphoma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are normal. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral pleural effusions.", "output": "1.Cholecystostomy with collapsed but edematous gallbladder compatible with decompressed acute cholecystitis.2.No intra or extrahepatic biliary ductal dilatation, intraluminal filling defect, or evidence of extrinsic compression of the bile duct.3.Splenic lymphomatous lesions, previously demonstrated on imaging."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for osteochondral defect of the talar dome. Right ankle pain. TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: The cartilage appears intact. There is an osteochondral lesion at the anterior medial aspect of the talar dome that is hypointense on T1 and hyperintense on T2, with an adjacent subchondral cyst within the medial malleolus. Mild bone marrow edema is identified within the anterior talus and middle cuneiform.ADDITIONAL", "output": "Osteochondral defect at the talar dome and bone marrow edema involving the base of the talus and middle cuneiform."}
{"instruction": "Generate impression based on findings.", "input": "Male 30 years old Reason: US shows new 1.7 cm segment 2 lesion History: hep B, hemangiomas ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are at least 3 T2 hyperintense lesions involving the right hepatic lobe the largest measuring 1.3 x 1.3 cm on image 47 of series 8. The lesions show peripheral nodular discontinuous enhancement which fill-in over time, compatible with hemangiomas. A subcentimeter lesion near the anterior aspect of the right hepatic lobe in segment 8 as seen on image 227/series 9 is too small to characterize. No suspicious hepatic lesions are identified. Multiple small polypoid lesions within the gallbladder adherent to the wall likely represent small gallbladder wall polyps.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.3 right hepatic lobe lesions with imaging features compatible with small hemangiomas. No suspicious hepatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with history of partial left nephrectomy for renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense lesions are benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes in the left kidney of partial nephrectomy.There is a 1.2 cm cystic lesion within the interpolar region of the left kidney with layering high T1 material and no significant enhancement compatible with a benign cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Status post bilateral breast augmentation.", "output": "1.Postoperative changes in the left kidney with no evidence of disease recurrence. 2.Stable left interpolar benign cyst."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with pain, evaluate for TFCC tear LIGAMENTS: Evaluation of the intrinsic ligaments of the wrist is limited due to lack of intra-articular contrast. No discrete fluid-filled tear of either ligament is evident.TRIANGULAR FIBROCARTILAGE COMPLEX: No fluid-filled tear is evident. However, there is intermediate signal along the undersurface of the disc suggesting degeneration. Heterogeneity of the fibers of the TFCC adjacent to the ulnar styloid is suggestive of degeneration and/or synovitis.TENDONS: Mild surface irregularity of the tendons of the first dorsal compartment with minimal fluid surrounding the tendons may reflect partial tearing and/or tenosynovitis of questionable current clinical significance. Increased signal along the extensor digitorum tendons dorsal to the the radius may reflect mild tenosynovitis, also of questionable current clinical significance. Volar bowing of the flexor retinaculum probably reflects prior carpal tunnel release.BONES: Small cysts are noted within the proximal pole of the scaphoid and trapezium, likely degenerative. ADDITIONAL", "output": "1.Findings suggestive of degeneration/proximal surface fraying of the TFCC articular disk without discrete fluid-filled tear.2.Mild synovitis and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "47 years, Female, leg weakness. Multiple sclerosis, evaluate for progression. Brain: There is a T2/FLAIR hyperintense lesion involving the juxtacortical white matter of the right posterior frontal lobe as well as along the medial cortical surface. There is also a juxtacortical lesion along the left intraparietal sulcus. There is also a lesion along the undersurface of the corpus callosum adjacent to the right frontal horn as well as along the inferior aspect of the callosal splenium on the. Additional periventricular lesion is seen adjacent to the right temporal horn. Asymmetric FLAIR hyperintensity along the right medial aspect of the right middle cerebellar peduncle is also unchanged. Allowing for slight differences in technique, there is no definite evidence of a new lesion compared to prior MRI from 1/21/2014. Brain parenchymal volume is preserved. T1 hyperintensity is noted associated with the right frontal and right medial temporal lesions. No intracranial mass or mass effect is identified. Ventricles and sulci are within normal limits. Calvarium and extracranial soft tissues are grossly unremarkable.Thoracic spine: There are multiple T2/STIR hyperintense lesions in the thoracic cord. There is a lesion involving the left hemicord at the T5 level with mild associated volume loss and present previously. Small lesion is suspected at the left dorsal T1 level, not definitively seen on prior study. There is a small left T3-T4 lesion which appears to be present on prior. There is a lesion extending from T6 to T7 levels not definitively seen on prior.Vertebral body heights and alignment in the thoracic spine are normal. Minimal degenerative changes are seen without significant spinal canal or neural foraminal stenosis. Small left paracentral disc protrusion at the T5 level is noted.Partially imaged cervical spine demonstrates diminished changes with multiple disc bulges at C3-C4, C4-C5, C5-C6, and C6-C7. There is moderate associated associated canal stenosis.", "output": "1. Multiple T2/FLAIR hyperintense lesions including the juxtacortical and periventricular white matter as described above are not significantly changed allowing for slight differences in technique compared to 1/21/2014. The morphology and distribution of these lesions is consistent with known demyelinating disease. No new lesion is definitively appreciated in the brain.2. Multiple T2/STIR hyperintense lesions in the thoracic cord consistent with known demyelinating disease. Left T5 lesion was seen on prior studies and is associated with mild volume loss. There are additional smaller lesions, which are described above, not definitively seen on prior, and suspected to represent progression of disease since 1/21/2014.3. Degenerative changes in the cervical spine with multiple disc bulges including C3-C4, C4-C5, C5-C6, and C6-C7. There is at least moderate associated spinal canal stenosis, which can be better assessed with a dedicated cervical spine MRI study."}
{"instruction": "Generate impression based on findings.", "input": "Brachial neuritis or radiculitis. Intermittent right C4 radiculopathy The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal. There are right sided uncovertebral osteophytes at this level associated with disk material which narrow the right neural foramen and encroach on the right sided exiting nerve roots. T1 signal hyperintensity with minimal T2STIR hyperintensity adjacent to the right sided uncovertebral hypertrophy suggests chronic stage of endplate reaction possibly with a minor subacute component.At C5-6 there is no significant compromise to the spinal canal. There are subtle right sided uncovertebral osteophytes at this level associated with adjacent T2 STIR hyperintensity and T1 hypointensity suggesting subacute stage of inflammatory reaction. There is mild narrowing of the right neural foramen. There is minimal posterior ligamentous hypertrophy at this level.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.", "output": "1.There are uncovertebral osteophytes at C4-5 encroaching the right sided exiting nerve roots (right C4 nerve roots) with associated with chronic and possibly some subacute inflammatory changes.2.There is mild narrowing of the right neural foramen at C5-6 associated with subacute inflammatory change (more inflammatory change than at C4-5 but smaller osteophytes)."}
{"instruction": "Generate impression based on findings.", "input": "60 year old with coronary artery disease s/p PCI, HTN, dyslipidemia, smoking history and peripheral artery disease presenting for evaluation for ischemia. MEDICATIONS: aspirin, amlodipine, atorvastatin, carvedilol, hydrochlorothiazide First Pass PerfusionDuring hyperemia, there were perfusion defects present in the (1) apical anterior, septal, and inferior walls; (2) mid inferior, inferoseptal, anteroseptal, anterior, and anterolateral walls; (3) and in the basal anterior, anterolateral, inferior and inferoseptal walls.Viability/ Myocardial ScarThere are 3 distinct areas with late gadolinium enhancement. The first is a non-transmural myocardial infarction involving the basal to mid inferoseptum, this territory has an intermediate probability of viability. The second is a non-transmural myocardial infarction involving the mid to apical anterior wall, this territory has an intermediate probability viability. The third is a transmural patch of late gadolinium enhancement in the basal inferolateral wall. Because the late gadolinium enhancement is associated with hypertrophy rather than thinning, it is likely not due to a myocardial infarction and suggests the presence of an infiltrative or inflammatory process. This territory is also not likely to be viable. The remainder of the myocardium (which is a substantial amount of myocardium) is free of late gadolinium enhancement and likely to be viable. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function with moderate concentric left ventricular hypertrophy. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 149 ml/m2 (normal range: 74+/-15), the LVEDV is 336 ml (normal range 142+/-34), the LV end systolic volume index is 87 ml/m2 (normal range 25+/-9), the LVESV is 195 ml (normal range 47+/-19), the LV mass index is 98 g/m2, and the LV mass is 222 g. There is global hypokinesis which is worst in the basal to mid inferior wall. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 77 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 mild 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 FindingsSmall (<1mm) axillary lymph nodes present. 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. There is an extensive amount of ischemia in a multi-vessel coronary distribution as described above. 2. There is an extensive amount of myocardial viability. Aside from the two above described non-transmural myocardial infarctions, much of the remainder of the myocardium is viable.3. There is an atypical pattern of late gadolinium enhancement involving the basal inferolateral wall suggesting the presence of a concomitant non-ischemic (possibly infiltrative or inflammatory) myocardial process.4. Severe LV dilation with mildly reduced systolic function (LVEF 42%) with global hypokinesis, most pronounced in the basal to mid inferior wall.5. Normal RV size with mildly reduced systolic function (RVEF 48%).6. Severe 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": "18-year-old female with previously treated right forearm venous malformation, now with recurrent symptoms. Question recanalized malformation versus persistent anomalous vessels. There is a lesion extending from the mid distal anterolateral aspect of the forearm to the proximal first carpal row with an exuberantly serpiginous and dilated appearance. This lesion measures approximately 2.0 x 2.2 cm (series 6, image 21) and 15.2 cm long (series 4, image 15). The lesion contains increased T2 signal and decreased T1 signal and enhances after contrast administration, suggestive of a vascular or lymphatic malformation. There appears to be infiltration into the superior and deep muscles of the forearm. The lesion also traverses through the flexor tendons, for example completely surrounding the flexor pollicis longus tendon (series 6, image 14).", "output": "Vascular or lymphatic malformation of the mid distal forearm to the proximal carpal bones."}
{"instruction": "Generate impression based on findings.", "input": "Female, 37 years old, with intractable headache. Approximately 10 T2 hyperintense lesions are identified located predominantly in the periventricular regions and corpus callosum, though there are several in the juxtacortical white matter as well. The largest lesion is within the left centrum semiovale. Several lesions demonstrate a radial orientation with respect to the ventricles. The remainder of the brain demonstrates relatively normal morphology. No evidence of significant parenchymal edema or mass effect is seen. Overall parenchymal volume is within acceptable limits. No abnormal extra-axial collections are detected. The ventricular system is normal in size and morphology.On MRA imaging of the head, no significant intracranial vascular stenosis or occlusion is identified. No aneurysms are suspected. The region of the ACOM artery is within normal limits. Large bilateral PCOM arteries are seen. The right P1 segment is hypoplastic.", "output": "1. Multiple white matter lesions are seen with a distribution and morphology which are highly suggestive of demyelinating disease, though other etiologies including gliosis, sequelae of prior inflammation, and vasculitis can be entertained.2. No significant vascular abnormality is detected.3. No prior examination is available at the time of this dictation. If prior exams can be made available, we will be happy to compare and make an addendum to this report."}
{"instruction": "Generate impression based on findings.", "input": "Neck and arm pain, C6 distribution weakness, left upper extremity. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis with apex at the C4-C5 level. Alignment is otherwise maintained. There is nonspecific subcentimeter focus of low T1 and T2 signal involving the anterior inferior aspect of the C6 vertebral body with adjacent T2 hyperintensity which may be on a degenerative basis but not well evaluated by MRI.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex with mild effacement of the ventral thecal sac. There is moderate narrowing of the left neural foramen related to uncovertebral hypertrophy and facet arthropathy. Overall no significant spinal canal or right neural foraminal stenosis.C4-5: Small disc osteophyte complex with effacement of the ventral thecal sac. There is mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. Overall no significant stenosis of the spinal canal or right neural foramen.C5-6: Small disc osteophyte complex with effacement of the ventral thecal sac. There is mild to moderate left neural foraminal narrowing related to uncovertebral hypertrophy and minimal right neural foraminal narrowing. Overall no significant spinal canal stenosis.C6-7: Small disc osteophyte complex with partial effacement of the ventral thecal sac. There is mild to moderate left neural foraminal narrowing related to uncovertebral hypertrophy. Overall no significant spinal canal stenosis or right neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "1. Multilevel degenerative changes in the cervical spine. There is varying mild to moderate degrees of neural foraminal narrowing on the left as detailed above.2. There is partial effacement of the ventral thecal sac related to small disc osteophyte complexes and reversal of cervical lordosis. Dorsal thecal sac remains patent without significant spinal canal stenosis overall at any level. "}
{"instruction": "Generate impression based on findings.", "input": "40yoF with congenital nystagmus, episodical tinnitus, history of 3.5 month prematurity presenting with dizziness episodes and has upper motor neuron signs on The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. The pituitary stalk measures up to 2 mm in thickens. There is no diffusion abnormality. There is no acute intracranial hemorrhage. No extra-axial fluid collection is identified.The meatal loop of the right anterior inferior cerebellar artery extends far into the right internal auditory canal. The bilateral vestibulocochlear nerves are intact.", "output": "1. Normal non contrast brain MR.2. The meatal loop of the right anterior inferior cerebellar artery extends far into the right internal auditory canal.3. The pituitary stalk is at the upper limit of normal for thickness."}
{"instruction": "Generate impression based on findings.", "input": "58 year old female. Right breast lumpectomy in 2/2001 for invasive mammary carcinoma. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable postsurgical scarring in the right breast upper outer quadrant. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No interval change or MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "78 years Female (DOB:6/5/1937)Reason: evaluate for radiculopathy History: right sciatica, chronic and severePROVIDER/ATTENDING NAME: REEM H JAN DAVID L PITRAK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is mild loss of vertebral body height at L2 and L1. There is some superior endplate compression at L2. These mild compressions were also present on the CT of the abdomen from 11/25/2014 and do not appear to have changed. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. There is encroachment of the nerve roots at the lateral recesses. There is narrowing of the neural foramina as a result of disc material which is worse on the right side where there is encroachment of the right-sided exiting nerve roots within the neural foramina. There are endplate reactive changes at this level which are bright on T2 and dark on T1 suggestive of subacute change.At L4-5 there is loss of disc space height, disc desiccation and a diffuse disc bulge. There are endplate reactive changes which are bright on T1 and T2 at this level. This suggests chronic change. There is bilateral facet and ligamentum flavum hypertrophy at this level. There is effacement of the fat at the lateral recesses bilaterally at this level. Overall there is a moderate degree of spinal stenosis present. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with ligamentum flavum hypertrophy. Is no significant compromise to the spinal canal or neural foramina. There is mild narrowing of the spinal canalAt L2-3 there is no significant compromise to spinal canal or neural foramina. There are Schmorl's nodes at this level. There is some mild loss of disc space height, disc desiccation and diffuse disc bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are multiple cysts present in both kidneys. Some of them have low signal intensity on T1 and some are heterogeneous.", "output": "1.There are multilevel degenerative changes present in the lumbar spine with moderate spinal stenosis at L4-5 and encroachment of the right-sided exiting nerve roots at L5-S1. There are subacute endplate reactive changes present at L5-S1.2.There is mild loss of vertebral body height at L2 and L3 which has been present on prior exams3.Multiple renal cystic lesions are present. Some are suspected to contain blood products. Please refer to ultrasound from 3/29/2016 for further comments."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: LumbagoDiagnosis Edits: Clinical question: low back painSigns and Symptoms: low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a conjoined right-sided nerve root sleeve present at this level. There is a left far lateral disc protrusion at this level which displaces the left-sided exiting nerve root as it exits the neural foramen. Compared to the previous exam this has not changed substantially. There is a subtle pars defect on the right side at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and endplate reactive change present at this level. There is a broad-based right far lateral disc protrusion at this level which mildly displaces the right-sided exiting nerve root after it exits the neural foramen. Overall these findings have not changed since the prior examAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "There are degenerative changes present in the lumbar spine which are stable when compared to the exam from last year. There are far lateral disc protrusions on the left side at L5-S1 and on the right side at L4-5 which mildly displaces the exiting nerve roots as the exit their respective neural foramina."}
{"instruction": "Generate impression based on findings.", "input": " There is no acute infarct, mass, or cerebral edema. There are scattered periventricular and subcortical white matter T2 hyperintensities which are nonspecific, and likely represent chronic microvascular ischemic changes. The ventricles and basal cisterns are unchanged with apparent absence of the septum pellucidum. The optic chiasm and the optic nerves appear diminutive, most prominent the left optic nerve. The corpus callosum is fully formed, however there are focal areas of thinning best appreciated on the sagittal images. These findings suggest presence of a midline developmental anomaly, such as septo-optic dysplasia.There is no midline shift or herniation. There are few mucous retention cysts in the nasal cavity. The skull and extracranial soft tissues are unremarkable.", "output": "1.No acute infarct or mass effect.2.Mild chronic microvascular ischemic changes.3.Findings suspicious for septo-optic dysplasia."}
{"instruction": "Generate impression based on findings.", "input": "70 year old man with history of recent diagnosis of cardiomyopathy with EF of 20% and no obstructive coronary disease by angiography, now referred for cardiac MRI to assess for possible etiologies as part of an advanced HF therapies evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 194 ml/m2 (normal range: 74+/-15), the LVEDV is 438 ml (normal range 142+/-34), the LV end systolic volume index is 163 ml/m2 (normal range 25+/-9), the LVESV is 368 ml (normal range 47+/-19), the LV mass index is 99 g/m2 (normal range 85+/-15), and the LV mass is 224 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is transmural late gadolinium enhancement in the inferoapical, anteroapical and true apex with thinning suggestive of previous infarction. There is transmural late gadolinium enhancement in the basal inferolateral wall. There is no LV thrombus. In a 4-chamber view there outpouching at the apex compatible with apical aneurysm. Left AtriumThe left atrium is severely dilated. The interatrial septum is thickened.Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. There is severe hypokinesia of the apical one half of the right ventricle. The basal one half demonstrates moderate to severe hypokinesia. The overall RV ejection fraction is 13%, the RV end diastolic volume index is 157 ml/m2 (normal range 82+/-16), the RVEDV is 355 ml (normal range 142+/-31), the RV end systolic volume index is 136 ml/m2 (normal range 31+/-9), and the RVESV is 307 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 leaflets are tethered. There is at least moderate mitral regurgitation which appears eccentric. Pulmonic ValveThe pulmonic valve opens widely. There is pulmonary regurgitation, visually this appears trace or mild.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The ascending aorta measures 37mm at the level of pulmonary artery bifurcation. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated (38mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere are bilateral shoulder prostheses present. A portion of the splenic flexure is visualized. There is evidence of diverticulosis without diverticulitis.", "output": "1. Severely dilated left ventricle with severely reduced systolic function (EF = 16%). 2. There is thinning of the apex with transmural late gadolinium enhancement suggestive of previous infarction. This speaks to an ischemic component to his cardiomyopathy. 3. Suspected left ventricular apical aneurysm. 4. Severely dilated right ventricle with severely reduced systolic function (EF = 13%).5. Mitral leaflet tethering with at least moderate mitral regurgitation. 6. Dilated pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "History of diarrhea and abdominal pain, evaluate small bowel for evidence of Crohn's disease. 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: The small and large bowel are normal in caliber without evidence of obstruction. There is increased fibrofatty proliferation involving the proximal small bowel mesentery. An approximately 6 cm segment of terminal ileum demonstrates mild luminal narrowing without upstream bowel dilation, mild bowel wall thickening, restricted diffusion, and mildly increased wall enhancement compatible with active inflammation. The remaining small and large bowel are unremarkable in appearance. No fistula or fluid collections are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mild stenosis and active inflammation involving an approximately 6 cm segment of terminal ileum without associated obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Malignant neoplasm of bladder, unspecified Joint derangement, unspecifiedClinical question: 69 y/o female with met urothelial cancer, c/o finger locking, new visual deficit. EvaluateSigns and Symptoms: finger locking, numbness in hand, visual deficit MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .", "output": "1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No evidence for brain metastases.3.No orbital mass or lesion along the visual pathway is appreciated."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: 69-year-old male with head/neck cancer; evaluate for metastases or any abnormality. Signs and symptoms: Confusion. Pre-and post enhanced brain MRI:No acute intracranial process and negative diffusion-weighted images.Examination demonstrates few tiny foci of FLAIR and T2 hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres which are nonspecific and demonstrate no enhancement. This appearance however often represent microvascular ischemic changes.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is within normal otherwise. Examination also fail to demonstrate any abnormal enhancement of brain parenchyma, meninges, calvarium or the retropatellar spaces to suggest metastatic disease.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal and within normal pattern of enhancement.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.", "output": "1.No acute intracranial process and negative diffusion weighted series.2.Findings suggestive of minimal chronic small vessel ischemic strokes.3.Unremarkable pre and post enhanced brain MRI otherwise and in particular without evidence of metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for foraminal stenosis and disk protrusion. Signs and symptoms: Right foot numbness and pain. Nonenhanced lumbar MRI:T12 -- L1 demonstrate mild changes unremarkable otherwise.L1 -- L2 demonstrate mild degenerative changes and unremarkable otherwise.L2 -- L3 demonstrate mild this disease and mild to moderate bilateral ligamentum flavum hypertrophy however without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disk disease and moderate bilateral ligamentum flavum hypertrophy. No spinal stenosis or neuroforaminal compromise.L4 -- L5 demonstrate advanced disk disease with significant loss of disk height, significant right and moderate left ligamentum flavum hypertrophy and mild facet disease. There is no convincing evidence of central spinal stenosis. Asymmetric right-sided ligamentum flavum hypertrophy protrudes into the right neural foraminal with resultant moderate foraminal compromise. Patent left neural foramina.L5 -- S1 demonstrate moderate disk disease and loss of disk height, moderate left facet and moderate bilateral ligamentum flavum hypertrophy. There is a broad-based central and rightward disk protrusion projecting into the epidural space and without significant mass effect on the thecal sac. It results in significant right lateral recess compromise. There is also moderate bilateral neural foraminal compromise secondary to hypertrophic changes of posterior elements.", "output": "1.Degenerative changes primarily centered at L4 -- 5 and L5 -- S1 levels however without evidence of central spinal stenosis. There are moderate bilateral neural foraminal compromise at L5/S1 level and a broad-based central and rightward disk protrusion with resultant significant right lateral recess compromise. Moderate right neuroforaminal compromise at L4 -- 5. 2.Mild degenerative changes at other levels as detailed per level above."}
{"instruction": "Generate impression based on findings.", "input": "59 year old male with history of sarcoid by LN biopsy, aortic aneurysm repair s/p repair who presents for cardiac MRI for further evaluation of cardiac sarcoid involvement. Left VentricleThe left ventricle is normal in size and systolic function. No significant interval change is noted when compared to the previous cardiac MRI. The overall LV ejection fraction is 63% (compared to 61%), the LV end diastolic volume index is 85 ml/m2 (normal range: 74+/-15), the LVEDV is 198 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 119 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is linear, mid-myocardial late gadolinium enhancement in the basal inferior wall to suggest an underlying fibrosing, infiltrative, or inflammatory process. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 43 % (compared to 46%), the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 237 ml (normal range 142+/-31), the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9), and the RVESV is 135 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 trace 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 common origin of the innominate and left common carotid arteries. There has been a valve sparing interposition graft procedure. The anastomosis appears to terminate at the expected location of the sinotubular junction. The sinus of Valsalva is mildly dilated, stable at 44 mm using similar measurement technique by the same observer (nonorthogonal/axial technique). 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 pericardial effusion.Extracardiac FindingsLow lung volumes with perihilar increased signal compatible with patient's known pulmonary involvement with sarcoidosis. Stable perihilar lymphadenopathy. Splenomegaly.On the coronal scout images, a portion of the kidneys are included in the field-of-view. There is a right renal cyst with apparent solid exophytic component measuring 15 mm. Further evaluation with a dedicated renal ultrasound is recommended.", "output": "1. The left ventricle remains normal in size and systolic function (LVEF 63%, compared to 61%)2. The right ventricle remains normal in size and systolic function (RVEF 43%, compared to 46%)3. Stable linear, mid-myocardial late gadolinium enhancement in the basal inferior wall suggestive of myocardial involvement with sarcoidosis. 4. Postsurgical changes compatible with valve sparing interposition graft procedure of the ascending aorta. Stable ectasia of the sinus of Valsalva.5. On the coronal scout images, a portion of the kidneys are included in the field-of-view. There is a right renal cyst with apparent solid exophytic component measuring 15 mm. Further evaluation with a dedicated renal ultrasound is recommended. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Headache, migraine. MRI: The anterior portions of the images are somewhat degraded by dental brace artifacts. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. MRA: There is no evidence of significant proximal steno-occlusive lesions or aneurysms.", "output": "1. No evidence of intracranial demyelinating process, infectious lesions, or acute infarct, within the limits of dental brace artifacts.2. No evidence of significant steno-occlusive cerebrovascular lesions or aneurysms."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Slurred speechClinical question: strokeSigns and Symptoms: stroke MRI of the brainThere is a hematoma centered in the right frontal lobe involving the right middle and inferior frontal gyri which is associated with a vasogenic pattern of edema. There is shift of the septum pellucidum approximately 7 mm to the left of midline.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are punctate foci of T2 and FLAIR signal hyperintensity present in the brainstem.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.", "output": "1.There is a large hematoma centered in the right frontal lobe associated vasogenic edema and midline shift.2.Periventricular and subcortical white matter punctate lesions of a mild degree and punctate lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 3.There is no evidence for dural venous sinus thrombosis to explain the patient's hemorrhage.4.Etiology for the patient's right frontal lobe hemorrhage cannot be established on this exam. It's possible that an underlying mass or other cause may be masked by the sheer size of the hematoma."}
{"instruction": "Generate impression based on findings.", "input": "Reason: pt with adenoid cystic carcinoma. Evaluate for brain metastasis History: headache, nausea The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left temporal bone surgery and left parotid surgery. Some enhancing tissue at the surgical site was present on prior CT exams and is suspected to represent postoperative change.There is mild asymmetric enhancement along the left facial nerve compared to the right. Both left and right enhance to the same extent. The left look slightly thicker.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Some mild asymmetry in the enhancement along the left facial nerve may be related to postoperative change in the venous plexus but is non-specific. The possibility it represent early perineural spread cannot be excluded. Please correlate with clinical findings of the left facial nerve and if appropriate, a follow-up MRI would be helpful.2.The patient is status post left temporal bone surgery and left parotid surgery. Some enhancing tissue at the surgical site was present on prior CT exams and is suspected to represent postoperative change.3.No evidence for brain metastases."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 20 y.o. female with likely new onset ileal Crohn's disease. Please eval for signs of small bowel Crohns disease as well as abscess formation. Abd XR suspicious for obstruction. History: N/V with colonoscopy prep, abd XR concerning for SBO 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: There is an approximately 15 to 20 cm segment of narrowing with hyperenhancement and bowel wall thickening, likely corresponding to acute inflammation of a strictured segment. This segment of bowel and is approximately 10 cm from the ileocecal valve. The distal 10 cm of terminal ileum appear normal. Proximal to this segment of narrowing, there is severe small bowel dilatation up to 7.2 cm, consistent with obstruction. A large amount of stools present within the colon.Small mesenteric lymph nodes are noted. No abscesses or fistulas are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Narrowed 15 to 20 cm segment of distal ileum which ends 10 cm proximal to the ileocecal valve likely represents acute on chronic inflammation from Crohn's disease with stricture formation.2.Severely dilated and fecalized proximal small bowel, consistent with high-grade obstruction.Findings discussed with Dr. Rao at 4:30 PM on 5/12/2016."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Localized swelling, mass and lump, head Essential (primary) hypertensionDiagnosis Edits: |Clinical question: HISTORY OF RIGHT MANDIBLE MASSSigns and Symptoms: HISTORY OF RIGHT MANDIBLE MASS Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.There is a mass centered in the right mandible associated with contrast enhancement and some mild enlargement. There is disruption of the cortex along the right anterior lateral aspect of the mass with some mild protrusion of the mass through this defect. Masses high signal on T2 and low signal on T1 and without diffusion restriction. No flow voids are identified within the mass to suggest arteriovenous malformation.Within the visceral space the thyroid gland demonstrates multiple small nodules the largest one of which measures 9 x 12 mm axial dimensions. It is high signal on T2 and relatively lower signal on T1. The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. There are patchy high signal foci on T2 imaging in the brainstem which are most likely vascular related. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are multilevel degenerative changes present in the cervical spine with reversal of the normal cervical curvature at C3-4, loss of disc space height, disc desiccation and endplate and uncovertebral osteophytes resulting in encroachment of right-sided exiting nerve roots at C6-7 and C5-6 and some narrowing of the spinal canal due to endplate osteophytes at C3-4, C4-5 and C5-6 .MRA neck:The right inferior alveolar artery is asymmetrically larger than the left side and courses along the superior aspect of the mass. No convincing evidence for arteriovenous malformation. The anterior aspect of the mandible was not included on this exam.There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is fetal origin of the right posterior cerebral artery.", "output": "1.An expansile mass along the right mandible suspected represent a hemangioma. There is a small amount of extraosseous extension along the right anterolateral aspect of the mass. However, the entire mandible was not included on the MR angiogram. As a result of the convenience of the patient and noncontrast MRA of the mandible with specific attention this area would be helpful.2.Multiple thyroid nodules.3.Multilevel degenerative changes are present in the cervical spine."}
{"instruction": "Generate impression based on findings.", "input": "12-year-old male status post liver transplant 4/2015. Chronic elevation of transaminases with nodular contour of the liver seen on recent ultrasound. Evaluate for bile duct abnormalities and liver morphology.EXAMINATION: MRI MRCP with and without intravenous contrast 12/13/2016 The intrahepatic bile ducts are very straight. Focal narrowing of the common bile duct (series 901, image 55) with no intra or extrahepatic biliary ductal dilatation. The common bile duct proximal and distal to this area of narrowing measures 5 mm in caliber, normal.The liver demonstrates normal signal intensity. No focal hepatic lesions.The spleen is normal.The pancreas is normal.The adrenal glands are normal.The kidneys are normal.No free fluid.The soft tissues are normal.The lung bases are normal.Bone marrow signal intensity is normal.", "output": "Focal narrowing of the common bile duct with no intra or extrahepatic biliary ductal dilatation. This may be related to stenosis and a noncompliant biliary tree."}
{"instruction": "Generate impression based on findings.", "input": "Assess prepontine cistern for tuberculosis: history of potential TB meningitis, incompletely treated meningitis recently finished therapy. Now persistent headaches and photophobia. There is interval progression of leptomeningeal enhancement along the surface of the pons, medulla, basal cisterns, and along the surface of the cerebellum. There is also interval progression of high T2 signal with punctate foci of enhancement and mild susceptibility effect in the medial left thalamus. There are also scattered punctate foci in the white matter of the bilateral cerebral hemispheres, which are stable to perhaps slightly more conspicuous in some cases. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. There is redemonstration of an ovoid enhancing lesion in the right frontal calvarium that measures up to 12 mm, without associated soft tissue swelling.", "output": "1. Interval progression of leptomeningeal enhancement along the surface of the pons, medulla, basal cisterns, and along the surface of the cerebellum, which may represent tuberculous meningitis.2. Interval progression of high T2 signal with punctate foci of enhancement in the medial left thalamus may represent evolving tuberculous cerebritis. 3. Mild bilateral cerebral white matter hyperintensities are nonspecific.4. A right frontal calvarial lesion is nonspecific, but may also represent a manifestation of tuberculosis versus an atypical hemangioma. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Chiari malformation, status post decompression. Syrinx and developmental delay. Brain MRI:There is no abnormal diffusion restriction. A few prominent perivascular spaces are again noted in the brain. No abnormal signal to suggest a developmental abnormality is evident in the supratentorial brain. Stable postoperative changes of suboccipital craniectomy and removal of the posterior arch of C1 with resultant expanded CSF space at the foramen magnum. The cerebellar tonsils have a rounded/uncrowded morphology. Stable mild platybasia, dorsi flexion and invagination of the dens. The ventricles are stable in size with normal configuration.CSF flow study:There is good, stable to slightly improved, biphasic flow demonstrated anterior and posterior to the upper cervical cord. At the foramen magnum, flow remains attenuated anteriorly and barely detectable posteriorly. Cervical spine MRI:Examination demonstrates further interval decreased size of cervical syrinx with resultant decreased caliber of cervical cord. The largest AP axis of the most expanded component of cervical syrinx is at C6-7 measuring 2.8 mm compared to prior study at this level of 8.7 mm.The vertebral body heights and alignments are maintained. No suspicious bone marrow signal abnormality is identified in the cervical spine. Intervertebral discs demonstrate normal height and signal. No significant spinal canal or neural foraminal narrowing is evident.Thoracic spine MRI:There has again been significant interval decreased size of the thoracic syrinx. The largest AP axis of syrinx in the upper thoracic spinal cord measures approximately 2 mm compared to prior study measurement of 5.6 mm. The syrinx does still extending to the level of the T10 vertebral body. The vertebral body heights and alignments are maintained. No suspicious bone marrow signal abnormality is identified in the thoracic spine. Intervertebral discs demonstrate normal height and signal. No significant spinal canal or neural foraminal narrowing is evident.", "output": "1.Postoperative changes related to Chiari decompression surgery are redemonstrated. Decompressed posterior fossa contents with stable to slight interval improvement in CSF flow along the upper cord, and stable attenuated flow through the foramen magnum. 2. Significantly decreased syrinx caliber in both the cervical and thoracic regions. "}
{"instruction": "Generate impression based on findings.", "input": "Right lower extremity pain, evaluate for right L5-S1 synovial cyst. Radiculopathy. There are small disc bulges and facet hypertrophy at L4-5 and L5-S1 with up to mild to moderate right L4-5 neural foraminal narrowing, but no significant spinal canal stenosis. The vertebral column alignment is within normal limits. There is mild loss of anterior vertebral body height of T12, with a superior end plate disc herniation, which is unchanged since October 2014. The 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. There is a subcentimeter sacral perineural cyst. There are bilateral probable inferior renal cysts.", "output": "Degenerative spondylosis at L4-5 and L5-S1 with up to mild to moderate right L4-5 neural foraminal narrowing, but no significant 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": "23-year-old male patient with history of tuberous sclerosis, evaluate for angiomyolipoma.EXAMINATION: MR renal protocol with and without contrast. ABDOMEN:LIVER, BILIARY TRACT: Layering gallstones noted without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Reference exophytic lesion in the left mid kidney (series 501 image 21) currently measures 1.7 x 1.8 cm, previously 2.7 x 2.7 cm and now has a more discrete region of T2 hypointensity compared to prior examination. This lesion does not demonstrate enhancement and does not contain fat on in and out of phase images.A lesion in the mid/inferior pole of the left kidney again demonstrates fat on in and out of phase imaging and currently measures 2.0 x 1.3 cm (series 401 image 22).Multiple T1 and T2 hypointense lesions are noted in the kidneys bilaterally, which may represent hemorrhagic cysts. Many T2 hyperintense renal cysts are noted bilaterally, measuring up to 2.3 cm in the inferior pole of the right kidney, unchanged.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.Exophytic lesion in the mid left kidney has decreased in size compared to prior examination and does not contain fat. Recommend continued follow up of this lesion.2.Angiomyolipoma in the mid/inferior pole of the left kidney is unchanged in size.3.Numerous bilateral renal cysts.4.Cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Gowing right parotid mass, please evaluate. There is a relatively well-defined, enhancing mass in the deep left parotid gland that measures up to 15 mm. There is no gross evidence of perineural tumor extension. There is no evidence of cervical lymphadenopathy. The right parotid and bilateral submandibular glands, thyroid gland, and upper aerodigestive tract appear to be unremarkable. There is multilevel degenerative cervical spondylosis. There are multiple T2 hyperintense lesions in the cervical spinal cord, brainstem, and cerebellum.", "output": "1. A mass in the deep left parotid gland that measures up to 15 mm may represent a salivary neoplasm, such as a pleomorphic adenoma.2. Demyelinating lesions in the cervical spinal cord, brainstem, and cerebellum are better delineated on the recent brain and cervical spine MRI."}
{"instruction": "Generate impression based on findings.", "input": "Acute hypoxic event at birth. Evaluate brain structures. There is no evidence of intracranial hemorrhage, mass or edema. There is diffuse low attenuation in the subcortical tissues consistent with unmyelinated brain tissue, an expected finding given the patient's age. There are no CT findings of hypoxic injury -- if clinical concern remains recommend noncontrast MRI.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": "Unremarkable brain CT. If clinical concern remains for hypoxic injury, recommend noncontrast MRI."}
{"instruction": "Generate impression based on findings.", "input": "right lower extremity weakness and numbness There is linear diffusion restriction lesion on the left lower pons without evidence of susceptibility artifacts indicating acute ischemic infarction without hemorrhagic transformation.Previously seen diffuse patchy high signal intensities on pons on FLAIR images are not shown on today's scan indicating resolution of possible central pontine myelinolysis.Scattered high signal intensities on bilateral periventricular white matters on FLAIR images indicate non specific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. 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. Acute ischemic infarction without hemorrhagic transformation on the lower pons, left side.2. Resolution of possible findings of central pontine myelinolysis since prior exam.3. No change of non specific small vessel disease."}
{"instruction": "Generate impression based on findings.", "input": "Female, 73 years old, with stage IV lung cancer and ongoing upper back pain. Mild compression of the T1 vertebral body is seen with approximately 20% loss of vertebral body height. Mild edema is seen along the superior endplate more than the inferior endplate with edema also evident in the left T1 pedicle and lamina. On postcontrast images, enhancement is seen in a pattern similar to that of the edema.The anterior paravertebral soft tissues around the T1 level are thickened and edematous. Particularly on the left, there is a well defined area of soft tissue thickening which measures 12 x 12 mm transaxial and up to 33 mm in the craniocaudal dimension.The remaining vertebral bodies demonstrate relative preservation of height allowing for endplate irregularity throughout the cervical region. Spinal alignment is anatomic. No other pathologic marrow signal or enhancement is seen.The spinal cord demonstrates normal signal intensity throughout. Details of cord morphology will be discussed by level below.C2-3: Mild facet hypertrophy. Minimal disk osteophyte complex. No significant spinal canal or neuroforaminal stenosis. C3-4: Facet hypertrophy. Posterior disk osteophyte. Mild generalized spinal canal stenosis with mild flattening of the ventral cord. No cord signal abnormality. Mild left foraminal narrowing.C4-5: Facet hypertrophy. Mild posterior disk osteophyte. Mild generalized spinal canal stenosis without definite cord deformation. Moderate right and mild left foraminal narrowing. C5-6: Facet hypertrophy. Posterior disk osteophyte asymmetric to the left. Mild generalized spinal canal narrowing without definite cord deformation. Severe left and moderate right foraminal narrowing.C6-7: Facet hypertrophy. Mild posterior disk osteophyte. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. C7-T1: Facet hypertrophy worse on the left. No significant spinal canal stenosis. Moderate left foraminal narrowing.Multiple pulmonary nodules are visualized in the lung apices.", "output": "A mild compression deformity of the T1 vertebral body is seen with associated edema and enhancement. Also noted is inflammation in the anterior paravertebral soft tissues adjacent to T1 with a more mass-like soft tissue lesion on the left. The constellation of findings is suspicious for metastatic involvement of the T1 vertebral body and possibly the adjacent anterior paravertebral tissues. A benign process is considered much less likely."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate/monitor for neurovascular assessment. The current invasive squamous cell cancer concern for sinus/skull/left ORBIT/current artery. CTA of intracranial circulation:45 cc of Omnipaque 350 is administered for this exam.Vertebral -- basilar system.Taken bilateral vertebral arteries, basilar artery, posterior cerebral arteries and superior cerebellar arteries. It is some mild intracranial atherosclerotic disease with moderate to severe compromise of the origin and proximal portion of the right superior cerebellar artery and high-grade stenosis of the perimesencephalic component of right superior cerebellar artery. Atherosclerotic irregularity of basilar artery and posterior cerebral arteries with no vascular lumen compromise. There is no evidence of tumor involvement/encasement of these vasculature from patient's known skull base destructive tumor.Right internal carotid is patent across the skull base and mid neuritis of compromise of the lumen or encasement by tumor in the skull base. The right anterior and middle cerebral arteries and their branches are well visualized and unremarkable. There is hypoplastic right A1 segment of anterior cerebral artery. There is a single trunk of the anterior subdural tree beyond the anterior communicating level consistent with azygos anterior cerebral artery.Left internal carotid artery demonstrate slight decreased in its caliber is pre-cavernous and its posterior genu within the cavernous sinus. This appears to be result of extension of tumor into the left cavernous sinus which applies to mass effect on the left internal carotid artery anteriorly. In the left internal carotid artery proximal and distal to these segments demonstrate normal caliber. There is no evidence of high-grade stenosis of the muscle and no areas of an aneurysm is identified. Cavernous carotids demonstrate heavy calcifications bilaterally. The branches of left anterior and middle cerebral arteries are unremarkable. There are no posterior communicating arteries visible.  Nonenhanced head CT:Examination demonstrates a large destructive mass in the skull base primarily on the left however with extension across the midline to the right side. The tumor destruction involves the left carotid canal and left cavernous sinus. There is also extensive postoperative changes of left maxillary sinus left nasal cavity, sphenoid sinus. These findings were described more in detail on prior CT of soft tissues of neck.Images through the intracranial space demonstrate no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.There is evidence of minimal periventricular low attenuation of the left posterior frontal -- parietal which was noted on prior MRI exam. Bilateral posterior frontal cortical and subcortical low attenuation likely local small old strokes are again identified and unchanged since prior MRI exam.", "output": "1.Non-infused head CT demonstrate no evidence of acute intracranial process. Small areas of encephalomalacia of bilateral posterior frontal -- parietal lobes remains stable since prior MRI exam. Extensive destructive bony lesion of the skull base with involvement of left cavernous sinus and left carotid canal is partially visualized on this exam.2.CTA of intracranial circulation demonstrate minimal compromise of the lumen of the pre-cavernous left internal carotid artery as well as posterior genu of left internal carotid artery. There is no evidence of any vascular aneurysm or any significant compromise of any intracranial vasculature secondary to tumor encasement. There is evidence of intracranial atherosclerotic disease with moderate stenosis at the origin of the right superior cerebellar artery and perimesencephalic component of left superior cerebellar artery. Minimal atherosclerotic vascular irregularity of other intracranial vasculature with no hemodynamically significant stenosis. There is azygos anterior cerebral artery as described above. "}
{"instruction": "Generate impression based on findings.", "input": "58 year old male with a history of recurrent atrial fibrillation status-post ablation referred for cardiac MRI prior to repeat ablation. Left VentricleAssessment of systolic function limited by atrial fibrillation. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 133 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 132 ml (normal range 47+/-19), the LV mass index is 20 g/m2 (normal range 85+/-15), and the LV mass is 42 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Right VentricleThe right ventricle is normal in size and has low-normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 130 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).Left AtriumThe left atrium is normal in size (91ml). All four pulmonary veins drain normally into the left atrium. There is an early branch of a small pulmonary vein near the ostium of the right superior pulmonary vein. Late gadolinium enhancement images of the left atrium are of limited quality; however, the largest \"ablation\" gaps were probably around the left upper and right superior pulmonary veins. A smaller \"ablation\" gap was probably present around the right inferior pulmonary vein. The ablation line around the left inferior pulmonary vein is not well seen. The dimensions of the pulmonary veins at the ostium are:Right superior pulmonary vein: 19 x 15.5 mmRight inferior pulmonary vein: 14.6 x 11 mmLeft inferior pulmonary vein: 10.4 x 11.1 mmLeft superior pulmonary vein: 12.9 x 16.6 mmRight 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 (sinus of Valsalva 36x36x37 mm).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 FindingsThere are small mediastinal lymph nodes present. Multiple high T2-signal hepatic masses noted, which are statistically most likely hemangiomas or cysts. 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. The left ventricle is normal in size and systolic function (LVEF 56%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration .2. The right ventricle is normal in size and has low-normal systolic function (RVEF 50%). 3. Normal left atrial volume.4. Normal pulmonary vein anatomy. 5. Left atrial LGE imaging was of limited quality; however, the largest \"ablation\" gaps were probably around the left upper and right superior pulmonary veins. A smaller \"ablation\" gap was probably present around the right inferior pulmonary vein. The ablation line around the left inferior pulmonary vein is not well seen.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with a history of a \"trigger finger\" of the third digit status post release. There is mild volar displacement of the flexor digitorum profundus tendon from the head of the third metacarpal. For reference, the flexor digitorum profundus tendon is approximately 2.3 mm from the volar aspect of the head of the third metacarpal, compared to 1.5 mm in the fourth digit. The flexor digitorum profundus tendon is approximately 1 mm from the volar aspect of the base of the third proximal phalanx, compared to 0.5 mm in the fourth digit. There is further separation of the flexor digitorum superficialis, which is approximately 6 mm from the volar aspect of the head of the third metacarpal, compared to 4.5 mm for the fourth digit. The flexor digitorum superficialis is approximately 4.5 mm from the volar aspect of the base of the third proximal phalanx of the third digit, compared to 3 mm for the fourth digit.There is fluid within the flexor tendon sheath and mild edema extending through the superficial soft tissues along the flexor tendon apparatus. The A2 pully appears intact. The flexor digitorum superficialis tendon itself appears normal and inserts normally upon the middle phalanx. There is mild increased signal intensity within the flexor digitorum profundus tendon as it courses along the proximal phalanx, perhaps reflecting mild tendinosis, but it inserts in normal fashion on the distal phalanx. There is a cyst within the third metacarpal head, of doubtful clinical significance.The remaining visualized bones and soft tissues appear normal.", "output": "Surgical changes of trigger finger release with mild volar displacement of the flexor tendons, as described above."}
{"instruction": "Generate impression based on findings.", "input": "Male, 52 years old. Reason: labral tear? History: hip pain ACETABULAR LABRUM: There is irregularity along the anterior superior labrum, compatible with a tear.ARTICULAR CARTILAGE AND BONE: Joint is otherwise intact, without significant abnormality. Normal signal of the visualized skeletal structures.SOFT TISSUES: The muscles appear normal. ADDITIONAL", "output": "Irregularity along the anterior superior labrum, compatible with a tear."}
{"instruction": "Generate impression based on findings.", "input": "Leg weakness, acute onset pain, history of cancer, sciatica. Rule out herniated disc, cord compression other pathology. 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 disc desiccation of L3-4, L4-5 and L5-S1. There is mild loss of disc height at the L5-S1 level with degenerative changes at the endplate including a Schmorl's node. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The spinal cord terminates appropriately at the L2 level.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is mild facet hypertrophy and ligamentum flavum thickening but no significant compromise to spinal canal or neural foramina.L3-L4: There is a disc bulge with facet hypertrophy and ligamentum flavum thickening which causes mild central canal stenosis. There is no significant compromise to the neural foramina.L4-5: There is a disc bulge and moderate facet hypertrophy and ligamentum flavum thickening which causes mild central canal stenosis. No significant compromise to the neural foramina.L5-S1: There is facet hypertrophy and ligamentum flavum thickening but no significant compromise to spinal canal or neural foramina.", "output": "1.Mild degenerative changes of the lower lumbar spine with mild diffuse disc bulges at L3-4 and L4-5 levels which cause mild central canal stenosis at the L3-4 and L4-5 level. No evidence of herniated disc or significant neural foraminal compromise."}
{"instruction": "Generate impression based on findings.", "input": "Female 56 years old Reason: goiter with multiple nodules History: none RIGHT LOBE MEASUREMENTS: 7 x 2.2 x 2.5 cmLEFT LOBE MEASUREMENTS: 8.5 x 3.2 x 2.5 cmISTHMUS MEASUREMENTS: 6 mmRIGHT LOBE: Background thyroid is heterogeneous. Again noted multiple nodules within the right thyroid lobe. Largest nodule is in the mid right thyroid lobe and measures 2.3 x 1.7 x 2.6 cm. This is relatively unchanged compared to previous study. This nodule has heterogeneous echotexture and may represent a solid nodule versus a complex cystic nodule.LEFT LOBE: Background thyroid is also heterogeneous. Multiple nodules are also present within the left lobe. Largest nodule is in the inferior aspect of the left thyroid lobe and measures 2.3 x 1.8 x 1.6 cm and not significantly changed compared to previous study.This nodule has heterogeneous echotexture and may represent a solid nodule versus a complex cystic nodule.ISTHMUS: There is a new heterogeneously appearing nodule at the left lower aspect of the isthmus was measuring 2.2 x 1.6 x 2.2 cm. This nodule has complex cystic areas. At the periphery of the nodule there may be solid areas versus complex cystic component.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter and diffusely heterogeneous background thyroid. Bilateral nodules are grossly unchanged. However there is a new complex appearing cystic nodule arising from the left lower aspect of the isthmus."}
{"instruction": "Generate impression based on findings.", "input": "Intraventricular meningioma status post radiation therapy: surveillance. There is no significant interval change of the T2 hypointense enhancing mass within the atrium of the left lateral ventricle, which measures up to 1.7 x 1.4 cm in axial cross-section. There is also unchanged surrounding ependymal enhancement and confluent T2 hyperintensity in the left peritrigonal white matter and posterior left thalamus with scattered punctate foci of susceptibility effect. There are unchanged nonspecific scattered punctate foci of cerebral white matter T2 hyperintensity. There is no evidence of acute intracranial hemorrhage, hydrocephalus, or acute infarct. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable.", "output": "No significant interval change of the left lateral ventricular mass with persistent ependymal enhancement and vasogenic edema in the adjacent brain parenchyma. "}
{"instruction": "Generate impression based on findings.", "input": "Right sensorineural hearing loss. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There are numerous scattered areas of predominantly subcortical T2 hyperintensity with a faint striated pattern, suggestive of slightly prominent perivascular space. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. Numerous areas of predominantly subcortical white matter T2 hyperintensity likely represent terminal zones of myelination. Nevertheless, follow up MRI in approximately one year may be useful, if clinically warranted.2. No evidence of retrocochlear or inner ear lesions."}
{"instruction": "Generate impression based on findings.", "input": "25 year old with strong family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Bilateral patchy areas of parenchymal enhancement especially along the fat and glandular tissue junction are normal. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. Annual surveillance with MRI can be performed. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with history of necrotizing cholecystitis now with apparent hernia on surgical site. Increased pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodensities in the right and caudate lobe of the liver which are too small to characterize but most likely represent cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right upper quadrant. Incisional hernia containing nonobstructed colon and small bowel segments.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Subtle focal enhancement in the left posterior peripheral zone of the prostate. Correlation with PSA level and/or MRI of the prostate may be helpful.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Large right upper quadrant incisional herniaSubtle focal enhancement in the left posterior peripheral zone of the prostate. Correlation PSA level is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Female, 51 years old, with left arm pain and possible C6-7 cyst or lesion seen on outside hospital exam. A mild reversal of the normal cervical lordosis is seen. Vertebral body heights are preserved. Mild degenerative endplate irregularity is seen at several levels, most notably C5-6. No worrisome marrow replacement or marrow edema is detected.The visualized spinal cord shows normal morphology and signal characteristics except as discussed below.An oval T2 hyperintense structure measuring up to 5 mm in length is evident within the left C6-7 neural foramen, corresponding to a similar-appearing lesion noted on the prior outside examination. This lesion shows no internal enhancement. A similar-appearing but smaller structure is evident within the left C7-T1 neural foramen.No pathologic marrow space or intraspinal enhancement is seen.C2-3: Unremarkable. C3-4: Left facet hypertrophy. Mild posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac. Mild left foraminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac with slight flattening of the ventral cord but no cord signal abnormality. Mild to moderate bilateral foraminal narrowing. C5-6: Left facet hypertrophy. Posterior disc-osteophyte complex formation. Moderate ventral dural sac effacement with flattening of the ventral cord but no significant cord signal abnormality. The overall spinal canal is moderately narrowed. Severe right and moderate left foraminal narrowing. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation. Mild ventral thecal sac effacement without significant canal stenosis. Mild foraminal narrowing.C7-T1: Unremarkable.", "output": "1.A subcentimeter structure is identified within the left C6-7 neural foramen showing imaging characteristics most compatible with a perineural root sleeve cyst. There is also very likely an additional smaller root sleeve cyst within the left C7-T1 neural foramen.2.Mild to moderate cervical degenerative findings most significantly affecting the C5-6 level where there is a moderate spinal canal narrowing and severe right/moderate left foraminal narrowing."}
{"instruction": "Generate impression based on findings.", "input": "Neoplasm of uncertain behavior of brain and spinal cord. Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy Other postprocedural status(V45.89) The patient is status post right temporal craniotomy for right temporal lobe surgery and partial removal of the hippocampus. There is redemonstration of T2 and flair signal hyperintensity adjacent adjacent to the surgical bed compatible with gliosis.There is metal artifact from the patient's dentition which significantly distorts SWI and DWI imaging and obscures visualization of the orbits and paranasal sinuses.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the mastoid air cells are clear. There is mucosal thickening in the left sphenoid sinus. The rest of the paranasal sinuses are not adequately visualized.Incidental note is made of congenital fusion of C2 and C3.", "output": "1.Status post right temporal lobe and hippocampal surgery. The examination is stable when compared to the prior exam2.No left temporal lobe cyst is identified3.Congenital fusion of C2 and C3 can be associated with Klippel-Feil."}
{"instruction": "Generate impression based on findings.", "input": "91-year-old female patient with ulceration. Question of osteomyelitis of the coccyx. There is diffuse, heterogeneous signal abnormality of the marrow on the fat-suppressed T2-weighted images as well as heterogeneous enhancement following contrast administration. This is a nonspecific finding, but we cannot exclude a marrow infiltrating process.There is ulceration with edema of the subcutaneous fat posteriorly. There is also generalized edema type signal involving the paraspinal, pelvic, and hip musculature. Ulceration appears to extend to the coccyx, but the signal intensity of the bone marrow on T1-weighted sequences is preserved arguing against osteomyelitis. There is a rim-enhancing fluid collection adjacent to the left ischial tuberosity that we suspect communicates with the skin surface via a sinus tract. Adjacent signal intensity of the bone itself is preserved on T1 weighted images arguing against osteomyelitis.There is a collection of nonenhancing near fluid signal intensity along the posterior aspect of the proximal left femur that measures approximately 6.5 x 2.5 cm in the transverse dimension and appears to communicate with the skin surface. Although we see no specific findings of osteomyelitis of the underlying femur, evaluation is limited due to artifact from the patient's orthopedic hardware. Poorly defined nonenhancing tissue adjacent to the right ischial tuberosity likely represents phlegmon with preservation of underlying bone marrow signal intensity on the T1-weighted images.Incompletely imaged on this study is a fluid collection along the labia, left of midline, which perhaps represents a cyst.A Foley catheter and air is noted within the bladder. There is small amount of free fluid within the pelvis.", "output": "1. Soft tissue ulceration and additional soft tissue abnormalities as described above, but we see no convincing imaging findings to suggest osteomyelitis.2. Diffuse heterogeneity of the bone marrow is nonspecific, but could perhaps represent a marrow infiltrating process."}
{"instruction": "Generate impression based on findings.", "input": "6 months post ACDF The patient has undergone anterior fusion of C5 through C7 with side plate, screws, and bone graft. The alignment is anatomic. The vertebral body heights are preserved.", "output": "Post-operative changes, as above."}
{"instruction": "Generate impression based on findings.", "input": "56 years Male (DOB:9/12/1959)Reason: right leg pain. History: right leg painPROVIDER/ATTENDING NAME: JAVAD HEKMATPANAH JAVAD HEKMATPANAH Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level. There is mild encroachment of the nerve roots at the lateral recess at this level.At L4-5 there is no significant compromise to the neural foramina. There is some disc desiccation and diffuse disc bulge at this level. There is some mild facet hypertrophy at this level. There is some effacement of fat at the lateral recess bilaterally at this level with encroachment of the nerve roots at the lateral recesses bilaterally.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "There are degenerative changes present lumbar spine associated with moderate encroachment of the nerve roots at the lateral recess at L4-5 bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old male with right knee pain and swelling, concern for re-tear of the medial meniscus. MENISCI: There is linear signal abnormality within the posterior horn and body of the medial meniscus which extends from the tibial articular surface through the peripheral fibers of the meniscus, with formation of small peripheral intrameniscal and parameniscal cysts. The anterior horn of the medial meniscus is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact, and the bone marrow signal is normal.LIGAMENTS: The anterior cruciate and posterior cruciate ligaments as well as the medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "Signal abnormality within the medial meniscus extending from the tibial articular surface through the peripheral fibers. This represents a tear, although comparison with prior outside imaging will ensure that the signal abnormality was not previously present."}
{"instruction": "Generate impression based on findings.", "input": "76 year old male with known CAD, has had noted cecrease in LV EF, MRI done to assess. MEDICATIONS: Amlodipine, atorvastatin, carvedilol, clopidogrel, lisinopril, hydrochlorothiazide, spironolactone First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is presence of late gadolinium enhancement in the mid and basal anterior wall, the apical anterior and apical inferior, and basal and mid anterolateral wall, involving up to 50% of the LV wall thickness, suggesting prior myocardial infarction.Left VentricleThe left ventricle is normal in size with mildly decreased ejection fraction. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 202 ml (normal range 142+/-34), the LV end systolic volume index is 54 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 67 g/m2, and the LV mass is 138 g. There is hypokinesis in the mid anterior, mid anterolateral wall and apical cap of the ventricular myocardial wall. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 210 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 116 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 trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 Findings11.3 x 4.4 cm T2 hyperintense mass in the right axillary region on image 14 of series 201 with internal hypointense lesion or laterally which measures 4.1 x 1.6 cm. 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": "Unexpected right axillary, fat-containing mass with probable soft tissue component, as above. Further evaluation with dedicated, gadolinium-enhanced chest wall mass MRI suggested.1. No perfusion defects/ \"ischemia\" present during hyperemia.2. There is presence of late gadolinium enhancement in the mid and basal anterior wall, the apical cap, and basal and mid anterolateral wall, involving up to 50% of the LV wall thickness, consistent with prior myocardial infarction. There is hypokinesis in the mid anterior, mid anterolateral wall and apical cap of the ventricular myocardial wall. 3. Normal LV size and mildly decreased systolic function (LVEF 46%).4. Normal RV size and systolic function (RVEF 45%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "72 year old woman who presents with congestive heart failure and multiple risk factors. She is referred to rule out ischemia and to evaluate etiology of LV dysfunction.MEDICATIONS: carvedilol, furosemide, aspirin First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted.Viability/ Myocardial ScarThere was no evidence of myocardial infarction. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal septum and an epicardial late gadolinium enhancement pattern involving the basal inferolateral wall. These findings are atypical for prior myocardial infarction and suggest underlying myocardial fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 123 ml/m2 (normal range: 65+/-11), the LVEDV is 235 ml (normal range 109+/-23), the LV end systolic volume index is 87 ml/m2 (normal range 18+/-5), the LVESV is 167 ml (normal range 31+/-10), the LV mass index is 83 g/m2, and the LV mass is 159 g. There is global hypokinesis with regional variation.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 67 ml/m2 (normal range 69+/-14), the RVEDV is 128 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 57 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. Mild atherosclerosis is noted in the descending thoracic aorta. 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 FindingsBilateral axillary lymph nodes noted. The largest on the right is 1cm and on the left is 1.2cm. 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. No perfusion defects/ \"ischemia\" present during hyperemia; however, the diagnostic sensitivity of vasodilator stress testing in the presence of severe LV dysfunction is reduced.2. There was no evidence of myocardial infarction. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal septum and an epicardial late gadolinium enhancement pattern involving the basal inferolateral wall. These findings are atypical for prior myocardial infarction and suggest underlying myocardial fibrosis, inflammation, or infiltration suggesting a non-ischemic etiology of the cardiomyopathy. 3. Severe LV dilation with severely reduced systolic function (LVEF 29%).4. Normal RV size and systolic function (RVEF 55%).5. Severe left atrial dilation.6. Moderate mitral regurgitation.7. Axillary lymph nodes are noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Detectable PSA after prostatectomy in 2014, evaluate for recurrent disease PELVIS:PROSTATE: Status post prostatectomy. No evidence of disease recurrence.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: Fat containing osseous lesion in the right superior pubic ramus, likely a hemangioma.OTHER: No significant abnormality noted.", "output": "No evidence of disease recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Lower extremity pain and numbness in the face of newly diagnosed multiple slcerosis. 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 or neural foramen stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. However, there is a retroflexed uterus with a subcentimeter low signal focus in the myometrium.", "output": "1. No evidence of significant spinal canal or neural foramen stenosis in the lumbar spine.2. Retroflexed uterus with a subcentimeter low signal focus in the myometrium, which may represent a fibroid. Further evaluation via pelvic ultrasound may be useful for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Weakness, decreased urine, constipation There are numerous lesions throughout the cervical, thoracic, lumbar spine and visualized pelvis consistent with diffuse osseous metastases. Vertebral body heights are maintained. There is mild anterolisthesis of T2 and T3. Alignment is otherwise maintained. There is at least moderate cervical spinal canal stenosis at the C3-C4, C4-C5, C5-C6, and C6-C7 levels related to prominent disk osteophyte complexes and ligamentum flavum buckling in the cervical spine. There is possible T2 signal abnormality involving the cervical cord at the C5-C6 level which may represent myomalacia.There is epidural lipomatosis in the thoracic spine which mildly narrows the thoracic spinal canal. In the lumbar spine there are degenerative changes throughout with severe spinal canal stenosis at the L3-L4 and L4-L5 levels on a degenerative basis.", "output": "1. Diffuse osseous metastatic disease without findings to suggest acute cord compression from metastatic disease.2. Severe degenerative changes in the cervical and lumbar spine which result in severe spinal canal stenosis at L3-4 and L4-5. There is at least moderate spinal canal stenosis in the cervical spine at C3-C4, C4-C5, C5-C6, and C6-C7 levels. There is possible T2 signal abnormality involving the cervical cord at the C5-C6 level which may represent myelomalacia.3. Please note due to the screening nature of this protocol, details including cord signal abnormality are not as evident as dedicated protocols of the spine. If clinically indicated, consider complete spine MRI study for further evaluation. "}
{"instruction": "Generate impression based on findings.", "input": "Left superificial parotidectomy for Warthin's tumor one year ago with increasing pain and left pharyngeal wall fullness. There has been interval left superficial parotidectomy. There appears to be scar tissue, but no evidence of tumor in the surgical bed. There is no significant cervical lymphadenopathy. The right parotid and bilateral submandibular glands are unremarkable. There is a punctate right thyroid cyst. There is mild prominence of the lingual tonsil, with a 3 mm diameter cystic lesion on the left side. The upper aerodigestive tract is otherwise unremarkable. The orbits and imaged intracranial structures are unremarkable. There is a punctate cystic lesion in the anterior wall of the left external auditory canal, which may represent an inclusion cyst. There is a small left maxillary sinus retention cyst. There is multilevel degenerative cervical spondylosis and findings related to laminoplasty.", "output": "1. Interval left superficial parotidectomy with what appears to be scar tissue, but no evidence of tumor in the surgical bed. 2. Mild prominence of the lingual tonsil, with a 3 mm diameter cystic lesion on the left side, which may represent a retention cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Paralysis agitans, DBS stage 1 today The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "Examination is limited for the purposes of stereotactic guidance for deep brain stimulator placement. There is no intracranial mass lesion or brain hemorrhage identified.MRI of the brain is within normal limits"}
{"instruction": "Generate impression based on findings.", "input": "Generalized abdominal pain [R10.84] / Unqualified visual loss, left eye, normal vision right eye [H54.62], Reason for Study: ^Reason: >1cm vegetation on aortic valve w/ loss of vision. Eval for embolic strokes History: above There are multiple susceptibility lesions on bilateral frontal lobes, left parietal lobe and bilateral occipital lobes without surrounding edema. These findings non specific, thus may suggest parenchymal calcifications, or petechial chronic hemorrhages or cavernous malformations. There is no evidence of acute ischemic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Right mastoid air cells show partial opacifications.", "output": "1. Multiple susceptibility lesions without surrounding edema or mass effects on bilateral hemispheres as described above. Differential diagnosis is wide including calcifications, chronic petechial hemorrhages or cavernous malformations.2. No acute ischemic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Female, 28 years old, headaches, worse postpartum. Thinning and mild outward bowing of the calvarium along the right frontal and temporal lobes is unchanged and may be at least in part due to prior interventions. Signal abnormality relating to the tract of a prior ventricular catheter is again seen coursing through the right frontal lobe.Cystic encephalomalacia affecting the inferior right frontal lobe is unchanged. Mild encephalomalacia affecting the anterior right temporal lobe is also unchanged. No new areas of parenchymal signal abnormality are detected. Diffusion weighted images are normal. There is no evidence of parenchymal edema or mass effect. On postcontrast images, no evidence of pathologic parenchymal or extra-axial enhancement is detected.No evidence of acute intracranial hemorrhage is seen. No new abnormal extra axial fluid collections are detected. The size and morphology of the ventricles are normal.", "output": "Stable examination with no new findings to account for the patient's worsening headaches."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old man with history of Crohn's on Humira with abdominal cramping. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal in signal and morphology. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder appears normal.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: There is fibrofatty proliferation in the region of the terminal ileum. Prominent subcentimeter mesenteric lymph nodes noted. No significant bowel wall thickening or dilated loops of bowel are noted in the abdomen. Specifically, the terminal ileum appears normal.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: An approximately 3.5 cm segment of distal descending colon and proximal sigmoid colon (17/44) appears narrowed without change throughout the examination and circumferentially enhances on postcontrast imaging. Additionally, there is circumferential enhancement of the distal sigmoid colon and the rectum over a length of approximately 6 cm (20/62). The mid sigmoid colon appears relatively spared.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Active inflammatory bowel disease involving the proximal sigmoid colon and distal sigmoid/rectum with sparing of the mid sigmoid colon. Suggestion of focal areas of involvement in the descending colon as well.2.Findings of remote inflammatory bowel disease in the region of the terminal ileum. No evidence of active terminal ileitis."}
{"instruction": "Generate impression based on findings.", "input": "60 old male with bloody diarrhea ABDOMEN:LUNG BASES: 2 x 1.3 cm paracardiac hypodense lesion adjacent to the right atrium, Bessemer number 11, series number 3. This may represent a solid lesion versus pericardial cyst. Further evaluation with MRI may be helpful.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal stones. No hydronephrosis. Bilateral simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Wall thickening involving the sigmoid colon and rectum which may indicate colitis. Further ovation with endoscopy is recommended.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Wall thickening of the rectosigmoid compatible with colitis.Right nephrolithiasis.Right paracardiac lesion which likely represents a complex pericardial cyst. Further evaluation with cardiac MRI may be helpful to differentiate from paracardiac adenopathy due to its high density.."}
{"instruction": "Generate impression based on findings.", "input": " This exam is limited as the patient terminated the exam early prior to the completion of susceptibility weighted imaging and coronal T2 weighted imaging. There is no evidence of acute infarct. There are no areas of abnormal parenchymal signal. 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. There is unchanged diffuse marrow replacement. There is an unchanged retention cyst within the right sphenoid sinus. There is unchanged proptosis. There is unchanged T1 and T2 hyperintensity invaginating into the superficial left parotid lobe that likely represents normal fat or possibly a small lipoma.", "output": "1.No evidence of acute ischemia.2.Unchanged proptosis of uncertain etiology or significance.3.Unchanged diffuse marrow replacement that is nonspecific and of uncertain etiology.4.Unchanged right sphenoid retention cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for pituitary abnormality: partial GH deficiency. Pituitary: There is a non-enhancing sliver between the adenohypophysis and neurohypophysis. The pituitary gland is not enlarged. The infundibulum is intact. There is no mass effect upon the cavernous sinus or optic apparatus. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an anterior right frontal lobe developmental venous anomaly. The brain parenchyma otherwise 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": "1. Findings suggestive of a minute pars intermedia cyst.2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Right anterior frontal lobe developmental venous anomaly."}
{"instruction": "Generate impression based on findings.", "input": "Confusion and disorientation. Evaluate for ischemic infarct. 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 skull and extracranial soft tissues are unremarkable. Incidental note is a prominent air-filled space inferomedial to the right orbit with some displacement on the ostiomeatal complex although this remains patent. This may be a large Haller cell. CT would provide more information if clinically warranted. Note is also made of a partial empty sella.", "output": "1.No evidence of intracranial hemorrhage, mass, or acute infarct.2.Incidentally noted prominent air-filled space inferomedial to the right orbit which may represent a large Haller cell. CT would provide more information if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "5-year-old female patient with tethered cord repair, lipomyelomeningocele, yearly MRI. Evaluate for change. Thoracic Spine:Vertebral body heights and disc spaces are within normal limits with anatomic alignment. Bone marrow signal is normal. There is no thoracic cord signal abnormality.Lumbar Spine:There are postoperative findings related to attempted detethering of the filum terminale. Redemonstration of lipomatous mass centered along the dorsal aspect of the thecal sac that extends from the level of L3-S1. This mass has decreased in thickness now measuring 7 mm in maximal thickness, previously 9 mm. The conus medullaris is low in position, distorted, and terminates within the lipomatous mass, unchanged. The cord remains tethered along the dorsal aspect of thecal sac with prone imaging. The lower lumbar and upper sacral vertebral posterior elements are absent.Vertebral body heights and disc spaces are otherwise normal in height and in anatomic alignment. Bone marrow signal is normal. The lower lumbar dorsal subcutaneous fat is prominent, but does not appear to communicate with the intrathecal lesion, unchanged.", "output": "Post-operative changes of the lumbosacral spine with a tethered spinal cord and decreased size of an associated intraspinal lipoma. "}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male patient with cirrhosis, segment 6/7 arterially enhancing focus. Evaluate liver lesions, masses, HCC screening, hepatic vessel patency. ABDOMEN: LIVER, BILIARY TRACT: Hepatic cirrhosis with sequela of portal hypertension. There are scattered T2 hyperintense foci in the liver compatible with cysts. A nonspecific segment 6/7 1 cm arterially enhancing focus is again identified, but does not demonstrate washout on more delayed images. There is a new 1 cm focus of arterial enhancement within the caudate lobe, which also does not demonstrate washout on more delayed imaging.SPLEEN: The spleen is enlarged measuring 19 cm in length.PANCREAS: A a 0.8 cm cystic lesion within the body of the pancreas which does not demonstrate enhancement likely represents a sidebranch IPMN in addition to two more cystic foci, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace left pleural effusion. Interval decrease in ascites.", "output": "1.Cirrhosis with sequela of portal hypertension. No definite arterially enhancing lesion with washout to suggest HCC.2.Non-specific segment 6/7 and segment 1 arterially enhancing lesions; these could be perfusional in etiology, however, should continue to be followed on subsequent imaging. "}
{"instruction": "Generate impression based on findings.", "input": "62 year old male patient with history of chronic HBV, history of complex cyst. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense nonenhancing lesions are compatible with hepatic cysts, unchanged. No suspicious hepatic lesion is identified. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No suspicious hepatic lesion to suggest hepatocellular carcinoma. Scattered hepatic cysts are stable."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evidence of malignancy. Signs and symptoms: Patient with focal area of enhancement in right C6 vertebrae which enhances. CT of the cervical spine:Examination demonstrate a lytic lesion in the right superior aspect of C7 vertebrae. There is thinning of the cortex posteriorly and at the level the superior endplate of T1 however without any break/defect of the cortex.Finding correspond to the previously noted enhancing focus in C7 on prior MRI exam. Possibility of malignancy should be considered. There is no evidence of fracture or malalignment. There is also no evidence of any additional foci of cystic change of the column.Limited images through the skull base are also negative.The alignment the vertebral column is within normal.", "output": "1.There is an osseous lytic lesion within the superior right lateral aspect of T7 vertebrae corresponding to the region of enhancement noted on prior MRI. This lesion measures approximately 12 x 8 x 8-mm in size. There is no evidence of extension of the lesion into the cortex and no evidence of fracture. Possibility of malignancy should be considered till proven otherwise.2.Negative nonenhanced CT of cervical spine otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Female 37 years old Reason: Right shoulder rotator cuff injury History: Right shoulder pain. ROTATOR CUFF: There is focal poorly defined increased signal intensity seen on the fluid sensitive sequences along the myotendinous junction of the supraspinatus tendon that may represent a strain or perhaps focal degeneration, but we see no discrete tear. There is an insertional undersurface tear of the posterior fibers of the infraspinatus tendon involving just over 50% of the tendon thickness, but sparing the bursal surface fibers. The tear measures approximately 8 mm in the craniocaudal dimension. There is a cyst in the underlying humeral head. There is mild atrophy of the infraspinatus muscle.The teres minor muscle and tendon appear intact.There is thickening and increased signal intensity of the subscapularis tendon that extends into the subscapularis muscle which we suspect is iatrogenic due to infiltration of gadolinium during the procedure.We see no findings to suggest a full thickness rotator cuff tear.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. We see no gadolinium within the subacromial/subdeltoid bursa. There is mildly increased signal intensity within the subacromial/subdeltoid bursa seen on the fluid sensitive sequences that may represent a mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is increased signal intensity and deformity of the anterior superior labrum that may represent a tear, but is of uncertain clinical significance. The inferior labrum appears normal. There is minimal posterior translation of the humeral head relative to the center of the glenoid.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL", "output": "1.Partial-thickness undersurface tear of the infraspinatus tendon at its insertion.2.Poorly defined focal increased signal intensity along the myotendinous junction of the supraspinatus may represent a strain, but we see no full-thickness rotator cuff tear.3.Findings suggestive of a mild subdeltoid bursitis.4.Increased signal intensity within the anterior superior labrum may represent a tear, but is of uncertain clinical significance."}
{"instruction": "Generate impression based on findings.", "input": "Female, 53 years old, with history of neurofibromatosis type II, with worsening gait and ataxia. MRI brain and IACs:Findings are redemonstrated compatible with right parietal and bilateral occipital craniotomy. The dura remains diffusely thickened. Superimposed on this are numerous dural based enhancing tumors compatible with meningiomas scattered throughout the intracranial space. These show no significant interval change in size from the prior examination. Some of these lesions are associated with mild parenchymal edema, particularly at the vertex.Enhancing lesions involving both IACs are also redemonstrated compatible with schwannomas. A bulky lesion on the right measures 36 x 26 x 25 mm, previously of similar size when measured in the same manner. This lesion significantly encroaches upon the CP angle cistern and exerts mass effect on the brainstem and pons similar to prior. A much smaller lesion involving the left IAC measures 15 x 6 x 7 mm, unchanged from prior.A small mildly hemosiderin stained surgical cavity or area of encephalomalacia is unchanged along the right middle frontal gyrus. No new intracranial lesions are detected. No new abnormal fluid collections are seen. The ventricles are stable in size and morphology.MRI cervical spine:Numerous small intramedullary enhancing lesions are seen within the cervical spinal cord which appear unchanged in size and number compared to prior exams. A small lesion along the left dorsal surface of the cord at C3 is unchanged as well. A bulky intramedullary tumor at T1 also appears unchanged from the prior exam.At C7-T1, a large extramedullary tumor which may be both intradural and extradural, spanning the right neural foramen, is unchanged in size. This lesion slightly flattens the right ventral spinal cord similar to prior. A bulky left dorsal dural based tumor at T4 is partially visualized.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. Mild cervical spondylosis is seen with no areas of significant associated spinal canal or foraminal stenosis.A bulky soft tissue mass is partially visualized along the right brachial plexus, as well as another more posteriorly along the right levator scapulae.", "output": "1.No significant interval change in the size of multiple intracranial meningiomas, nor of the bilateral IAC schwannomas. No new intracranial masses are identified.2.Numerous intramedullary lesions are redemonstrated in the visualized spinal cord compatible with primary cord tumors, statistically most likely ependymomas. The lesions show no significant interval change in size or number. Multiple extra-medullary tumors representing a combination of schwannomas and meningiomas are also unchanged."}
{"instruction": "Generate impression based on findings.", "input": " There are postoperative findings related to transsphenoidal surgery. There is a persistent hypoenhancing nodule that measures up to 4 mm in width in the left pituitary. There is no mass effect upon the optic apparatus. There is minimal leftward deviation of the pituitary stalk. There is hyperintensity on the post-contrast images in the right middle ear and mastoid air cells. There is a partially-imaged right maxillary sinus retention cyst.", "output": "1. Postoperative findings with a persistent nonspecific nodule in the left pituitary.2. Possible right otomastoiditis."}
{"instruction": "Generate impression based on findings.", "input": "Left knee pain. Evaluate for left knee meniscus tear. MENISCI: There is bandlike increased signal intensity within the body and posterior horn of the medial meniscus indicating intrasubstance degeneration. Within the posterior horn, the signal abnormality extends to the tibial articular surface, indicating a horizontal tear. Mucoid material also extends through the periphery of the meniscus at the junction of the body and posterior horn, with formation of a small parameniscal cyst. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: I see no fluid-filled articular cartilage defects. Small lobulated foci of signal abnormality in the distal femoral metaphysis and proximal tibial metaphysis likely represent benign enchondromas.LIGAMENTS: The cruciate and collateral ligaments are intact. There is a tiny rounded focus of near fluid signal intensity adjacent to the distal fibers of the anterior cruciate ligament that may represent a small ganglion.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "Degeneration and horizontal tear of the medial meniscus with other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Seizures despite medications. No seizures or epileptiform activity were captured on EEG during this admission. History is suggestive of localization-related epilepsy (complex and simple partial with possibly right temporal lobe onset) that is intractable, without status epilepticus. There is apparent asymmetry of the hippocampi, right smaller than left. The brain parenchyma and otherwise appears unremarkable. There is no evidence of intracranial hemorrhage, mass, 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.", "output": "Apparent asymmetry of the hippocampi, right smaller than left, without evidence of tumors. This is nonspecific and follow up via a brain MRI with contrast may be useful. "}
{"instruction": "Generate impression based on findings.", "input": "Right distal tibia and distal femur osteomyelitis after old MVA. Evaluate for acute changes. Two views of the right femur show deformity of the femoral diaphysis likely due to old healed fractures, appearing similar to the prior study, with anterior bowing deformity of the mid-diaphysis. Screw fragments are noted within the mid-femoral diaphysis. Two screws affix a patella fracture in near-anatomic alignment. Heterotopic calcification is noted in the soft tissues lateral to the ilium, unchanged. Moderate osteoarthritis affects the knee. We see no acute process in the femur.Two views of the right tibia/fibula show old postoperative deformity of the right tibia/fibula reflecting healed fractures, appearing similar to the prior study. There is a geographic lucency within the distal tibial metadiaphysis that corresponds to an intramedullary lesion of near fluid signal intensity on a recent outside hospital MRI. This appears more prominent on the current study than the prior study and we cannot exclude an intramedullary abscess.", "output": "1. Post-traumatic deformities as described above.2. Geographic lucency in the right distal tibial metadiaphysis corresponding to a fluid signal intensity lesion on prior OSH MRI appears more prominent on this examination; we cannot exclude an intramedullary abscess."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B, AFP 4000, evaluate for HCC ABDOMEN:LIVER, BILIARY TRACT: Liver contour: The liver contour is smooth. Features of portal hypertension: None. Portal vein: Patent. Hepatic veins: Patent.Hepatic artery: Conventional.Lesions: 2.1 x 1.2 cm arterially enhancing lesion in segment IVb demonstrates washout on delayed postcontrast imaging (series 1101, image 247). Contiguous or adjacent punctate focus of parenchymal washout without definite arterial enhancement (series 1101, image 263).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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Segment 4B arterially enhancing lesion meets the criteria for HCC.2.Immediately adjacent punctate focus of parenchymal washout without definite arterial enhancement raises the possibility of a satellite HCC, or is just a poorly imaged tiny portion of the primary mass itself. "}
{"instruction": "Generate impression based on findings.", "input": "Right lower extremity giving out, follow-up laminoplasty, more stiffness. Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained. Interval straightening of the cervical spinal curvature is noted compared to the preoperative study, finding which may be in part positional and can be correlated with radiographs. Bone marrow signal is benign.Postsurgical changes of laminoplasty are again seen from C3 through C7 with decompression of the spinal canal. There remains diminished CSF spaces at the C3-C4 level but clearly improved since prior study. Thinning of the cord with T2 hyperintensity involving the dorsal aspect of the cord at the C3-C4 level is again seen and consistent with myelomalacia.No new cord signal abnormality or evidence of residual high-grade spinal canal stenosis is appreciated at any level. There is moderate to severe neural foraminal stenosis at C2-C3, C3-C4, C4-C5, C5-C6, and C6-C7 as seen previously related to pronounced uncovertebral hypertrophy.There is small residual postoperative fluid collection in the posterior paraspinous soft tissues at the C6 level.Lumbar spine: For the purposes of this dictation, consistent with prior reports, the lowest visualized intervertebral disc space is labeled L4-S1. There are 4 nonrib bearing lumbar vertebrae labeled L1-L4Conus terminates normally at the L1 level and is unremarkable in signal. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L2 on L3 which appears slightly worse since prior study from 7/29/2015 and suggests possible instability at this level. There is advanced facet arthropathy in this level with fluid in the facet joints appearing similar to prior.Multilevel degenerative changes include disc desiccation and mild height loss at the L2-L3, L3-L4, L4 S1 levels not significant changed since prior.Individual levels as below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. Mild ligamentum flavum hypertrophy and facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Diffuse disc bulge with uncovering of the disc and superimposed central extrusion extending 8 mm superiorly which is similar to prior. Moderate ligamentum flavum thickening and facet arthropathy, left greater than right. Moderate spinal canal stenosis appears slightly worse since prior from 7/29/2015 but slightly better than 7/5/2014 study. There is mild to moderate right and moderate left neural foraminal stenosis at this level which appears worse.L3-L4: Mild disc bulge, ligamentum flavum thickening and facet arthropathy is unchanged. Mild spinal canal stenosis is unchanged. Moderate left and mild right neural foraminal stenosis is unchanged.L4-S1: Diffuse disc bulge, asymmetric to the right, is unchanged. Facet arthropathy and ligamentum flavum thickening is unchanged. No significant central canal stenosis. Narrowing of the right lateral recess with contact of the descending right S1 nerve root is unchanged. Moderate bilateral neural foraminal stenosis is unchanged.", "output": "1. Postsurgical changes of cervical laminoplasty from C3 to C7 with decompression of the spinal canal. No significant change in cord T2 hyperintensity with cord thinning at the C3-C4 level consistent with myelomalacia. No new cord signal abnormality or evidence of residual high-grade stenosis in the cervical spine.2. Moderate to severe neural foraminal stenosis bilaterally from C2-C3 to the C6-C7 levels as seen previously.3. Compared to the preoperative study, there has been some straightening of the cervical spinal curvature. While this may be in part positional, further assessment with radiographs can be considered.4. Please note transitional anatomy in the lumbar spine with numbering scheme as above. Multilevel degenerative changes in the lumbar spine are again seen. Compared to 7/29/2015, there appears to be slight worsening of anterolisthesis at the L2-L3 level and can be correlated with dynamic radiographs for dynamic instability. Moderate spinal canal stenosis at this level also appears slightly worse since 7/29/2015 but improved since 7/5/2014 study, when there was a larger disc herniation. Please see details above regarding neural foraminal stenosis in the lumbar spine."}
{"instruction": "Generate impression based on findings.", "input": " MRI Brain:There is about 13.4mm x 14.1mm x 25mm sized soft tissue mass with high T2/FLAIR signal intensity and flow voids along the distal left cervical ICA to the the level of the left jugular bulb. This is suspicious for a paraganglioma (glomus jugulare). There is minimal scattered periventricular and subcortical T2/FLAIR signal hyperintensity which is nonspecific but likely related to small vessel ischemic disease. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse volume loss. The ventricles and basal cisterns are otherwise unremarkable. There is no midline shift or herniation. MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: The left common carotid artery arises from the brachiocephalic trunk which is a normal variant. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion. There is enhancement of the likely left side jugular bulb paraganglioma with suggestion of early venous drainage into the adjacent left internal jugular vein.", "output": "1.Large likely left jugular bulb paraganglioma predominately along the petrous portion of the left ICA to the level of the left jugular bulb. No evidence of an acute infarct.2.Questionable partially assessed tongue atrophy which could conceivably be secondary to mass effect on the left hypoglossal nerve by the tumor. Correlate for possible additional CN9-CN11 involvement.3.Prominent left mastoid air cell fluid which is nonspecific but correlate for possible mastoiditis.4.No significant high grade vascular stenosis in the neck or intracranial vasculature.Findings were discussed with the Neurology resident on call, Dr. Santos De Lima (pager 9203) the primary physician taking care of the patient at the time of the finding by Dr. Veronesi, Neuroradiology fellow."}
{"instruction": "Generate impression based on findings.", "input": "16-year-old male with history of shoulder dislocation, evaluate for labral tear ROTATOR CUFF: Mild increased signal at the distal supraspinatus tendon consistent with tendinosis. No evidence of discrete tear. Muscles appear normal without atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. No definite labral tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "Mild distal supraspinatus tendinosis. No discrete labral tear."}
{"instruction": "Generate impression based on findings.", "input": "74 years, Male, confusion, preoperative evaluation for brain tumor resection. Examination is limited to sequences for operative planning. Again seen is a heterogeneously enhancing mass with central necrosis centered in the left parietal lobe with extension into the left temporal lobe as well as the anterior aspect of the occipital lobe, similar to prior exam. Mass is again noted to extend to the ependymal surface and also noted to extend slightly across midline at the splenium. Mass measures approximately 5.0 x 4.3 cm in the axial plane and up to 5 cm in the craniocaudal dimension. There is surrounding edema and associated mass effect on the left lateral ventricle. There is also ventriculomegaly which is similar to prior. There is mild rightward midline shift. No uncal herniation. Evidence of recent left transparietal biopsy noted.", "output": "Heterogeneously enhancing mass with central necrosis centered in the left parietal lobe with extension into the left posterior temporal lobe, anterior occipital lobe, and slight extension across the splenium into the right parietal lobe. Appearance of the mass is consistent with a high-grade glioma neoplasm."}
{"instruction": "Generate impression based on findings.", "input": " The cerebellar tonsils are low lying, extending up to approximately 8 mm inferior to the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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 unremarkable.", "output": "1. No evidence of acute or subacute infarct.2. Low-lying cerebellar tonsils are compatible with Chiari 1 malformation. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Davis is a 62-year-old female with family history of breast cancer in mother (diagnosed at age 50), sister (diagnosed at the age of 40), and a paternal cousin. She is of an Ashkenazi Jewish heritage. Mild parenchymal enhancement is noted bilaterally.Right breast: In the right upper outer breast, 10:00 location (posterior depth), there is a stable 9 mm enhancing mass which is unchanged when compared to multiple prior exams. In the right upper outer breast, 11:00 location (anterior depth), there is a 5 mm enhancing focus. This was seen on prior MRI in 2014 and to a lesser extent on MRI from 2012. Left breast: In the left inferior breast, 6:00 location (anterior depth), there are two parallel linear enhancing areas. These were also seen on prior MRI in 2014 and to a lesser extent on MRI from 2012. No abnormal axillary lymph nodes are identified in either axillary region.Drs. Schacht, Abe and Sheth concurred on the management discussed below.", "output": "Bilateral enhancing foci which appear slightly more prominent on today's MRI exam. Given that these were seen on prior MRI from 2014 and to a lesser extent on MRI from 2012, a short term MRI examination in 6 months is recommended to confirm stability of these findings. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": " Images are moderately limited by patient motion, especially postcontrast imaging. Postoperative changes are again seen from a previous right frontal approach biopsy of the thalamus, with a few foci of susceptibility. There is redemonstration of mild subtle residual gyral thickening along the right insula, similar to prior exams. There is no corresponding enhancement.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.", "output": "Continued stable appearance of mild residual asymmetric gyral thickening along the right insula, within motion limitation."}
{"instruction": "Generate impression based on findings.", "input": "Male, 60 years old, history of lung cancer metastases to the brain. Minimal if any residual enhancement is seen at the site of a previous lesion along the medial right occipital lobe, similar to the immediate prior examination and improved relative to examinations from August 2014. No reliably detectable enhancement is seen at the site of prior lesions in the right parietal lobe and the right middle frontal gyrus.No new enhancing lesions are seen. Mild periventricular T2 hyperintensity is seen along with a few scattered additional subcortical foci of white matter signal abnormality. Findings are nonspecific and unchanged. No parenchymal edema or mass effect is detected. No significant intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. Ventricles are normal in size and morphology.Patchy nonspecific enhancement persists unchanged within the right parietal bone. Also noted is a 9-mm enhancing lesion which localizes along or within the left orbital roof (see image 14 of series 1001 and image 41 of series 1201). This lesion was not detectable on the first available brain MRI from 1/17/14, and has slowly increased in size on subsequent studies.", "output": "1. No definite evidence to suggest recurrent or new metastatic disease in the brain parenchyma.2. Note is made of a slowly growing 9-mm region of enhancement within or along the left orbital roof. The significance of this finding is uncertain and the differential diagnosis would include both a benign lesion, such as a hemangioma, as well as metastatic disease. Continued attention to this area on subsequent studies is encouraged."}
{"instruction": "Generate impression based on findings.", "input": "Male, 29 years old, history double up see with drop attacks, image guidance during laser ablation. Selected sequences are provided for guidance during laser ablation.Two laser ablation fibers are in place, one of which approaches from the right posterior parietal region coursing anteriorly and inferiorly to track along and terminate within the body of the right corpus callosum; the second approaches from the right frontal region and tracks inferiorly and posteriorly through the right corpus callosum genu and terminating at the level of the rostrum.On postcontrast images, a blush enhancement is seen along the distal aspects of both laser fibers compatible with procedure-related disruption to the blood brain barrier. Again seen is encephalomalacia of the anterior right temporal lobe along with evidence of multiple prior bilateral craniotomies.", "output": "Image guidance during laser ablation reveals the placement of two laser fibers, one which tracks along the right corpus callosum body, while the other tracks along the right corpus callosum genu and rostrum. Postcontrast images reveal a blush enhancement along the distal aspects of both fibers compatible with procedure-related disruption of the blood brain barrier."}
{"instruction": "Generate impression based on findings.", "input": "Lumbago [724.2], Reason for Study: ^Reason: r/o DJD progression/ spinal cord compression History: lower back pain with radiation to left thigh For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is acute compression fracture of L2 vertebral body with about 20% of height loss.There is no definitive evidence of retropulsion of fracture fragment.The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at theL1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: Mild bilateral ligamentum flavum thickening, no neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc, previously seen central to left disc protrusion is not shown on today's scan. Instead there is broad based diffuse bulging of disc toward left side foramen causing minimal neural foraminal narrowing but does not show any evidence of direct nerve root compression. L3-L4: Diffuse bulging of disc with bilateral ligamentum flavum thickening causing mild to moderate spinal canal stenosis. L4-L5: Diffuse bulging of disc, minimal spinal canal stenosis. Subchondrosclerosis of bilateral facet joint with the minimal thickening of ligamentum flavum. L5-S1: no neuroforaminal narrowing or spinal stenosis.", "output": "1. Acute compression fracture of L2 vertebral body with the 20% of height reduction.2. Degenerative spondylosis of L-spine.3. Retracted previously seen L23 disc protrusion with remained broad based disc bulging without evidence nerve root compression.Comment: if the back pain is clinically intolerable with conservative management, please contact neurointerventional radiology for percutaneous kyphoplasty if indicated. "}
{"instruction": "Generate impression based on findings.", "input": "Right lower extremity radiculopathy, S1 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 with focal T1 hyperintensity involving the L3 vertebral body compatible with a hemangioma or focal fat. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge eccentric to the left.. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation and minimal bulge. No spinal canal or neural foraminal stenosis.L5-S1: There is a right paracentral disc extrusion which effaces the lateral recess. Annular fissure is also evident. There is caudal migration of the extruded disc fragment which remains contiguous with the parent disc fragment, without findings to suggest sequestration. There is mass effect on the right S1 nerve root. Left lateral recess and central canal remain patent. Neural foramina also remain patent. Paraspinous soft tissues are within normal limits.", "output": "Disc extrusion at L5-S1 with effacement of the right lateral recess and suspected impingement of the right S1 nerve root."}
{"instruction": "Generate impression based on findings.", "input": "Other malignant neoplasm without specification of site [199.1], Reason for Study: ^Reason: 21 y/o with h/o metastatic testicular cancer to brain and lung. c/f brain metastasis as well as hemorrhage into metastasis vs. Leptomeningeal disease. Brain MRIThere is subacute hemorrhagic foci on the right precentral gyrus cortex which shows some enhancement with minimal surrounding edema. Considering the patient's clinical history of malignancy, this lesion could represent hemorrhagic metastasis.There are multiple enhancing lesions on the right posterior medulla and right inferoanterior aspect of cerebellar hemisphere, again indicating metastatic lesions.There is no evidence of acute ischemic lesion on this scan.There is no evidence of abnormal leptomeningeal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate non visualization of the right vertebral artery from the level of C34. Considering the size of proximal right vertebral artery and tapering fashion of the distal visualized portion of the right vertebral artery, arterial dissection can be a differential diagnosis. Axial fat saturation T1 scan of the neck shows intra-luminal high signal intensity on the right vertebral artery which suggest possible intraluminal thrombus or very slow flow. However, due to motion artifacts and low spatial resolution, evaluation of vertebral arterial wall hematoma which could be diagnostic for the possibility of arterial dissection cannot be precisely evaluated.Otherwise, normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries were seen. Bilateral vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. There are multiple lung lesions demonstrated. The largest lesion is on the right upper lung and the size was 21mm.Orbit MRIThe globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement.", "output": "1. Multiple metastatic lesions including the right frontal lobe pre central gyrus (hemorrhagic), right posterior medulla and right cerebellar hemisphere.2. No acute ischemic lesion. No abnormal leptomeningeal enhancement.3. Non visualization of right vertebral artery indicating right vertebral artery occlusion. 4. Normal brain MRA. Normal Orbit MRI. "}
{"instruction": "Generate impression based on findings.", "input": "Headaches No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns as well as gray/white matter differentiation remains within normal.Limited real paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable.Calvarium is intact. Small densely calcified lesion along the inner table of the skull in the right pterion with extension inferiorly along the greater wing of sphenoid on the right is noted there is a lucent line separating this lesion from the inner table of the skull which may represent the dura. The finding may not present heavily calcified dural (dural plaque) however possibility of heavily calcified meningioma cannot be ruled out. This lesion can be further evaluated with a dedicated MRI examination of brain with contrast. I detect no soft tissue component with this finding which is best appreciated on bone density images 5 through 12.", "output": "1.Negative CT of brain parenchyma.2.Thin densely calcified extra-axial dural based lesion at the level of right pterion may represent a dural plaque or a heavy calcified meningioma. Please see above comments. Follow-up with a dedicated MRI is recommended."}
{"instruction": "Generate impression based on findings.", "input": "34 years, Male, Reason: 34 yo male w/ GBM; s/p 3 resections, RT (59.4 Gy and 33 fractions), BCNU, and TMZ+RT; recently relapsed. Again seen is a left frontal tumor resection cavity with multiple adjacent foci of susceptibility compatible with chronic blood products. Since the prior exam from 7/12/2016, there has been marked increase in nodular and heterogeneous enhancement surrounding the left frontal resection cavity along its lateral, medial, and inferior aspects. Interval increase in enhancement extends across the corpus callosal genu into the right frontal lobe, left basal ganglia inferiorly, posteriorly into the left parietal lobe, as well as across the splenium into the right parietal lobe. Inferior tumor extension is noted now filling the suprasellar cistern with associated mass effect including posterior displacement of the midbrain. Elevated cerebral blood volume is noted with the increased areas of enhancement.There is also increase in T2/FLAIR hyperintensity in the left frontal, left parietal, right frontal, and right parietal lobes. There is worsened mass effect including increased effacement of the left lateral ventricle. There is subfalcine herniation and rightward midline shift measuring approximately 8 mm at the level of the foramen of Monro. The right temporal horn is enlarged indicative of entrapment. The third ventricle is posteriorly displaced and dilated which appears to be related to obstruction at the cerebral aqueduct. There is increase in edema in the midbrain. There is effacement of the bilateral ambient cisterns related to downward herniation.There is restricted diffusion associated with the tumor. No evidence of infarct or new large hemorrhage. Major flow-voids are grossly preserved. Right transparietal shunt catheter is in place with its tip in the lateral ventricle abutting the septum pellucidum, similar to prior.", "output": "1. Compared to 7/12/2016, there is marked progression of known glioblastoma with increased extension in the left frontal and left parietal lobes, increased extension across the corpus callosum, inferior extension into the basal ganglia as well as inferior extension into the suprasellar cistern. 2. Worsened mass effect includes midline shift, dorsal displacement of the midbrain, and downward herniation. There is also increase in dilatation of the lateral and third ventricles which is suspected to be related to obstruction at the level of the cerebral aqueduct.Dr. Ali discussed findings with Dr. Lukas at 1600 hrs on 8/12/2016."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with altered mental status. Again seen are patchy areas of low attenuation in the subcortical and periventricular white matter, which are nonspecific and have progressed since recent MRI. Please refer to the MRI report from 5/22/2009 for further detail. There may be a new focus of low attenuation in the right brainstem (image 8/36, series 2), which may be further evaluated with MRI if clinically indicated.There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid collections. The ventricles are midline, with normal volume and morphology. There is no midline shift or mass effect.The calvaria and other osseous structures are intact, with no fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. New hypoattenuating focus in the right midbrain, which may be further evaluated by MRI if clinically indicated.2. Progression of extensive white matter abnormality, with differential including demyelinating disease versus underlying metabolic abnormality. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 53 years old, with left upper extremity radiculopathy. Assess for disc herniation. Straightening of the cervical lordosis is demonstrated, similar to prior. Spinal alignment is otherwise unremarkable.Vertebral body morphology is within normal limits. No pathologic marrow replacement or marrow edema is seen.The visualized spinal cord is free of pathologic signal abnormality. Additional details by level as follows:C2-3: Stable tiny subchondral cyst along the C2 endplate. No significant spinal canal stenosis or neuroforaminal narrowing. C3-4: Interval decrease in size of a previously seen central disc protrusion. Small persistent central annular fissure. No significant foraminal narrowing. C4-5: Left facet hypertrophy. Slight interval progression of posterior disc-osteophyte complex formation asymmetric to the left. Mild effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. Mild left foraminal narrowing, progressed. C5-6: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing, progressed. Mild right foraminal narrowing, unchanged. C6-7: Posterior disc-osteophyte complex formation with an asymmetric/focal component in the right paracentral zone appearing similar to prior. Mild generalized spinal canal stenosis and slight ventral cord flattening are unchanged. Mild to moderate right neuroforaminal narrowing is unchanged.C7-T1: No spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues are unremarkable. A small Tornwaldt cyst is evident within the nasopharynx.", "output": "1.Decrease in the size of the previously seen central disc protrusion at C3-4.2.Slight interval progression of posterior disc-osteophyte complex formation asymmetric to the left at C4-5 with mild progressive left foraminal narrowing.3.Posterior disc-osteophyte complex formation at C6-7 with mild generalized spinal canal stenosis and mild ventral cord flattening, unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Right knee patellofemoral pain no improvement with PT, NSAIDS or injection evaluate for chondral injury vs meniscus tear History: right knee pain MENISCI: The lateral meniscus appears intact. There is minimal heterogeneity of the undersurface of the posterior horn of the medial meniscus which may reflect minimal undersurface fraying. No fluid-filled or unstable tear is evidentARTICULAR CARTILAGE AND BONE: There is focal partial-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle, centrally, with a tiny focus of degenerative subchondral signal abnormality. There is subjective thinning of the lateral tibiofemoral articular cartilage. There is full-thickness articular cartilage degeneration along the lateral facet of the patella with focal full-thickness articular cartilage defects and delamination. There is underlying degenerative subchondral signal abnormality. There is a full-thickness articular cartilage cleft along the medial facet of the patella.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "Osteoarthritis of the knee most pronounced along the patellofemoral articulation with full thickness articular cartilage defects and delamination as described above. Superficial fraying of the medial meniscus. No fluid-filled or unstable meniscal tear is evident. Other findings as described."}
{"instruction": "Generate impression based on findings.", "input": "Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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 acute intracranial hemorrhage, mass, or ventriculomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Right hemiparesis and facial droop. There is restricted diffusion and high T2 signal and swelling within the left paramedian pons. A punctate focus of restricted diffusion is also present within the left posterior parietal lobe at the gray-white matter junction. There are a few punctate foci of susceptibility effect in the left pons. The ventricles are within normal limits in size and configuration. There are several foci of T2 hyperintensity are present in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. There is a left frontal convexity extra-axial mass that measures up to 7 mm in thickness, without compression of the underlying brain. There is diffuse cerebral volume loss. The skull, orbits, and scalp soft tissues are unremarkable.", "output": "1. Acute ischemic infarct involving the left paramedian pons and an additional punctate focus of acute infarction within the posterior left parietal lobe at the gray-white junction, with petechial hemorrhagic conversion in the pons.2. A small left frontal convexity mass likely represents a meningioma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Please evaluate for osteomyelitis in a patient with right knee pain and history of below-the-knee amputation. Again seen are findings related to below the knee amputation. The patient's knee is held in flexion which limits evaluation of the knee joint, proximal tibia, and distal femur.There is sclerosis of the residual proximal tibial diaphysis likely representing chronic osteomyelitis and corresponding to signal abnormality seen on prior MRI. The tibia appears similar to that seen on prior radiographs in July 20, 2015 with no progression of osteolysis.", "output": "Surgical changes of below-the-knee amputation with sclerosis of the residual tibia consistent with chronic osteomyelitis without progression of osteolysis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: scoli History: scoli Bilateral spinal fixation rods with left-sided pedicle screws entering the T4-L3 vertebral bodies and right-sided pedicle screws entering the T4, T6, T8, T10, L2 and L3 vertebral bodies. There is no radiographic evidence of hardware complication.", "output": "Orthopedic fusion of the thoracolumbar spine."}
{"instruction": "Generate impression based on findings.", "input": "Male, 85 years old, with weakness, hyperreflexia, spasticity and atrophy. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No worrisome marrow signal replacement or marrow edema is detected. The visualized spinal cord demonstrates normal morphology and signal characteristics.Loss of disc T2 signal is seen throughout the visualized spine. In addition, there is loss of disc height at C5-6 and C6-7. Additional level specific findings are as follows:C2-3: Left facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing.C3-4: Bilateral facet hypertrophy. Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Moderate bilateral foraminal narrowing. C4-5: Bilateral facet hypertrophy. Posterior disc-osteophyte complex formation. Minimal spinal canal narrowing. Moderate bilateral foraminal narrowing. C5-6: Bilateral facet hypertrophy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C6-7: Bilateral facet hypertrophy. No spinal canal stenosis. Very mild left foraminal narrowing. C7-T1: Bilateral facet hypertrophy. No spinal canal stenosis. No significant foraminal narrowing.", "output": "1.Multilevel cervical spondylosis resulting in scattered mild spinal canal stenosis and mild to moderate neuroforaminal narrowing.2.No evidence of high-grade spinal canal stenosis is seen. No cord impingement or cord edema is suspected."}
{"instruction": "Generate impression based on findings.", "input": "History of chronic hepatitis C. Interval follow-up of enhancing liver mass. ABDOMEN:LIVER, BILIARY TRACT: Redemonstration of a homogeneously enhancing lesion within segment 2 the liver measuring 1.3 x 1.3 cm (series 102 image 82), previously 1.5 x 1.5 cm. The lesion has mildly increased T2 signal and restricted diffusion and retains contrast on the delayed images and does not show washout.The liver has a nodular surface contour consistent with cirrhosis. Hepatic artery, portal vein, and hepatic veins are patent. No biliary ductal dilatation. No findings to suggest portal hypertension.SPLEEN: No significant abnormality noted.PANCREAS: Mildly atrophic pancreas with diffuse prominence of the main pancreatic duct appearing similar to prior.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts. No suspicious mass lesion or hydronephrosis.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.No significant interval change in enhancing focus in segment 2 of the liver. Enhancement characteristics are not compatible with HCC, and the lesion is likely benign. 2.Cirrhotic morphology liver without sequela of portal hypertension."}
{"instruction": "Generate impression based on findings.", "input": "Language delay, localization related epilepsy, but normal EEG. There is a submillimeter nodular focus in the mid frontal scalp, with linear extension to the underlying calvarium. There is no evidence of intracranial hemorrhage, mass, or infarct. The brain parenchyma, brainstem, and cerebellum appear unremarkable. There is an appropriate degree of white matter myelination. 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 are grossly unremarkable.", "output": "A submillimeter nodular focus in the mid frontal scalp, with linear extension to the underlying calvarium may represent an atretic encephalocele or related entity, for which ultrasound may provide further characterization. Otherwise, no evidence of potential seizure foci."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female with right upper quadrant abdominal pain, nausea, and vomiting ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. Cholelithiasis is noted. Small filling defect at the distal common bile duct at the level of the ampulla likely reflects a small gallstone. There is an arterially enhancing lesion in hepatic segment six measuring 1.4 x 1.2 cm (series 13, image 135). Additional arterially enhancing lesions within hepatic segment seven and two. These lesions are isodense to liver parenchyma on subsequent phases.SPLEEN: Probable splenule inferior to the pancreatic tail measuring 1.2 x 1.3 cm.PANCREAS: Mild edema type signal surrounding the pancreatic head may reflect pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Cholelithiasis with pericholecystic fluid can be seen in the setting of acute cholecystitis.2.Choledocholithiasis with small stone at the distal CBD at the level of the ampulla. Mild edema surrounding the pancreatic head may reflect mild pancreatitis.3.Arterially enhancing lesions within hepatic segment two, six, and seven may represent hepatic adenomas or focal nodular hyperplasias. Follow-up MRI in 6-12 months with FNH protocol is recommended to ensure stability."}
{"instruction": "Generate impression based on findings.", "input": "Male, 54 years old, with neutropenic fever and altered mental status in a patient with AML status post stem cell transplant. A small focus of T1 hyperintense material, likely blood, is seen within the left superior frontal sulcus. The edges of the sulcus show susceptibility compatible with hemosiderin staining. Similar findings are also evident along several sulci of the right middle frontal gyrus. These findings are new relative to the prior exam.A few scattered foci of T2 hyperintensity are seen within the periventricular white matter which are not significantly changed from prior. A punctate focus of susceptibility within the left frontal lobe is new and compatible with chronic microhemorrhage.No mass effect or parenchymal edema is detected. The ventricles are within normal limits for size but slightly larger than on the prior examination, a finding which may represent interval volume loss.A mucus retention cyst is present in the right maxillary sinus. Patchy mucosal thickening or secretions are evident in the right frontal sinus and left ethmoid air cells.", "output": "1. A small amount of blood product is seen within the left superior frontal sulcus and along some of the sulci of the right middle frontal gyrus. There is no significant associated mass effect or parenchymal edema. No underlying lesions are seen to account for these areas of hemorrhage. Discussed with Dr. Lurain at 8:15 AM on 2/14/15.2. Otherwise no definite evidence of any other acute intracranial abnormality including no findings to suggest acute ischemia or intracranial infection."}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of ischemic stroke. There is a small, focal area of signal abnormality centered within the posterior aspect of the left putamen extending into the adjacent left frontal deep white matter which demonstrates increased T2 signal, mixed T1 signal, increased signal on diffusion-weighted images, and isointense signal on ADC images compatible with a subacute infarction. This area corresponds to the hypodensity described on recent CT. The remaining brain parenchyma appears within normal limits for age. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening within the maxillary sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable.", "output": "Subacute infarct involving the left putamen and adjacent deep white matter which was also present on recent CT from 7/20/2016."}
{"instruction": "Generate impression based on findings.", "input": " Thoracic spine: There is high T2 signal of the intervertebral disc T9-T10 with erosions of the inferior endplate of T9 and the superior endplate of T10, as well as slight focal kyphosis. There is epidural extension of the disc material and fluid with impingement upon the spinal cord, which displays patchy high signal in this region, and paravertebral extension of the inflammatory process with multiple small fluid collections, particularly on the right side. At the T9 and T10 levels, there is also hypertrophy of the ligamentum flavum, which contributes to severe spinal stenosis. The neural foramina is also severely narrowed bilaterally. There are multiple intravertebral disc herniation in the inferior endplates of T6 through T8 and T10 through T12 and the superior and inferior endplates of T11 and T12, with associated degenerative endplate marrow signal alterations. There is bilateral renal atrophy, with multiple cysts.Lumbar spine: There are multiple intravertebral disc herniation with associated degenerative marrow changes. At L4-L5 and L5-S1, there are disc bulges, ligamentum flavum hypertrophy, and bilateral facet degenerative changes with effusions and synovial cysts with mild spinal canal stenosis and at least moderate narrowing of the neural foramina bilaterally at both of these levels. There is straightening of the lumbar spine alignment in the sagittal plane.", "output": "1. Discitis-osteomyelitis at the level of T9-T10 with epidural extension that results in spinal cord compression and mild edema. The infectious process also extends into the paraspinal region with what appears to be multiple small abscesses. However, characterization is limited due to the lack of intravenous contrast. 2. Multiple thoracic and lumbar intravertebral disc herniations.3. Degenerative spondylosis at L4-L5 and L5-S1 with at least moderate narrowing of the neural foramina bilaterally and mild spinal canal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Suspected viral mmeningitis. A lumbar puncture was done which revealed an elevated opening pressure. Brain MRI: There is a subcentimeter nodular lesion with susceptibility effect in the left corona radiata with an adjacent small development venous anomaly. There is no evidence of cerebral abscess or abnormal leptomeningeal enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is flattening of the pituitary gland. The ventricles and basal cisterns are normal in size. 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.Brain MRV: There is apparent focal constriction of the bilateral transverse sinuses. There is no evidence of cerebral venous sinus thrombosis.Orbits MRI: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.", "output": "1. Small cavernous malformation in the left corona radiata with an adjacent small development venous anomaly.2. No evidence of cerebral abscess or abnormal leptomeningeal enhancement.3. No evidence of cerebral venous sinus thrombosis.4. No evidence of orbital lesions.5. Flattening of the pituitary gland and apparent focal constriction of the bilateral transverse sinuses can be manifestations of elevated intracranial pressure."}
{"instruction": "Generate impression based on findings.", "input": "55 years Male (DOB:9/2/1960)Reason: 55yom w IDDM, HTN, Rheumatoid arthritis on prednisone and MTX, presenting with right hemibody \"clumsiness\" having subacute Lt MCA stroke, pls eval age of infarct . pt has central nystagmus and complains of vertigo concern for concurrent brainstem infarct History: see abovePROVIDER/ATTENDING NAME: WILLARD W SHARP ADIL JAVED There is a focus of diffusion restriction present in the left postcentral gyrus associated with punctate focus of diffusion restriction in the left inferior parietal lobule. These foci of diffusion restriction associated with FLAIR and T2 signal abnormalities. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.On susceptibility images are multiple foci of punctate signal loss within the distribution of the area of diffusion restriction.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Findings are compatible with subacute infarction in the left parietal lobe.2.No evidence for brainstem infarction"}
{"instruction": "Generate impression based on findings.", "input": "Parkinson's disease preoperative planning for deep brain stimulation. There is no evidence of intracranial mass lesions. There is nonspecific bilateral globi pallidi T2 hyperintensity. There is mild diffuse 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 is mild scattered paranasal sinus mucosal thickening.", "output": "Unremarkable MRI with regard to preoperative planning."}
{"instruction": "Generate impression based on findings.", "input": "Male, 59 years old, with brain metastasis, history of non-small cell lung carcinoma, planning examination for stereotactic radiosurgery. A 9 mm, round, homogeneously enhancing nodule is evident within the cortex of the left occipital lobe. This lesion produces no significant surrounding edema and there is no associated mass effect.A 3 mm focus of extra-axial enhancement is seen along the right planum sphenoidale. No other intracranial enhancing lesions are seen. No parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.", "output": "1.A 9 mm cortically based enhancing lesion is seen within the left occipital lobe causing no significant edema or mass effect. Given the history, this most likely represents a focus of metastatic disease.2.A 3 mm focus of extra-axial enhancement along the right planum sphenoidale could represent a small incidental meningioma. Attention on follow-up examinations will be required."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with confusion on Coumadin found down at bedside with no neurologic findings. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodense region within the subcortical and periventricular white matter consistent with small vessel disease, age indeterminate. Well defined hypodense region within the left MCA territory and left cerebellum consistent with previous strokes. No acute cortical stroke is seen, however, if there is clinical concern for acute ischemia, an MRI may be considered. Dense atherosclerotic calcifications noted throughout the large vessels.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": "Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered."}
{"instruction": "Generate impression based on findings.", "input": "Male, 2 years old, with sensorineural hearing loss status post meningitis. Brain MRI:The ventricles and sulci are mildly, diffusely prominent, consistent with global volume loss, greater than expected for the patient's stated age, however unchanged in extent. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. No leptomeningeal or pachymeningeal enhancement is appreciated. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. IAC MRI:There has been interval decrease in bilateral pathologic enhancement of the cochlea, vestibules, and to a lesser degree the semicircular canals. The inner ear structures otherwise demonstrate normal morphology and T2 signal characteristics. No mass lesion or pathologic enhancement is evident in the IACs or CP angles. The eighth cranial nerves are present bilaterally. Previously described questionable pathologic enhancement of portions of the bilateral facial nerves are unchanged, and are felt to be within normal anatomic variation for the appearance of post cisternal facial nerves.", "output": "1.The ventricles and sulci are mildly, diffusely prominent, consistent with global volume loss, greater than expected for the patient's stated age, however unchanged in extent. 2.There has been interval decrease in bilateral pathologic enhancement of the cochlea, vestibules, and to a lesser degree the semicircular canals,"}
{"instruction": "Generate impression based on findings.", "input": "70 year-old female. History of bilateral renal cysts (complex). Evaluate for bilateral renal mass. ABDOMEN:LIVER, BILIARY TRACT: Hepatic dome is not included in the field of view. No suspicious hepatic lesion in the visualized liver. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Complex left upper pole cyst with with enhancing thin septations is 3.5 x 3 cm (series 10, image 27), unchanged. A second adjacent cyst with T1 hyperintensity and a fluid-fluid level and no appreciable enhancement on subtraction sequences, most likely a hemorrhagic cyst (series 10, image 21), unchanged at 2.2 x 2.1 cm.Right interpolar region simple cyst measures 3.9 x 3.3 cm (series 10, image 40), unchanged.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": "Mildly complex left upper pole cystic lesion with enhancing thin septations is indeterminate, continued follow-up is recommended. No new suspicious lesions."}
{"instruction": "Generate impression based on findings.", "input": "43 years Male (DOB:11/12/1972)Reason: history of brain mets s/p SRS please History: nonePROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left occipital craniotomy.There is redemonstration of T2 and FLAIR hyperintense lesions in the left precuneus which are stable compared to the prior exam. There are additional foci of susceptibility present in this location as well. There is no contrast enhancing lesion identified in the surgical bed.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There is redemonstration of postoperative changes in the left precuneus which are stable. Most likely this represents posttreatment change"}
{"instruction": "Generate impression based on findings.", "input": "History of cervical spine fusion at C5-C6. Status post car accident with new right arm pain/paresthesias. There are postsurgical changes of anterior cervical fusion at the C5-C6 level with associated artifact slightly limiting evaluation. There appears to be moderate degree of spinal canal stenosis at this level. There is questionable signal abnormality in the cord at this level without cord swelling. There are additional disc osteophyte complexes throughout the cervical spine with mild to moderate degree of spinal canal stenosis also present at the C4-C5 and C6-C7 levels.There is otherwise no high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine. The vertebral bodies are appropriate in the overall alignment and height. Mild degenerative changes in the lumbar spine are also present including a disc bulge at the L2-L3 level with dorsal annular fissure. No evidence of epidural hematoma.", "output": "This is a limited exam specific for the exclusion of cord compression only. There is no evidence of acute cord compression or epidural hematoma. There are postsurgical changes of ACDF at the C5-C6 level with moderate spinal canal stenosis at this level and questionable small focus of T2 hyperintensity within the cord, which is age-indeterminate. There are also multilevel disc osteophyte complexes particularly at the C4-C5 and C6-C7 levels with associated mild to moderate degree of spinal canal stenosis. Dedicated cervical spine MRI can be considered for better assessment of these findings.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine."}
{"instruction": "Generate impression based on findings.", "input": "Left upper extremity weakness and neck pain. C4-C5 fusion. Multiple sequences are motion degraded and repeated. Again seen are postoperative changes of ACDF at C4-C5 with solid osseous fusion better demonstrated on CT. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Susceptibility artifact from patient's hardware and motion degradation somewhat limit evaluation. There is abnormal T2 signal involving the right ventral aspect of the cord at the C4-C5 level likely representing myelomalacia, presumably from prior compressive myelopathy. There is no spinal canal stenosis on the current study at this level.There is mild developmental narrowing of the cervical spinal canal with superimposed degenerative changes including small disc osteophyte complexes and mild multilevel facet arthropathy. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy. There is partial effacement of the ventral and dorsal thecal sac without significant spinal canal stenosis overall. There is mild to moderate right and mild left left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C4-5: No significant compromise to the spinal canal or neural foramina. Cord signal abnormality as described above.C5-6: There is a small disc osteophyte complex and ligamentum flavum thickening contributing to mild spinal canal stenosis. There is up to moderate, right slightly worse than left neural foraminal stenosis.C6-7: No significant compromise to the spinal canal. Minimal bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.", "output": "1. Postoperative changes of ACDF at C4-C5, with solid osseous fusion better demonstrated on CT.2. Degenerative changes in the cervical spine superimposed on mild developmental narrowing of the cervical spinal canal. There is mild spinal canal stenosis at the C5-C6 level. Otherwise no evidence of high-grade spinal canal stenosis. Neural foraminal stenosis is worst at the C5-C6 level where there may be impingement of the C6 nerve roots, right worse than left.3. Abnormal T2 signal involving the right ventral cord at the C4-C5 level likely represents myelomalacia and may be related to prior compression. There is no spinal canal stenosis on the current study at this level.."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old male status post left knee dislocation and multi ligamentous injury. MENISCI: The lateral meniscus appears intact. There is increased globular signal abnormality within the posterior horn and body of the medial meniscus suggesting intrasubstance degeneration. Some of this signal extends to the tibial articular surface indicating undersurface fraying/degenerative tearing. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There are focal full-thickness articular cartilage defects centrally as well as along the medial and lateral facets of the patella, with underlying subchondral signal abnormality. There is an apparent full-thickness articular cartilage cleft along the medial facet of the femoral trochlea. The articular cartilage of the medial tibiofemoral compartment appears relatively spared, as is the cartilage along the lateral tibiofemoral compartment.LIGAMENTS: There is disruption of the ACL. There is complete rupture of the PCL. There is indistinctness and increased signal abnormality within the proximal fibers of the lateral collateral ligament proper indicating a tear. The IT band and biceps femoris appear intact. The medial collateral ligament appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Complete rupture of the ACL and PCL. Indistinctness of the proximal fibers of the lateral collateral ligament proper, indicating a tear.2. Focal full-thickness articular cartilage defects affecting the patellofemoral joint. Other findings as described above.3. Elevated tibial tubercle to trochlear groove distance with measurements provided above which may be post traumatic in etiology.4. Nonspecific edema type signal abnormality within the tibialis anterior muscle as described above."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male patient with history of gout, pain and swelling of the left knee. Mild osteoarthritis on films with probable meniscal tear, knee clicking. MENISCI: The lateral meniscus appears intact. There is increased, multidirectional signal intensity within the posterior horn of the medial meniscus which likely represents complex tearing. Additionally the body of the medial meniscus appears macerated.ARTICULAR CARTILAGE AND BONE: There is full-thickness loss of the articular cartilage of the posterior aspect of the weightbearing portion of the medial femoral condyle articular cartilage. There is marked thinning of the articular cartilage more anteriorly. The articular cartilage of the lateral tibiofemoral compartment appears grossly intact. There is fraying and partial-thickness tearing of the articular cartilage of the lateral patellar facet.Edema and subchondral cyst formation is noted within the intercondylar notch of the tibia.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1. Complex tearing of the medial meniscus as described above.2. Chondromalacia most predominately affecting the medial femoral compartment.3. Edema within the intercondylar notch of the tibia."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of vasculitis History: occasional CP CHEST:LUNGS AND PLEURA: Grossly unremarkable.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedMR ANGIOGRAPHY: Mild circumferential wall thickening involving the ascending aorta, arch, descending aorta and abdominal aorta with shallow ulcerations are unchanged. The aorta is normal in caliber throughout. The ascending aorta measures 28 mm in diameter, unchanged.There is a common origin of the innominate and left common carotid arteries.There is a high-grade focal stenosis at the ostium of the left subclavian artery with poststenotic dilatation to 7 mm, similar to the prior exam. Smooth narrowing at the origin of the right subclavian artery appear similar to the prior exam. The common carotid arteries appear normal.There is high-grade stenosis at the origin of the celiac artery measuring 7 mm in length with 6 mm poststenotic dilatation, similar to the prior exam. The SMA is patent. The renal arteries are patent.Focal thrombosed dissection inferior to the origin of SMA is unchanged. Iliac arteries are not within the field of view on this study.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "1. High-grade narrowing at the origins of the left subclavian and celiac arteries are unchanged since the prior exam.2.Circumferential wall thickening of the thoracic and abdominal aorta is unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Please evaluate for white matter lesion or change in pituitary: Langerhans cell histiocytosis, headaches. Brain: 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.Pituitary: There is an unchanged punctate pars intermedia cyst. The pituitary gland and infundibulum are unchanged in size. The optic apparatus and cavernous sinuses are intact.", "output": "1. No evidence of white matter lesions.2. Unchanged appearance of the pituitary gland and infundibulum."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for etiology of right hip/low back pain in pt with AML s/p recent bone marrow biopsy History: right hip pain and low back pain, acute onset, s/p recent bone marrow bx 1 week ago, radiation of pain down back of right leg The exam is slightly limited by motion artifact.BONE MARROW: Extensive red marrow may be secondary to patient's therapy.SOFT TISSUES: Large hematoma extending from the iliac crest to the lesser trochanter. Inflammation of the surrounding the soft tissues of the thigh, infection cannot be excluded.JOINTS: No significant abnormality noted.ADDITIONAL", "output": "Large hematoma extending from the iliac crests to the lesser trochanter. Inflammation of the surrounding soft tissues of the thigh, infection cannot be excluded.Findings discussed with Dr. Olatoyosi Odenike at the time of dictation."}
{"instruction": "Generate impression based on findings.", "input": "Male 77 years old Reason: severe low back pain with radicular pain in right leg Moderate degenerative disc disease affects the L2-3 level. Marked degenerative disease at L4-5 and L5-S1. Compression fracture of the L5 vertebral body, which appears to have progressed since MRI 11/17/2015. The full extent of the L5 vertebral body is not well-visualized. However, there is apparent retropulsion of the L5 vertebral body secondary to this compression, however this is not well visualized on the radiograph. Again seen is bilateral L4 pars defects and a grade 1 anterolisthesis of L4 and L5. Hypertrophy of the spinous processes.", "output": "Compression fracture of L5 vertebral body appears to have progressed since most recent MRI, however the full extent of the L5 vertebral body is not well-visualized as detailed above. Cross-sectional imaging with CT or MRI is recommended for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Female 62 years old Reason: History of chronic diarrhea and NSAID's usage, chronic anal fissures. Assess for inflammation History: diarrhea ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Biliary tree is normal in caliber.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: Calcific arterial sclerotic disease affects the aorta.BOWEL, MESENTERY: Small bowel is normal in caliber and course. No focal inflammatory changes. Terminal ileum is normal in caliber without thickening or abnormal enhancement.BONES, SOFT TISSUES: Post surgical changes in the lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Above-average colonic fecal content.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No evidence of bowel inflammation."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with right adrenal adenoma ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is a right adrenal nodule measuring 2.5-1.9 cm demonstrating loss of signal on out of phase sequence compatible with a microscopic fat containing adrenal adenoma. The nodule in the left adrenal gland measuring 2.0 x 1.3 cm also demonstrates loss of signal on out of phase sequence compatible with microscopic fat containing adrenal adenoma.KIDNEYS, URETERS: Subcentimeter cyst in the superior pole left kidney. 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.Bilateral microscopic fat-containing adrenal adenomas as described above."}
{"instruction": "Generate impression based on findings.", "input": "History of pancreatic cystic lesion. Presents for follow-up. ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. The liver is normal morphology, size and enhancement. No focal suspicious lesion. Stable segment 8 probable flash filling hemangioma. (Series 1001/237)Stable segment 8 punctate cyst. (601/32)No biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: The spleen measures 15 cm in craniocaudal length without a focal lesion.PANCREAS: Several small cystic lesions are again noted in the pancreas. The largest is in the pancreatic head and measures 1.2 x 0.9 cm (series 401/27) compared to 7 x 5 mm previously.A lesion in the tail measures 1.0 x 0.8 cm (series 401/29), compared to 7 mm previously. These lesions do not clearly communicate with the main pancreatic duct which is normal in caliber. The pancreas demonstrates normal signal intensity and morphology otherwise. No peripancreatic inflammatory changes.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate right renal too small to characterize hyperintensity, probable a small benign renal cyst.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": "Mild interval increase in the size of the nonspecific cystic lesions within the pancreatic head and tail now measuring 1.2 and 1.0 cm respectively. No definite communication with the main pancreatic duct which is normal in caliber. Given their small size evaluation for mural nodularity/enhancement is limited. Given this limitation no suspicious postcontrast imaging features are evident. EUS/FNA sampling should be considered. At least continued imaging follow-up is recommended.Hepatic steatosis.Borderline nonspecific splenomegaly, unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Slurred speech and weakness. MRI: There is periventricular and subcortical white matter T2 hyperintensity and there is an area of encephalomalacia in the right superior frontal gyrus. There is a nonspecific punctate focus of susceptibility effect in the left frontal lobe white matter, which may represent a chronic microhemorrhage. There are mildly prominent perivascular spaces in the right inferior basal ganglia. There is no evidence of intracranial mass or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left lens implant.MRA: There may be minimal narrowing of the proximal left posterior cerebral artery. Otherwise, there is no evidence of significant steno-occlusive lesions or aneurysms.", "output": "1. Probable chronic small vessel ischemic cerebral white matter disease and chronic infarct in the right superior frontal gyrus, but no evidence of acute infarct.2. Perhaps minimal narrowing of the proximal left posterior cerebral artery. Otherwise, no evidence of significant steno-occlusive lesions involving the other proximal cerebral arteries."}
{"instruction": "Generate impression based on findings.", "input": "Severe headache. History of intractable epilepsy and brain cysts. 27 year old female with, cerebral palsy, encephalitis, post hemispherectomy as child, hydrocephalus with VP shunt and multiple revisions. Previous craniotomy for cyst fenestration and removal of Ommaya reservoir and intracranial catheter. There are findings related to previous right cerebral hemispherectomy. The multiloculated cystic structure at the resection margin which also involves the posterior aspect of the left cerebral hemisphere has slightly increased since the previous examination. The largest locule that along the posterior body/splenium of the corpus callosum now measures in the axial plane 3.4 cm x 2.7 cm (image #19 of series #501) compared to 2.3 cm x 2.2 cm (image #13 of series #7). These locules are now entirely fluid-filled with no air and have similar signal intensity to CSF with complete attenuation on FLAIR sequence.The moderate periventricular T2-hyperintensity in the left cerebral hemisphere and along the resection margin has not changed and may reflect gliosis. The tracts of the previous left parieto-occipital ventriculostomies and the associated susceptibility artifact remain unchanged. The left lateral ventricle remains collapsed except for its temporal horn. There is no diffusion restriction in the brain parenchyma. Apparent tethering of the upper cervical spinal cord to the posterior dura at the site of previous posterior decompression is unchanged, with mild associated kinking.The multiloculated fluid collection just deep to the partially resorbed right pterional craniotomy flap is not significantly changed in size with resolution of previously seen air. It shows diffusion restriction which most likely reflect the presence of blood products.The right internal carotid artery and its right anterior and middle cerebral arteries are small in size but show preserved flow voids. The other major intracranial arteries show also preserved flow voids, reflect gross patency.", "output": "1.Compared to the previous MRI from September 2015, the multiloculated cystic structure at the right hemispherectomy margin and involving the corpus callosum is slightly increased in size although results in no significant mass-effect.2.The air within this multiloculated cystic structure and in the extra-axial fluid collection at the craniotomy site is resolved and the cysts are now completely fluid-filled."}
{"instruction": "Generate impression based on findings.", "input": " MRI brain:The ventricles and sulci are within normal limits. There is mild global volume loss greater than expected for age but this is nonspecific. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is partial opacification of the right sphenoid sinus. MRI T-spine:The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is a small T7-8 central disc protrusion but no significant spinal canal or foraminal stenosis within the thoracic spine.", "output": "No evidence of a demyelinating process in the brain or thoracic spine. Global volume loss greater than expected for patient's stated age."}
{"instruction": "Generate impression based on findings.", "input": "53 are old female with history of right breast lumpectomy in 2014 for DCIS with clear margins, presents with new right-sided breast biopsy which is positive for DCIS adjacent to the prior lumpectomy bed. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact from biopsy clip is present within the mid central right breast, with adjacent 1.8-cm hematoma. Mild peripheral enhancement is present surrounding the biopsy cavity, and may be related to post biopsy change rather than DCIS given that it is largely thin and uniform around the hematoma. No abnormal lymph nodes are identified in either axillary region.", "output": "1. Post biopsy changes in the mid central right breast with associated clip. Mild peripheral enhancement is noted surrounding the biopsy cavity, likely post biopsy change. Residual DCIS is considered less likely.2. No MRI evidence of malignancy in the left breast or suspicious axillary node.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: left elbow pain The elbow appears normal without findings to account for the patient's pain.", "output": "Normal exam without findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Durkin submitted outside study for review. Submitted for review is:-Breast MRI: 8/7/2015 This examination was performed at Palos Community Hospital. Bilateral breast MRI was performed using the outside institutions protocol. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST: In the right upper outer breast (posterior depth), there is faint linear non-mass enhancement identified measuring approximately 2.8 cm in maximal dimension. Susceptibility artifact from biopsy marker clip is seen at the posterior aspect of this non-mass enhancement, compatible with biopsy proven malignancy. The MRI extent of enhancement measures larger than the mammographically visualized extent of calcifications (2.8 cm vs 1.4 cm) likely due to associated post-biopsy changes. In addition, in the right central breast, there is an oval enhancing mass measuring 0.7 x 0.5 x 0.6 cm. This enhancing mass is located approximately 5.5 cm anterior to the biopsy marker clip at site of known malignancy. LEFT BREAST: In the left lateral breast, there is susceptibility artifact from a biopsy marker clip, at the site of benign breast biopsy. Associated non-mass enhancement measuring approximately 2.6 cm in maximal dimension is present, likely representing associated post-biopsy changes. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "(1) Biopsy proven malignancy in the right upper outer breast with associated post-biopsy related changes. Clip is at the posterior aspect of this enhancement.(2) 0.7 cm enhancing mass in the right anterior central breast. An MR-directed US with possible biopsy is recommended for further evaluation. If no US correlate is identified, then an MR biopsy may be recommended. (3) Benign left breast biopsy with associated post-biopsy related changes. No MR evidence of malignancy in the left breast. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "46 year old with right breast cancer on neoadjuvant chemotherapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. A few scattered cysts are present. At the 10 o'clock position of the right breast, there is faint residual enhancement during the later phases of the dynamic study, measuring as a 1.0 x 0.9 x 1.0 cm mass. This is significantly decreased in size and degree of enhancement compared to the pre-treatment MRI. Previously this measured 3.3 x 3.0 x 2.8. The lymph nodes in the right axilla are normal in morphology. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.A port-a-cath is present in the left upper chest wall. Trace pleural effusions are present.", "output": "Significant response since the pre-treatment MRI. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Punctate hemorrhage on CT? Signs and symptoms: Dizziness and ataxia. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrate no convincing evidence of intracranial hemorrhage. Note should be made however that MRI is insensitive for detection of subtle isolated subarachnoid hemorrhage.FLAIR and T2-weighted images demonstrate scattered foci of FLAIR and T2 hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres. Minimal similar findings are also noted in bilateral basal ganglia and pons. Although nonspecific this appearance is often result of microvascular ischemic changes. Correlate with history and risk factors. Remote possibility of demyelinating disease cannot be entirely ruled out considering patient's stated age.Mild prominence of cortical sulci and lateral ventricles suggestive of underlying parenchymal volume loss.All CSF cisterns remain widely patent.The signal void of major intracranial arterial branches are identified.There is normal anatomical variation of a partially empty sella. Unremarkable calvarium and soft tissues of the scalp, unremarkable images through the orbits, paranasal sinuses and mastoid air cells.", "output": "1.No evidence of intracranial hemorrhage and negative diffusion weighted series.2.Diffuse foci of FLAIR hyperintensity in the subcortical, periventricular and minimally in bilateral basal ganglia and pons suggestive of chronic small vessel ischemic strokes. Correlate with history and risk factors and consider follow-up with enhanced imaging to exclude other white matter lesions if clinically warranted.3.Unremarkable nonenhanced brain MRI otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Male 21 years old; Reason: Is there an injury to the UCL? History: Medial elbow pain and felt a pop after a throw as a baseball catcher LIGAMENTS: The posterior fibers of the ulnar collateral ligament are indistinct, with associated high T2 signal, compatible with tearing. The anterior fibers of the ulnar collateral ligament are intact. The remaining ligaments of the elbow are unremarkable.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: No significant abnormality noted.", "output": "Partial full-thickness tear of the posterior fibers of the ulnar collateral ligament. "}
{"instruction": "Generate impression based on findings.", "input": "History of epilepsy status post laser ablation of the left hippocampus. There are postoperative findings related to left occipital approach laser ablation of the left hippocampus, where there are persistent punctate foci of high T2 signal and enhancement. The rest of the brain parenchyma appears unremarkable. There are also postoperative findings related to left temporal craniotomy and left frontal burr hole, with diffuse enhancement in the overlying scalp soft tissues. 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. There is a small left maxillary sinus retention cyst.", "output": "Expected postoperative findings related to left hippocampal laser ablation."}
{"instruction": "Generate impression based on findings.", "input": " This is a motion degraded exam and multiple sequences were repeated. The brain, brainstem, and cerebellum appear unremarkable. In particular, the globus pallidus, subthalamic nuclei, hippocampus, putamen, thalamus, and cranial nerve nuclei appear to be grossly intact. There degree of myelination is within the realm of normal. There is no evidence of acute infarction. There is a small amount of T1 hyperintense and T2 hypointense subdural hemorrhage within the posterior fossa. There are also a few punctate foci of extra-axial, probably subarachnoid hemorrhage along the bilateral posterior cerebral convexities. There is no midline shift or herniation. The orbits and scalp soft tissues are unremarkable.", "output": "1. A small amount of subacute subdural hemorrhage and probable subarachnoid hemorrhage long the bilateral posterior cerebral convexities.2. No discernible findings to suggest hyperbilirubinemic encephalopathy, although the exam is limited by motion artifact.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female, 76 years old, with left facial droop and memory loss. No restricted diffusion is seen. No evidence of edema or mass effect is observed. There are no large cortical defects. A small focus of apparent encephalomalacia in the right caudate head is similar to findings seen on prior CT. Numerous scattered foci of T2 hyperintensity are demonstrated within the cerebral hemispheres and pons. No findings are seen to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. Brain volume is relatively well-preserved. Ventricular size and morphology are also within normal limits.", "output": "1.No evidence of acute ischemia or any other definite acute intracranial abnormality.2.Findings are seen compatible with chronic microvascular and lacunar ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "63 year old man s/p CABG. Assess for ischemia, viability.MEDICATIONS: Regadenoson and aminophylline per protocol Status post CABG. First Pass PerfusionDuring hyperemia, subendocardial perfusion defects are present in the basal inferoseptal, inferior, and inferolateral wall as well as the mid inferoseptal and inferior walls of the LV.Viability/ Myocardial ScarThere is focal full thickness delayed hyperenhancement within the basal inferior and mid inferoseptal walls of the LV, consistent with previous myocardial infarct. A focal area of apparent delayed hyperenhancement with the basal/mid lateral wall may be artifactual.Left Ventricle There is moderate hypokinesis of the inferior wall of the basal and mid LV.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal.Right AtriumThe right atrium is moderately enlarged.Aortic ValveMild aortic regurgitation.Mitral ValveMild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveModerate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 FindingsSmall scattered pulmonary micronodules. Indeterminate T2 hyperintense hepatic lesion better characterized on previous MRI of the liver. 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. During hyperemia, subendocardial perfusion defects are present in the basal inferoseptal, inferior, and inferolateral wall as well as the mid inferoseptal and inferior walls of the LV.2. There is focal full thickness delayed hyperenhancement within the basal inferior and mid inferoseptal walls of the LV, consistent with previous myocardial infarct.3. Moderate tricuspid regurgitation. Mild aortic and mitral regurgitation.LV and RV function will be added as a separate addendum once those measurements have been performed."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out cord compression. Signs and symptoms: Numbness. Nonenhanced total spine MRI:Examination demonstrates normal signal intensity and anatomic alignment the vertebral column other than mild grade 1 anterolisthesis at L5 -- S1 which is believed to be secondary to degenerative disease.Examination in the cervical region demonstrate degenerative changes with resultant mild central spinal stenosis at C6 -- C7. The signal intensity and caliber cervical cord remains within normal.Examination of thoracic spine demonstrate normal signal intensity and caliber of cord without evidence of mass effect. No appreciable degenerative changes, spinal canal or neural foraminal compromise is present.MRI images of lumbar region demonstrate a centrally located disk protrusion with partial effacement of ventral subarachnoid space and no significant central spinal stenosis. The signal intensity of conus and the cauda equina demonstrate no abnormality. No evidence of spinal canal compromise at any other level.Mild grade 1 anterolisthesis at L5 -- S1 secondary to pars defect. This finding can be further assessed with a dedicated MRI of the lumbar spine.", "output": "1.No evidence of cord compression.2.Degenerative changes at C6 -- C7 results in mild central spinal stenosis. 3.Small disk protrusion at L1 -- L2 with partial effacement of ventral subarachnoid space as detailed.4.Grade 1 anterolisthesis at L5 -- S1 secondary to pars defect. Dedicated MRI of lumbar spine is recommended for further assessment. There is no evidence of spinal stenosis with this finding."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Possible stroke. Signs and symptoms: Left upper and/or extremity weakness. Nonenhanced head CT:Examination demonstrates a large area of vasogenic edema in the right frontal lobe there there is an isodense mass measuring 14 times 17-mm in size within the area of vasogenic edema. There is resultant effacement of adjacent cortical sulci however no midline shift is present. There is no evidence of hemorrhage associated with this finding. A questionable area of low attenuation in the inferior aspect of the left cerebellum may represent an additional focus of edema and or an artifact. Recommend follow-up with an MRI exam.", "output": "1.Right frontal lobe tumor measuring 17 times 14-mm in size with surrounding vasogenic edema.2.Either artifact or an additional small foci of edema in the inferior left cerebellum.3.Recommend follow-up with an MRI."}
{"instruction": "Generate impression based on findings.", "input": " No intra-articular gadolinium traverses the scapholunate or lunotriquetral intervals into the radiocarpal joint to suggest ligamentous disruption. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 6 seconds", "output": "Fluoroscopic guided injection of dilute gadolinium into the right wrist for subsequent MRI arthrogram examination. No fluoroscopic findings to suggest ligamentous disruption. Please refer to the subsequent MRI report for further information."}
{"instruction": "Generate impression based on findings.", "input": "Female, 69 years old. Left-sided low back pain with left-sided sciatica. Five lumbar type vertebral bodies are presumed to be present. The lumbar spine shows leftward thoracolumbar scoliosis more clearly demonstrated on recent radiographs. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact, terminating at approximately the L1 level. The paraspinal soft tissues are unremarkable.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is diffuse disc bulge and mild facet hypertrophy with mild right neural foraminal narrowing and no significant spinal canal stenosis.L3-L4: There is diffuse disc bulge and mild facet hypertrophy with mild right neural foraminal narrowing and no significant spinal canal stenosis.L4-5: There is grade 1 anterolisthesis of L4 over L5 with disc uncovering, diffuse disc bulge which is slightly more prominent posterolaterally toward the left neural foramen, as well as ligamentum flavum hypertrophy and facet hypertrophy, left greater than right, with severe left neural foraminal narrowing, mild right neural foraminal narrowing, as well as mild spinal canal stenosis.L5-S1: There mild facet hypertrophy with no significant compromise to spinal canal or neural foramina.", "output": "Degenerative changes involving the lumbar spine, most severe at the L4-5 level with severe left neural foraminal narrowing and mild spinal canal stenosis at this level. Up to mild neural foraminal narrowing at other levels."}
{"instruction": "Generate impression based on findings.", "input": "Possible oropharyngeal cancer and lung nodules. There is a somewhat ill-defined right oropharyngeal mass that appears to arise from the superior pole of the right palatine tonsil. The mass measures up to approximately 20 mm and there is no invasion of the parapharyngeal or masticator spaces. There are mildly and asymmetrically prominent right level 1B and 2A lymph nodes, which are otherwise not significantly enlarged by size criteria. There is a cystic left thyroid nodules that measures up to 17 mm. The salivary glands are unremarkable. There is mild multilevel degenerative cervical spondylosis. The orbits and imaged intracranial structures are unremarkable.", "output": "A right oropharyngeal mass that measures up to approximately 20 mm may indeed represent a tonsillar squamous cell carcinoma. Mildly and asymmetrically prominent right level 1B and 2A lymph nodes, which are otherwise not significantly enlarged by size criteria are nonspecific. "}
{"instruction": "Generate impression based on findings.", "input": "85-year-old woman with history of left lateral C1 fracture and right frontal brain mass diagnosed on outside CT. On the surface of the anterior right frontal lobe, there is a 34 x 31 x 25 mm (2001/20). It is unclear whether this mass is intra-axial or extra-axial with intraparenchymal invasion, however there is thickening of the adjacent dura. Additionally, there are curvilinear areas of calcification along the peripheral, posterior aspect of this mass, better characterized on the CT. This mass is isointense on T1 and slightly hyperintense on T2 weighted images with homogenous, avid enhancement. There is significant amount of abnormal T2/FLAIR signal in the underlying right frontal lobe white matter which extends through the genu of the corpus callosum into the medial left frontal lobe. There is local mass effect on the frontal horn of the right lateral ventricle, 9 mm of leftward midline shift, and slight asymmetric dilation of the left lateral ventricle suggesting entrapment. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage. A few additional foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter are nonspecific, but compatible with chronic small vessel ischemic changes. The major flow-voids are preserved.The patient is status post right cataract surgery, otherwise the sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits including the calvarium overlying the aforementioned mass. CERVICAL SPINE", "output": "1.Avidly enhance mass along the surface of the right anterior frontal lobe with peripheral calcification. While it is unclear whether this mass is intra or extra-axial, differentials include meningioma with invasion of the underlying parenchyma, a solitary dural based metastasis, or a primary glial neoplasm.2.Significant underlying vasogenic edema with midline shift and an asymmetric left lateral ventriculomegaly suggestive of entrapment.3.C1 fracture better characterized on recent CT.4.Edema in the interspinous cervical soft tissues which may indicate interspinous ligamentous injury, but no frank disruption of the major cervical ligaments is seen. No cord signal abnormality or epidural hematoma.5.Multilevel cervical degenerative disc disease with mild to moderate spinal canal stenosis and neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with biopsy proven invasive lobular carcinoma in the left breast presents for breast MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, there is an irregularly shaped enhancing mass with a marker clip at 2:00 position, consistent with biopsy-proven carcinoma. The lesion measures 12 x 12 x 12 mm (AP x LR x CC).There is an enhancing focus with irregular margins at retroareolar 4:00 position in the left breast, measuring 5 x 4 x 5 mm. This enhancing focus is located 46 mm anterior and inferior to the index cancer.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.", "output": "1. Biopsy proven carcinoma at 2:00 position in the left breast.2. Indeterminate enhancing focus at retroareolar 4:00 position in the left breast. MR directed ultrasound study is recommended. If the lesion is not detected on ultrasound study, MR guided biopsy should be considered.3. No MRI evidence for malignancy in the right breast.4. No abnormal lymph nodes in either axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Male, 63 years old, intracerebral hemorrhage. An acute hematoma is redemonstrated within the left basal ganglia which, accounting for differences in technique, has not substantially changed in size relative to the prior CT. This hematoma causes modest surrounding edema and mass effect with bulging of the insula into the Sylvian fissure. No clear evidence of any underlying enhancing or nonenhancing lesion is seen to account for this hematoma.Elsewhere in the brain, numerous periventricular and subcortical T2 hyperintense lesions are seen but without evidence of restricted diffusion. No pathologic intracranial enhancement is detected. The ventricular system remains patent allowing for minimal effacement of the left lateral ventricle. No other abnormal extra-axial fluid collections are seen.Mucosal thickening is demonstrated in the left maxillary sinus. Bone marrow signal characteristics are unremarkable.", "output": "1. Redemonstration of a left basal ganglia hematoma without significant interval change in size. No clear evidence of any underlying lesion is seen.2. Extensive scattered white matter lesions are seen which, although nonspecific, probably reflect chronic microvascular ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 12 years old Reason: genetic positive for ARVD with +FHx - evaluate for ARVD History: ARVD Left VentricleThe left ventricle is normal in size. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.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 pericardial thickening or effusion.Extracardiac Findings", "output": "1. No evidence of ARVD.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings."}
{"instruction": "Generate impression based on findings.", "input": " MRI Brain: There are no areas of abnormal signal or pathological enhancement to suggest demyelinating disease. There is a normal variant cavum septum pellucidum and vergae. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a small left maxillary sinus mucosal retention cyst, with other scattered mild thickening in the paranasal sinuses.MRI Orbits: Images are limited by patient motion, especially axial STIR images. There is diffuse atrophy of the optic nerves bilaterally, with again questioned mild increased T2 signal. There is no definite associated enhancement. The optic chiasm is not well delineated secondary to its significant atrophy.The globes and extraocular muscles are otherwise unremarkable.", "output": "1. Redemonstration of optic apparatus atrophy with likely chronic signal changes, without definite focal enhancement.2. Unremarkable contrast enhanced MRI of the brain."}
{"instruction": "Generate impression based on findings.", "input": "Vertigo. History of CVA 2/2010. Following for CVA No intracranial bleed, mass effect, edema, or midline shift. Moderately prominent extra-axial space and sulci. A moderate size patchy low attenuation is present in the left corona radiata, centrum semiovale, and left deep gray nuclei, new since previous CT, consistent with the acute infarction seen on 2/4/2010 MRI. It is consistent with interval maturation of an infarction with expected encephalomalacia. Within the limitation of the CT, which has less sensitive evaluation of the posterior fossa structures, it appears unremarkable. Basal cisterns are patent. Moderate vascular calcifications. No hydrocephalus. Opacification of right mastoid air cells, new since previous study. Otherwise, the rest of the visualized paranasal sinuses and mastoid air cells are clear", "output": "1. No intracranial bleed. 2. Interval maturation of the previously seen left sided white matter and deep gray matter MCA distribution acute infarction seen on 2/4/2010 MRI. 3. New right mastoid air cells congestive/inflammatory disease."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for cerebellar CVA: vertigo, uvular deviation, dysmetria. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there is a heterogeneous mass along the inferior portion of the left parotid gland that measures up to approximately 5 cm. There are bilateral maxillary sinus retention cysts, right larger than left.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysm.Neck MRA: There is no evidence of significant steno-occlusive lesions.", "output": "1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant steno-occlusive lesions in the head and neck arteries.3. Heterogeneous mass along the inferior portion of the left parotid gland that measures up to approximately 5 cm, which may represent a salivary gland neoplasm. "}
{"instruction": "Generate impression based on findings.", "input": "59 years Female (DOB:3/15/1957)Reason: r/o CNS mass History: neuropathyPROVIDER/ATTENDING NAME: SUSAN HONG SUSAN HONG There is a moderate degree of periventricular and subcortical patchy hyperintense white matter lesions present identified on the FLAIR and T2 images. There is no associated contrast enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some partial opacification of the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Periventricular and subcortical white matter patchy lesions of a moderate degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. "}
{"instruction": "Generate impression based on findings.", "input": " There is a 9 x 9 mm nonenhancing lesion in the midline sella which is T1 hyperintense to brain and very T2 hyperintense, nearly matching CSF signal. The lesion abuts the infundibulum and appears to displace the pituitary gland along the floor of the sella. This lesion appears to be stable in size when compared to prior studies dating back to 2007. The lesion projects up into the suprasellar space and approaches the optic structures, but does not impinge on them. There is patchy and confluent periventricular white matter T2 hyperintensity which is consistent with previously demonstrated small vessel ischemic disease.", "output": "T1/T2 hyperintense, non-enhancing lesion within the sella which displaces the pituitary gland; the appearance raises the question of a proteinaceous cyst or, perhaps less likely, a non-enhancing adenoma. The lesion has been stable in size dating back to studies from 2007."}
{"instruction": "Generate impression based on findings.", "input": "MRI CARD W/VASODILATOR STRESS WWO CNTRST, 9/6/2016 10:48 AM First Pass PerfusionDuring hyperemia, a non-transmural, moderate sized perfusion defect was noted in the basal anterolateral wall and the mid inferior and inferolateral wall. The overall ischemic burden is 9% of the LV mass. Viability/ Myocardial ScarThere is a small non-transmural myocardial infarction involving the basal anterolateral wall. This segment has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 82 ml/m2 (normal range: 74+/-15), the LVEDV is 163 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 45 g/m2, and the LV mass is 90 g. There is hypokinesis of the basal anterolateral and mid inferolateral walls. Native myocardial pre-contrast T1 relaxation time is mildly elevated in the septal mid myocardiumLeft AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 147 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve has evidence of flow acceleration suggesting at least mild aortic valve stenosis. Correlation with echocardiography suggested. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 FindingsLeft lung basilar discoid atelectasis, sternal wires consistent with previous bypass surgery. 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. There is evidence of hibernating myocardium involving the basal anterolateral and mid inferior and inferolateral walls. This territory is ischemic and mostly viable. 2. There is a small myocardial infarction involving the basal anterolateral wall. 3. Normal LV size and systolic function (LVEF 58%). The native myocardial T1-relaxation time is mildly increased in the mid interventricular level suggesting the presence of interstitial fibrosis. 4. Normal RV size and systolic function (RVEF 55%).5. There is at least mild aortic 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": "42 year old female with hypertension and new cardiomyopathy, referred to evaluate for etiology of LV dysfunction. Left VentricleThe left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 117 ml/m2 (normal range: 65+/-11), the LVEDV is 278 ml (normal range 109+/-23), the LV end systolic volume index is 80 ml/m2 (normal range 18+/-5), the LVESV is 191 ml (normal range 31+/-10). There is global hypokinesis with regional variation. LVH is present with LV wall thickness of 12-13 mm (despite LV enlargement).There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1080-1120ms. This is borderline abnormal. The extracellular volume fraction could not be reliably assessed.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 39%, the RV end diastolic volume index is 46 ml/m2 (normal range 69+/-14), the RVEDV is 109 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 71 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is at least moderate mitral regurgitation which is central.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 drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.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. Severely dilated left ventricle with moderate-severely reduced systolic function (EF 31%).2. Borderline elevated native T1 myocardial relaxation times (1080-1120ms) with no evidence of late gadolinium enhancement. This may suggest mild diffuse interstitial fibrosis. 3. Normal size right ventricle with mildly reduced systolic function (EF 39%).4. At least moderate mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " Thoracic spine:There is a CSF intensity collection within the thoracic spinal cord, expansile in appearance, extending from the T5/6 level inferiorly through the T9/10 level, measuring a maximal 5 x 6 mm transverse dimension at the T7/8 level.There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. There are no stenoses.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. There are no significant degenerative changes or stenoses.The conus is normal in signal and morphology and terminates at L1/2. There are no MRI findings of fatty filum. Upon prone positioning, the conus and cauda equina translated anteriorly.", "output": "1.A syrinx is present within the thoracic spinal cord extending from the T5/6 level inferiorly through the T9/10 level, measuring a maximal 5 x 6 mm transverse dimension at the T7/8 level.2.There are no MRI findings of fatty filum or tethered cord."}
{"instruction": "Generate impression based on findings.", "input": "Left upper extremity radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: There is a disc osteophyte complex with uncovertebral hypertrophy resulting in moderate left-sided neural foraminal stenosis. No significant spinal canal or right neural foraminal narrowing.C3-4: Small disc osteophyte complex with uncovertebral hypertrophy results in no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.C4-5: Left paracentral disc osteophyte complex and uncovertebral hypertrophy, left greater than right. There is mild to moderate stenosis involving the left aspect of the spinal canal at this level including mild impression on the left ventral aspect of the cord. There is moderate to severe left and moderate right neural foraminal stenoses.C5-6: Disc osteophyte complex including bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis, particularly on the left. There is severe left and moderate to severe right neural foraminal stenosis.C6-7: Disc osteophyte complex with uncovertebral hypertrophy. There is moderate to severe left and moderate right neural foraminal stenosis. No significant spinal canal stenosis.C7-T1: No significant compromise to the spinal canal. There is bilateral uncovertebral hypertrophy. There is mild bilateral neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "1. Multilevel degenerative changes in the cervical spine. There is mild to moderate spinal canal stenosis involving the left aspect of the spinal canal at the C4-C5 level and to a lesser degree at the C5-C6 level. No cord signal abnormality.2. There is multilevel neural foraminal stenoses, relatively worse at the C4-C5, C5-C6, and C6-C7 levels. Please see details above."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male. Elevated PSA, negative prostate biopsy x 2. Evaluate for prostate tumor. EPIC history: PSA ranging from 4.1 to 6.85 ng/mL. PELVIS:PROSTATE:Prostate Size: 3.8 x 5.1 x 5.5 cm.Peripheral Zone: No suspicious lesions.Central Gland: 1.5 x 2.4 cm T2 hypointense lesion with associated diffusion restriction and early enhancement in the apex of the prostate in the transitional zone, immediately anterior to the urethra, consistent with prostate cancer (series 704, image 104). Central gland hypertrophy.Seminal Vesicles: No evidence of invasion.Extracapsular Extension: The mass is confluent with the anterior prostatic capsule with extracapsular extension on the right (series 1001, image 8).BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Large transitional zone lesion in the apex consistent with prostate cancer. There is extracapsular extension on the right anteriorly."}
{"instruction": "Generate impression based on findings.", "input": " Limited examination of the complete spine shows no evidence of spinal cord compression or abnormal cord signal intensity. There is preservation of vertebral body heights and intervertebral disk spaces with normal lordotic curvature of the cervical and lumbar spine. Focal lesions are noted within the L1 and L5 vertebral bodies on STIR imaging and are nonspecific in the absence of contrast. Possible smaller lesion is also noted in the spinous processes of L1. Additional STIR hyperintense lesions is located anterior to the T4 vertebral body and adjacent to the aorta (series 6 or one, image 13) and along the aortic arch (series 601, image 3) are incompletely evaluated.", "output": "1.Limited evaluation of the spine with no evidence of spinal cord compression or abnormal cord signal intensity.2.Focal lesions in the L1 and L5 vertebral bodies, which are nonspecific but suspected to represent neoplastic process.3.Retroperitoneal lymphadenopathy and possible thoracic prevertebral and mediastinal lymphadenopathy is incompletely evaluated in this limited survey for acute spinal cord compression. Please refer to recent PET scan for further comments."}
{"instruction": "Generate impression based on findings.", "input": "Male, 18 years old. Recurrent dislocation ROTATOR CUFF: The rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. We see no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is a Hill-Sachs deformity of the humeral head posteriorly. Evaluation of the labrum is limited due to lack of intra-articular contrast. Although we see no fluid signal intensity traversing the anterior inferior labrum, intermediate signal intensity separates the anterior inferior labrum from the underlying glenoid, likely representing sequela of a prior labral tear. Furthermore, the superior labrum appears detached from the underlying glenoid anteriorly and is associated with a paralabral cyst. The posterior labrum appears normal.BICEPS TENDON: The tendon of the long head of the biceps appears normal.", "output": "Findings indicating prior anterior dislocation, including Hill-Sachs deformity and findings suggestive of prior anterior inferior labral tearing. There also appears to be a superior labral tear. These findings can be better evaluated with MR arthrography if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Chiari malformation with syrinx in thoracic spine: yearly follow up. There are postoperative findings related to Chiari decompression with a patent neo-foramen magnum and biphasic cerebrospinal fluid flow anteriorly. The long-segment syrinx appears to have a slightly larger caliber, measuring up to 3 mm, previously 2 mm. The vertebral column alignment is unchanged, with diffuse straightening in the sagittal plane. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. However, there is a horseshoe kidney with persistently prominent renal collecting systems and a distended bladder.", "output": "1. Postoperative findings related to Chiari decompression with a grossly patent neo-foramen magnum.2. The long-segment syrinx appears to have a slightly larger caliber, measuring up to 3 mm, previously 2 mm. 3. Horseshoe kidney with persistently prominent renal collecting systems and a distended bladder."}
{"instruction": "Generate impression based on findings.", "input": " The lacrimal glands are slightly prominent but symmetric and without focal lesions. The optic nerves are symmetric and normal in size and signal intensity. There is no suspicious intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable. There are scattered patchy foci of T2 hyperintensity within the supratentorial white matter. Mild prominence of the bilateral parotid glands also seen. Small left intraparotid lymph node. No suspicious salivary gland lesions are seen. No significant cervical lymphadenopathy.", "output": "1.Mild symmetric enlargement of the bilateral lacrimal glands and slight prominence of the bilateral parotid glands compatible with known Sjogren's. No priors are available for comparison; however, no aggressive features are seen to suggest lymphoma. 2.Scattered patchy foci of T2 hyperintensity within the supratentorial white matter are nonspecific but compatible with mild chronic small vessel ischemic changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: new dx MM, evaluate disease burden SKULL: Numerous myelomatous deposits throughout the skull.CERVICAL SPINE: Diffuse demineralization and multiple small lucencies of the cervical spine consistent with myelomatous deposits. Degenerative disc disease of the mid to lower cervical spine. THORACIC SPINE: Diffuse demineralization and multiple small lucencies of the thoracic spine consistent with myelomatous deposits. Small anterior osteophytes. LUMBAR SPINE: Degenerative changes of the lumbar spine. Myelomatous deposits in the L1 and S1 vertebrae are better seen on prior MRI spine. Diffuse demineralization and multiple small lucencies of the lumbar spine consistent with myelomatous deposits. RIBS: Healing fracture of the left 7th rib suspicious for myelomatous involvement. Small multiple lucencies of the bilateral scapulae and distal clavicles suspicious for myelomatous deposits. PELVIS: Numerous myelomatous deposits throughout the pelvis.UPPER EXTREMITY: Multiple small myelomatous deposits of the bilateral humerus and radius.LOWER EXTREMITY: Multiple small myelomatous deposits of the bilateral femurs, tibias, and fibulas. Mild osteoarthritis of the bilateral hips. Moderate osteoarthritis of the bilateral knees.", "output": "Diffuse myelomatous deposits involving the axial and appendicular skeleton as above."}
{"instruction": "Generate impression based on findings.", "input": "Persistent headaches and dysequilibrium. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of T2 hyperintensity in the cerebral white matter. 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 skull and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. There is a left maxillary sinus retention cyst.", "output": "1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mild scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent the result of chronic small vessel ischemic disease. "}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female with knee pain. Assess for meniscal injury. MENISCI: There is linear signal abnormality within the posterior horn of the medial meniscus which extends to the tibial articular surface and body of the meniscus consistent with a horizontal cleavage tear. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is mild chondromalacia affecting the articular cartilage along the lateral facet of the patella. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "Medial meniscus tear as described above. "}
{"instruction": "Generate impression based on findings.", "input": "16 day old male evaluate for bleed or mass. Signs and symptoms: Seizure No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. This examination is essentially within normal limits for patient's stated age of 16 days. Follow-up with an MRI is recommended. Calvarium is unremarkable. Mastoid air cells are been pneumatized.", "output": "Negative CT of brain without the infusion."}
{"instruction": "Generate impression based on findings.", "input": "60 years Female (DOB:2/15/1956)Reason: assess for mets History: presumed metastatic breast cancerPROVIDER/ATTENDING NAME: JOHN F. MCCONVILLE JOHN F. MCCONVILLE There is a punctate focus of diffusion restriction present in the right occipital lobe subcortical white matter. Another focus of diffusion restriction is present in the right cerebellar hemisphere which is associated with T2 and FLAIR signal hyperintensity.There is diffuse thickening of the calvarium associated with the marrow replacement throughout the calvarium, skull base and visualized upper cervical spineThere is diffuse pachymeningeal thickening present.Punctate focus of susceptibility effect is present in the upper vermis. This associated with some contrast enhancement. Another punctate focus of susceptibility effect is present along the right marginal ramus of the cingulate sulcus. This is not seen on any other pulse sequences and is therefore nonspecific.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrates mucosal thickening in the right sphenoid sinus and scattered opacities in the ethmoid air cells. The visualized portions of the mastoid air cells demonstrate partial opacification. The visualized portions of the orbits are intact. The left eyelid appears distorted possibly related to tape closing the patient's eyelids. Patient is status post intubation..", "output": "1.Findings are compatible with diffuse calvarial, skull base and upper cervical spine metastases.2.There is diffuse pachymeningeal thickening present which is a nonspecific finding. One possibility is that it is a reaction to the patient's calvarial metastatic disease.3.A microhemorrhage within the vermis is a nonspecific finding. It's conceivable this represents a small cavernoma or other hemorrhagic lesion. A follow-up exam would help differentiate this from metastatic disease.4.Findings suggest microinfarcts in the right cerebellar hemisphere and of the right occipital lobe"}
{"instruction": "Generate impression based on findings.", "input": "Left trigeminal nerve deficits. Face: There is a predominantly T2 intermediate, enhancing, relatively well-defined, mildly lobulated mass with low diffusivity within the left masticator space, centered around the posterior mandible, which appears to have cortical erosions medially. The mass measures up to 48 mm and surrounds the proximal left inferior alveolar nerve. The mass contains a cystic area laterally with fluid-fluid level that is suggestive of hemorrhage. The mass contributes minimally to oropharyngeal airway narrowing. There is mild posterior deviation and narrowing of the left internal jugular vein. The left internal carotid artery flow void appears to be intact. There is no convincing evidence of significant regional lymphadenopathy. There is no evidence of intracranial extension. Aside from mass effect upon the left parotid gland, the salivary glands are intact. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. The cisternal segments of the bilateral trigeminal nerves are also intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.", "output": "A bulky mass within the left masticator space likely represents a neoplasm such as a sarcoma."}
{"instruction": "Generate impression based on findings.", "input": " For the purposes of numbering, there are 5 nonrib-bearing lumbar vertebral bodies and a transitional segment labeled S1 for the purposes of this report. Please note the numbering is slightly different compared to previous exam dated 3/17/2009. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body are well-maintained. There is progression of loss of disc height at L5-S1 compared to prior exam. Remaining intervertebral discs heights are maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level.T12-L1: There is minimal disc bulge without significant spinal canal or neural foramina stenosis.L1-2: There is mild facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis.L2-L3: There is mild interval progression of left paracentral disc extrusion which extends mildly superiorly and inferiorly extends posterior to the L3 vertebral body to the L3-4 disc level, associated with mild spinal canal stenosis. There is mild facet arthropathy. There is mild right neural foraminal narrowing. There is no left neuroforaminal narrowing.L3-L4: There is central disc extrusion which is contiguous with above-described disc extrusion resulting in mild spinal canal stenosis. There is mild facet arthropathy. No neural foraminal narrowing.L4-L5: There is disc bulge. There is facet arthropathy and mild ligamentum flavum thickening. No significant spinal canal stenosis stenosis. There is minimal right neuroforamina narrowing. There is no left neuroforaminal narrowing. L5-S1: There is advanced facet arthropathy. There is mild disc bulge. There is mild to moderate neural foraminal stenosis bilaterally. There is no evidence of spinal canal stenosis.S1-S2: No significant disc bulge or spinal canal or neuroforaminal narrowing is evident.", "output": "1. Multilevel degenerative changes with disc extrusion extending from L2-3 to the L3-L4 level which is slightly progressed since the previous study dated 3/17/2009. There is mild associated spinal canal stenosis.2. Neuroforaminal stenosis is relatively worst at the L5-S1 level.3. Please note there is transitional anatomy as described above and the numbering scheme is slightly different from previous study dated 3/17/2009.4. Advanced facet arthropathy at L5-S1, which may be contributing to the patient's back pain."}
{"instruction": "Generate impression based on findings.", "input": "89-year-old female with hypothyroidism, hypertension, dementia, admitted with exacerbation of right-sided sciatica. Five lumbar type vertebral bodies are presumed to be present. There is a Schmorl's node involving the superior endplate of the T11 vertebral body with approximately 35 % loss of height involving the left aspect of the vertebral body suggestive of a mild chronic compression fracture. Small Schmorl's nodes are also noted involving the inferior L2 and upper and lower L3 endplates. Vertebral body heights are otherwise maintained. Alignment is grossly maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen with disc height loss and vacuum phenomena evident at the L1-L2, L2-L3, and L3-L4 levels. Individual levels, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: There is mild disc bulge, bilateral facet arthropathy, as well as a cystic structure dorsally which may represent a ligamentum flavum cyst versus a synovial cyst associated with the facet arthropathy. There is overall mild to moderate spinal canal stenosis at this level. There is mild bilateral neural foraminal stenosis.L3-L4: There is a large right-sided disc extrusion which effaces the right lateral recess and extends caudally along the dorsal aspect of the L4 vertebral body to the level of the L4-L5 disc. The inferior aspect of the extruded disc material appears to be in contact with the remainder of the disc material superiorly, but may represent a free fragment. There is also ligamentum flavum thickening and bilateral facet arthropathy contributing to severe spinal canal stenosis at this level. There is moderate to severe right-sided neural foraminal stenosis and moderate left-sided neural foraminal stenosis.L4-L5: There is a disc bulge eccentric to the right with ligamentum flavum thickening and bilateral facet arthropathy contributing to mild to moderate spinal canal stenosis. There is also moderate right and mild left neural foraminal stenosis. L5-S1: Minimal disc bulge and bilateral facet arthropathy with distended facet joints. There is no significant spinal canal or neural foraminal stenosis.Fatty atrophic changes are noted involving the lower lumbar paraspinous musculature at the L5 level, right greater than left. Bilateral renal cysts noted. Degenerative changes are also noted at the right T12 costovertebral joint with associated surrounding bone marrow edema.", "output": "Multilevel degenerative changes in the lumbar spine which are severe at the L3-L4 level. There is severe spinal canal stenosis as well as moderate to severe right-sided neural foraminal stenosis at this level. There is also a disc extrusion with inferior migration which appears to originate from the L3-L4 level and migrates inferiorly to the L4-L5 level, and is associated with complete effacement of the right lateral recess. There is suspected impingement of the exiting right L3 nerve root as well as the descending L4 nerve root.Please see findings at additional details as above."}
{"instruction": "Generate impression based on findings.", "input": "61 year old male patient with history of eye surgery. Evaluate for metallic foreign object prior to MRI. There is soft tissue swelling of the lateral aspect of the left scalp with foci of gas density which may reflect recent intervention or an abscess. There is a spherical density in the right orbit likely representing a prosthetic globe. The density of this prosthesis appears less than that of metal and we suspect it is MRI compatible. However, close attention should be paid to the patient's symptoms during the MRI examination.", "output": "We see no metallic foreign density and suspect the patient's right prosthetic globe is MRI compatible; however, close attention should be paid to the patient's symptoms during the MRI examination. Findings communicated to T Shah at 1725 hrs on 12/14/2015."}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval for lesions, assess hepatic vessel patency History: s/p OLT in 12/08, history of met HCC in right lung in 2009. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a right lobe transplant. No new or suspicious focal hepatic lesion. Hepatic vasculature is patent. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Splenomegaly, unchanged.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Extensive esophageal and splenorenal varices, unchanged.", "output": "1.Postsurgical changes of a right hepatic lobe transplant with no evidence of HCC recurrence.2.Stable splenomegaly and esophageal/splenorenal varices."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male with upper and lower left-sided weakness and history of metastatic bladder cancer, rule out metastatic disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There are scattered nonspecific punctate foci of high T2 signal in the periventricular and subcortical white matter. 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. There is a 1.7 x 1.2 cm enhancing mass in the right anterior masticator space. There is a partially-imaged nodule in the left posterior upper neck subcutaneous tissues. Otherwise, the orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1.A mass in the right anterior masticator space likely represents a metastasis. Another partially-imaged nodule in the left posterior upper neck subcutaneous tissues may also represent a metastasis.2.No evidence of intracranial metastases or acute infarction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "45 years Female (DOB:10/4/1970)Reason: s/p resection brain mat a long time ago. PLease evaluate for progression in brainstem History: WobblyPROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA There is redemonstration of enhancing lesions within the brain parenchyma. One in the left middle frontal gyrus posteriorly measures 7 mm and previously measured approximately the same. One along the left inferior frontal gyrus measures 6 mm and previously measured similar dimensions. One in the right centrum semiovale measures 5 mm and previously measured the same. One in the medial aspect of the right occipital lobe measures 7 mm and previously measured approximately the same though it enhances less on the current exam. One in the left cerebellar hemisphere measures 15 mm and is stable. One in the pons measures 10 x 13 mm and is stable. One in the left cerebellar hemisphere inferiorly measures 10 mm and previously measured the sameThe patient status post left frontal craniotomy and suboccipital craniotomy. There is a enhancement along the margins of the left frontal craniotomy site the calvarium and adjacent soft tissues. This most likely postoperative in nature. Within the suboccipital craniotomy site there are fluid collections present within the subcutaneous tissues which appear to be more organized on the current exam versus the prior.There is no abnormal enhancing lesion identified in the left frontal lobe at the surgical site. Previously within the posterior fossa at the surgical site there are 2 large lesions present. One was at the left cerebellar hemisphere inferiorly and the other one was medial aspect of the right cerebellar hemisphere. Comparing with the preoperative exam from 5/2/2016 there is a there are small foci of nodular enhancement present at the surgical margins which are more apparent on the current exam than on the prior. Small nodule is present along the left inferior cerebellum at the surgical margin which is not clearly delineated on the prior exam and was possibly obscured by associated findings. Another focus of nodular enhancement is present along the inferior aspect of the right cerebellar hemisphere at the surgical margin measuring 9 x 6 mm. There is also redemonstration of a enhancement along the surface of the cerebellum along the posterior fossa surgical sites which is likely postoperative in nature.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There are multiple lesions scattered within the brain parenchyma including supratentorial and infratentorial brain compatible with metastases. These are stable since the examination from May 4.2.The patient is status post suboccipital craniotomy for tumor removal/debulking. Postoperative changes include fluid collections at the surgical site. This could represent seroma or CSF leak. At the surgical margins within the cerebellum there are nodules in the enhancement which are suggestive of a small bits of residual or recurrent neoplasm.3.The patient is status post left frontal lobe surgery. There is no evidence for local recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Newly diagnosed prostate cancer, considering focal therapy or active surveillance. PSA 13.5. Prostate biopsy revealing Gleason 3+3 in the left lobe, one out of 12 cores. PELVIS:PROSTATE:Prostate Size: 5.3 x 4.3 x 3.8 cm.Peripheral Zone: Within the right mid peripheral zone, there is a 5 x 8 mm focus of abnormally decreased T2 and ADC signal (series 601, image 17) suspicious for neoplasm. There is an additional small focus of abnormally decreased ADC signal within the medial left mid peripheral zone (series 704, image 244) measuring 5 mm also suspicious for neoplasm.Central Gland: No significant abnormality.Seminal Vesicles: No significant abnormality.Extracapsular Extension: The right mid peripheral zone lesion appears to abut the capsule adjacent to the right neurovascular bundle but does not appear to extend beyond the capsule or to invade the neurovascular bundle.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Left and right peripheral zone lesions suspicious for neoplasm as described above without specific evidence of extracapsular extension."}
{"instruction": "Generate impression based on findings.", "input": "History of meningioma status post resection and radiation therapy now with new headache. There is evidence of prior left-sided craniotomy for biopsy or partial resection of tumor. There is redemonstration of a homogeneously enhancing extra-axial mass in the left superior cerebellopontine angle cistern measuring 22 x 22 x 28 mm (AP x TR x CC), previously 22 x 21 x 29 mm. The lesion abuts the dorsal aspect of petrous bone with resultant hyperostosis, with mass effect on the left aspect of superior pons. There is mass effect with effacement of the left Meckel's cave at this level. The enhancing dural tail of tumor extends along the left cerebellopontine angle inferiorly to the level of foramen magnum. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes. There is unchanged extensive T2/FLAIR hyperintensity of the left middle cerebellar peduncle, which could represent a combination of edema and encephalomalacia from tumor and surgery. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a partially empty sella. The skull and extracranial soft tissues are otherwise unremarkable. There is mild scattered mucosal thickening of the paranasal sinuses.", "output": "1. No significant interval change in size of a homogeneously enhancing extra-axial mass in the upper left cerebellopontine angle cistern, consistent with known petrous apex meningioma. There is unchanged mass effect on the left aspect of the pons. Unchanged diffuse T2/FLAIR hyperintensity of left middle cerebellar peduncle with volume loss.2. No acute infarct. Mild to moderate chronic small vessel ischemic changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Chiari malformation, concern for syrinx. The cerebellar tonsils have a pointed morphology and extend up to 20 mm inferior to the foramen magnum. There is interruption of cerebrospinal fluid flow across the foramen magnum. However, the spinal cord displays normal signal and morphology. 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 paravertebral soft tissues are unremarkable.", "output": "Low-lying cerebellar tonsils compatible with Chiari I malformation, but no evidence of cervical syrinx."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Abnormal reflex. Other conditions of brain(348.89)Clinical question: left fronto parietal hypodensity on CT headSigns and Symptoms: right leg spastic, mildly weak, Babinski MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. 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. There is disk dessication present at this level. At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. There is left sided facet hypertrophy at this level associated with mild narrowing of the left neural foramen. At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. There is loss of disk space height at this level. There is a disk bulge at this level.At C5-6 there is no significant compromise to the spinal canal . There is disk dessication present at this level. There is loss of disk space height at this level. There is a disk bulge at this level. There are right sided uncovertebral osteophytes at this level associated with encroachment of the left exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. There is loss of disk space height at this level. There is a disk bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.", "output": "1.There are multilevel degenerative changes in the cervical spine. There is no significant compromise to the spinal canal and only mild narrowing of the neural foramina 2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Mild reversal of the normal cervical curvature is a non-specific finding which can be seen with muscle spasm or patient positioning."}
{"instruction": "Generate impression based on findings.", "input": "Disturbance of skin sensation [782.0], Reason for Study: ^Reason: r/o ischemia History: transient RLE numbness, reflex asymmetry Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Focal tissue loss on the left cerebellar hemisphere indicating small chronic ischemic infarction.Scattered multifocal periventricular white matter high signal intensity lesions on FLAIR images indicate non specific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.", "output": "1. Non specific small vessel ischemic disease.2. No acute ischemic or hemorrhagic lesion.3. Normal brain MRI and neck MRA. "}
{"instruction": "Generate impression based on findings.", "input": " There is no evidence of intracranial hemorrhage or acute infarct. There appears to be patchy high signal on the thin-section postcontrast T1 images along the right internal auditory canal. There are also minimal scattered punctate foci of T2 hyperintensity within the cerebral white matter. The brain, brainstem, and cerebellar parenchyma otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1.Apparent patchy high signal on the thin-section postcontrast T1 images along the right internal auditory canal may be artifactual, vascular, inflammatory, or represent leptomeningeal metastatic disease. Follow up via a temporal bone MRI may be useful if there is clinical concern. Otherwise, no evidence of intra-axial metastases.2.Punctate foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic microvascular ischemic disease. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female, please evaluate mass on superolateral patella. MENISCI: The menisci appear intact without significant tearing.ARTICULAR CARTILAGE AND BONE: Tiny osteophytes affect the lateral and medial tibiofemoral compartments. A large osteophyte is seen off the superior aspect of the patella. There is a small amount of patellar edema with general thinning of the patellar cartilage.LIGAMENTS: The ACL, PCL, MCL, and LCL complex appears intact. EXTENSOR MECHANISM: Extensor mechanism appears intact.ADDITIONAL", "output": "3 cm lesion anterior to the patella as outlined above. These findings are nonspecific. The lesion is favored to be inflammatory in etiology, soft tissue mass is not excluded, especially on only noncontrast examination. Biopsy is recommended if clinically warranted for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old male, NF 2, status post resection of schwannoma and meningioma. Evaluate for new tumor. The patient is experiencing weakness. Brain and internal artery canal MRI:There is a focus of enhancement within the left sylvian fissure which appears to correlate with vascular structures when compared to T2 and susceptibility techniques. Although not described previously, this was present and unchanged on the most recent comparison of 12/3/2015. When comparing to the oldest, outside MRI dated 4/2/2015 (from Freeport Memorial Hospital), it appears to have enlarged.Redemonstrated is a contrast-enhancing left acoustic schwannoma, filling the left IAC, extending to involve the vestibule and a portion of the proximal semicircular canals. The largest portion within the left cerebellopontine angle measures 12 mm. These findings are unchanged in appearance.Redemonstrated is a contrast-enhancing right acoustic schwannoma, filling the right porous acusticus, extending to involve the vestibule, semicircular canals, as well as the geniculate ganglion and the right facial nerve (extending along its entirety to the parotid gland). The largest portion within the right cerebellar pontine angle measures 28 mm, which is unchanged in size. There remains mass effect upon the adjacent pons, middle cerebellar peduncle, and cerebellum, however without associated edema and unchanged in extent.There is a dural based enhancing mass underlying the left rectus gyrus which extends inferiorly into the superior-most left ethmoid air cells and adjacent inferior frontal sinus, most likely representing a meningioma. Given differences in technique, there has been no significant interval change.Also redemonstrated are a few, very small foci of enhancing prominence along the falx, probably anteriorly, which are unchanged in appearance. These likely represent very small meningiomas. There are a few foci of T2 hyperintensity within the within the white matter, predominantly subcortical in location, without associated restricted diffusion. Encephalomalacia involving the lateral left cerebellar hemisphere is stable.The ventricles and sulci are normal in size. The cerebellar tonsils are in appropriate position. There are no parenchymal masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The right mastoid air cells are completely opacified by fluid intensity material, unchanged. There has been prior retinal banding.Cervical spine MRI:Redemonstrated are postsurgical changes of suboccipital craniectomy and resection of the posterior arch of C1. Laminoplasties are also noted from C3 to C6. Again seen are multiple enhancing lesions throughout the cervical spine including nodular intramedullary lesions involving the cervical cord within the medulla and at the C1 and C2 levels which may represent ependymomas, unchanged in appearance. These are associated with T2 hyperintensity.Enhancing masses seen involving the right C2 nerve root and a smaller one on the left compatible with schwannomas, unchanged.C2-C3: Enhancing left nerve root with mild expansion of the neural foramina likely represents a schwannoma. There is mild intraspinal extension without significant cord deformity. These findings are unchanged.C3-C4: No enhancing lesions. No spinal or neuroforaminal stenosis. These findings are unchanged.C4-C5: Expansile lesion involving the right neural foramen again seen with intraspinal extension and mild residual mass effect on the right aspect of the cord. Partial resection as described previously. T2 hyperintensity within the right aspect of the cord. These findings are unchanged. C5-C6: Large, predominantly extraforaminal lesion on the right. Small enhancing extra foraminal lesion on the left. No spinal canal stenosis. These findings are unchanged. Previously demonstrated heterogeneous enhancement, posterior to the thecal sac has decreased in conspicuity. Indentation upon the posterior cord is again noted, unchanged, and still without intrinsic cord signal abnormality.C6-C7: Small, predominantly extraforaminal enhancing lesions bilaterally without expansion of the foramina. No spinal canal stenosis. These findings are unchanged.C7-T1: Small predominantly enhancing extraforaminal enhancing bilaterally lesions without expansion of the foramina. No spinal canal stenosis. These findings are unchanged.There is a relatively large lesion involving the peripheral aspect of the right C6 nerve root extending to the brachial plexus, unchanged.Vertebral body heights are normal. Mild focal kyphotic angulation at the C5-C6 level is again seen appearing more exaggerated, although this may be positional.", "output": "1.There is a focus of enhancement within the left sylvian fissure which appears to correlate with vascular structures when compared to T2 and susceptibility techniques. Although not described previously, this was present and unchanged on the most recent comparison of 12/3/2015. When comparing to the oldest, outside MRI dated 4/2/2015 (from Freeport Memorial Hospital), it appears to have enlarged. This constellation of imaging features may suggest an aneurysm which is stable compared to last December, however enlarged when compared to the prior April. CTA or catheter directed angiography could better characterize this finding and confirm an aneurysmal etiology.2.Stable bilateral acoustic schwannomas.3.Stable presumed meningioma underlying the left rectus tremors.4.Stable probable small meningiomas involving the falx.5.The right mastoid air cells remain completely opacified by fluid intensity material. 6.Again seen are multiple enhancing lesions throughout the cervical spine including nodular intramedullary lesions involving the cervical cord within the medulla and at the C1 and C2 levels which may represent ependymomas, unchanged in appearance.7.C4-C5: Expansile lesion involving the right neural foramen again seen with intraspinal extension and mild residual mass effect on the right aspect of the cord with associated T2 hyperintensity, unchanged. 8.C5-C6: Previously demonstrated heterogeneous enhancement, posterior to the thecal sac has decreased in conspicuity. Indentation upon the posterior cord is again noted, unchanged, and still without intrinsic cord signal abnormality.9.The remaining stigmata of NF 2 within the cervical spine MRI are stable in appearance as described in detail above."}
{"instruction": "Generate impression based on findings.", "input": "46 year old woman with history of OHT, referred for annual evaluation for CAV.MEDICATIONS: ASA, Lipitor, Lasix, Toprol XL, Cellcept, Rapamune, Prednisone First Pass PerfusionWas not performed per patient request.Viability/ Myocardial ScarWas not performed per patient request.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), the LVEDV is 143 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 39 g/m2, and the LV mass is 85 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 55 ml/m2 (normal range 69+/-14), the RVEDV is 121 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant. 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsProbable right renal cyst. 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. Limited study for size/function performed due to patient request.2. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%."}
{"instruction": "Generate impression based on findings.", "input": "History of left parotid space rhabdomyosarcoma, off therapy. Brain: There is no evidence of intracranial mass. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. 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 cerebellar tonsil remains low lying especially on the left. There is left parieto-occipital plagiocephaly. There is scattered paranasal sinus mucosal thickening. There is trace fluid in the left mastoid air cells. The orbits and scalp soft tissues are grossly unremarkable.Neck: There are post-treatment findings in the left parotid space region, but no evidence of underlying measurable mass lesions. The cervical lymph nodes are unchanged. The thyroid and major salivary glands are unchanged, including an asymmetrically small left submandibular gland. The major cervical flow voids are intact. The airways are patent. The osseous structures are unremarkable.", "output": "1. Post-treatment findings in the left parotid gland without discernible recurrent tumor.2. No significant change in the cervical lymph nodes.3. No evidence of intracranial mass."}
{"instruction": "Generate impression based on findings.", "input": "Brain lesion and cyst, abnormal MRI in the past, 3 month post surgical follow up. There has been interval evolution of postoperative findings related to left frontal convexity cyst fenestration, with a small amount of high T1 and low T2 signal extra-axial blood products along the anteromedial left frontal convexity and collapse of the cyst cavity. There is minimal residual T2 hyperintensity in the underlying brain parenchyma and no significant mass effect upon the underlying brain parenchyma. There is no evidence of acute territorial cerebral 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. There is bilateral otomastoid fluid.", "output": "Interval evolution of postoperative findings related to left frontal convexity cyst fenestration, with a small amount of late subacute extra-axial blood products along the anteromedial left frontal convexity and collapse of the cyst cavity. "}
{"instruction": "Generate impression based on findings.", "input": "Slurred speech, dizziness, concern for TIA There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Normal brain CT."}
{"instruction": "Generate impression based on findings.", "input": "History of rising PSA. Evaluate for prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.4 x 5.6 x 4.2 cm (AP by transverse by CC)Peripheral Zone: Within the posterior mid to superior aspect of the left peripheral zone there is confluent low T2 signal with associated restricted diffusion and early arterial enhancement extending to both the internal and peripheral capsule compatible with tumor. This measures 1.5 x 1.1 cm the axial plane. No extracapsular extension is evident.Central Gland: There is marked hypertrophy of the central gland with cystic changes compatible with benign prostatic hypertrophy. There is a focus of low T2 signal and restricted diffusion in the anterolateral right aspect of the central zone which measures 1.3 x 1.3 cm in axial dimension. On the postcontrast images however this does not demonstrate early arterial enhancement and is therefore likely a hyperplastic nodule.Seminal Vesicles: The seminal vesicles are unremarkable. No evidence of tumor involvement.Extracapsular Extension: NoneBLADDER: The bladder wall appears diffusely thickened and trabeculated compatible with chronic outlet obstruction.LYMPH NODES: There are multiple mildly prominent bilateral external iliac as well as retroperitoneal lymph nodes which are not pathologically enlarged by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.1.5 x 1.1 cm focus of abnormal signal within the left posterior peripheral zone compatible with tumor. No evidence of extracapsular extension. No pathologic lymphadenopathy within the visualized abdomen.2.Central zone findings of benign prostatic hypertrophy with associated bladder wall thickening suggestive chronic urinary tract outflow obstruction."}
{"instruction": "Generate impression based on findings.", "input": "DLBCL recurrent in CSF. Now receiving IT rituximab. Brain: There is increased patchy T2 hyperintensity and enhancement in the medial right basal ganglia region. There is increase in size of a lesion in the right basal ganglia region with enhancement along the margin of the right frontal horn. There also appears to be new T2 hyperintensity along the bilateral cerebellar tonsils. There is persistent infiltrative abnormal enhancement involving the optic apparatus. There are unchanged nonspecific foci of T2 hyperintensity without corresponding enhancement in the cerebral white matter. There is no evidence of acute infarction or intracranial hemorrhage. There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. There is no significant interval change in the size of the ventricular system. There is no midline shift or herniation. There is moderate right maxillary sinus mucosal thickening and an apparent fluid level in the left maxillary sinus. There is mild fluid signal within the mastoid air cells.Spine: There is no evidence of mass lesions or abnormal leptomeningeal enhancement in the spine. There is loss of the usual cervical and lumbar lordosis, but the thoracic vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is degenerative spondylosis at multilevel levels of the cervical spine with mild spinal canal stenosis. The vertebral bone marrow signal is unremarkable, aside from degenerative endplate signal alterations. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.", "output": "1. Persistent infiltrative abnormal enhancement involving the optic apparatus likely related to involvement by lymphoma. 2. Increase in size of a lesion in the right basal ganglia region with enhancement along the margin of the right frontal horn and involving the cerebellar tonsils also likely represent involvement by lymphoma. 3. No evidence of leptomeningeal disease in the spine.4. Findings suggestive of acute sinusitis."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for hemorrhage. Signs and symptoms: Headaches and dysarthria. CT of brain without infusion:High density material within the right internal carotid artery is consistent with prior embolization and coil placement.A slightly high density loculated and calcific tissue surrounding the basal cistern and within the cavernous sinuses is consistent with patient's known significant atherosclerotic disease with ectasia and tortuosity of the vasculature. These findings appear similar to prior CT and MRI examinations.Extensive areas of encephalomalacia of the right cerebral hemisphere with ex vacuo dilatation of the right lateral ventricle remain identical to prior studies. Few small foci of low-attenuation likely small vessel strokes in the left hemisphere are also noted and stable.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.", "output": "No evidence of acute findings and stable exam since prior study."}
{"instruction": "Generate impression based on findings.", "input": "Female, 25 years old, with history of prolactinoma, outside hospital records and images pending, evaluate size mass effect. A hypoenhancing nodule is evident within the right aspect of the pituitary gland measuring up to 7 x 5 x 7 mm. The right aspect of the gland is slightly enlarged by this process, but no evidence of significant suprasellar extension is seen. Likewise, there is no evidence of cavernous sinus invasion. The gland is otherwise unremarkable. The pituitary stalk enhances normally and enters the gland at midline.", "output": "A subcentimeter hypoenhancing nodule in the right aspect of the pituitary gland is seen compatible with the stated history of prolactinoma. No evidence of suprasellar or cavernous sinus encroachment is seen."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with pain. Evaluate for rotator cuff tear. ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscles and tendons appear intact. The rotator cuff is within normal limits for age.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial/subdeltoid bursa. The acromioclavicular joint is within normal limits.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate osteoarthritis affects the glenohumeral joint with cartilage degeneration and small osteophytes. The anterior superior labrum appears detached from the underlying glenoid and while this may represent a normal variant sublabral foramen, heterogeneous signal abnormality of the anterior labrum, more inferiorly, raises the possibility of a degenerative tear. There is no glenohumeral joint effusion. There are small subchondral cysts within the inferior glenoid.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL", "output": "1. Normal appearing rotator cuff.2. Glenohumeral joint osteoarthritis and probable degenerative tearing of the anterior labrum."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old male with medial knee pain after valgus injury. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. Note is made of bone marrow signal abnormality within the anterior aspect of the lateral tibial plateau as well as within the lateral aspect of the lateral femoral condyle consistent with contusions. Additionally, note is made of linear decreased signal abnormality within the lateral aspect of the proximal tibial plateau, as well as cortical irregularity, suspicious for a nondisplaced subchondral fracture of the tibial plateau (image 14 and 15; series 701).LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "Findings consistent with a nondisplaced subchondral fracture of the anterior aspect of the lateral tibial plateau. Bone contusion affecting the lateral femoral condyle."}
{"instruction": "Generate impression based on findings.", "input": " There is no acute cord compression. No gross change in the MRI appearance of the cervical and lumbar spine.", "output": "No acute cord compression."}
{"instruction": "Generate impression based on findings.", "input": "Female, 51 years old, history of lung cancer with brain metastases, presenting with dizziness, assess for progression. Brain MRI:Extensive metallic artifact is seen due to the placement of aneurysm clips along the right sylvian fissure and suprasellar region, and due to shunt apparatus in the posterior fossa. Diffusion-weighted images are particularly degraded, but within this limitation, no definite restricted diffusion is seen.Small bilateral subdural collections are again seen, predominantly along the frontal lobes, stable on the right and improved on the left. Diffuse dural thickening is also noted along both frontal lobes but particularly on the left where it is thicker than that seen on the prior exam.New small patches of parenchymal T2 hyperintensity are seen within the left and right middle frontal gyri of uncertain significance. Multiple scattered small foci of white matter T2 hyperintensity are also seen in the periventricular and subcortical white matter. Some of these may be new or perhaps just better visualized due to imaging at 3T. No evidence of any significant parenchymal edema or mass effect is observed.The left posterior fossa catheter system remains in stable position. Amorphous enhancement and T2 hyperintensity along the distal end of the catheter tip, at the level of the left foramen of Luschka, have not significantly changed from the prior examination. No additional or new pathologic enhancement is seen within the posterior fossa or in the cerebral hemispheres.The ventricular system is normal in size. A subcentimeter pineal region cystic lesion is again visualized. No evidence of new intracranial hemorrhage is detected. A few scattered punctate foci of susceptibility in the cerebral hemispheres are better visualized than on prior, likely due to imaging at 3T.Sequelae of right pterional craniotomy and multiple bilateral burr holes are again seen.Brain MRA:The distal right ICA and most of the proximal MCA is not visualized due to metallic artifact. The regions of the right PCOM and the ACOM arteries are also obscured. There is a relative paucity of right MCA distribution vessels. Elsewhere, no significant vascular stenosis is suspected. A 2.0 x 2.5 mm outpouching is evident from the left MCA bifurcation directed anteriorly and inferiorly. This appears similar to the prior CTA examination. There is also a 1 mm medially directed outpouching off of the left cavernous ICA which appears similar to the prior CTA. No additional aneurysms are suspected.Neck MRA:MRA image quality is slightly suboptimal but still diagnostic. No evidence of any significant vascular stenosis or occlusion is seen within the carotid or vertebral vessels of the neck.", "output": "1.No definite evidence of acute ischemia or any other definite acute intracranial abnormality allowing for substantial artifact related to prior surgical interventions.2.Small bilateral subdural collections are again seen, primarily along the frontal lobes. These are stable on the right and improved on the left relative to the prior MRI examination. Significant dural thickening is also seen along both frontal lobes but particularly on the left which is likely reactive to the long-standing subdural collections.3.New patches of T2 hyperintensity are seen within the left and right middle frontal gyri. These are of uncertain significance but could reflect the sequelae of prior parenchymal injury related to the previously seen large subdural collections.4.Numerous scattered small white matter lesions are also seen which are nonspecific but may reflect chronic microvascular ischemic disease.5.A left posterior fossa catheter system is in stable position. Amorphous signal abnormality and enhancement along the distal aspect of the catheter shows no significant interval change from the prior examination.6.No new parenchymal enhancing lesions are seen.7.On MRA imaging of the brain, there is a relative paucity of right MCA vessels which may be related to prior treatment of numerous aneurysms. Otherwise, no significant vascular stenosis is suspected.8.A 2.0 x 2.5 mm aneurysm arising at the left MCA bifurcation is unchanged relative to the prior CTA. Similarly, a 1 mm outpouching from the left cavernous ICA is also unchanged.9.Unremarkable MRA evaluation of the neck."}
{"instruction": "Generate impression based on findings.", "input": "Pancreatitis. Please evaluate for gallstones. Per medical record, history of renal cell cancer status post left nephrectomy and right clavicular mass resection. Please note numerous sequences are limited by extensive motion artifact. ABDOMEN:LUNG BASES: Patchy bilateral lung opacities seen on the large field of view sequences, right greater than left, which may represent aspiration or multifocal infection, better evaluated on the prior CT.LIVER, BILIARY TRACT: Ring-enhancing left hepatic lesion, measuring 1.1 x 1.1 cm (series 1902, image 297), suspicious for metastatic disease. Mild biliary ductal dilation, similar to prior CT. Distended gallbladder with biliary sludge. No choledocholithiasis evident, though further evaluation on MRCP images is limited by motion artifact.SPLEEN: Prominent, suggestive of splenomegaly. Splenule noted.PANCREAS: No loculated peripancreatic fluid collections. No pancreatic ductal dilation. No pancreatic mass evident. No differential parenchymal enhancement to suggest necrosis.ADRENAL GLANDS: The left adrenal gland is not seen. Right adrenal gland is within normal limits.KIDNEYS, URETERS: Patient is status post left nephrectomy. Right kidney with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large heterogenous collection without internal enhancement, compatible with hematoma, at the resected right clavicular head is partially imaged on the large field-of-view images, better seen on the prior CT.Subcentimeter foci of increased T2 signal in multiple vertebral bodies, without CT correlate, likely represent hemangiomas. OTHER: The mesenteric nodule seen on the prior CT is not included on the field of view of this exam.", "output": "1.Limited examination due to extensive motion artifact.2.No choledocholithiasis evident. 3.No peripancreatic fluid collections."}
{"instruction": "Generate impression based on findings.", "input": "75 year-old female with abnormal spells daily, abnormal EEG consistent with seizures, evaluate temporal lobes versus atrophy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Ventricular sizes and sulci are within acceptable limits for a patient of age 75 years. There are mild scattered foci of high T2 signal within periventricular and subcortical white matter, consistent with sequela of chronic small vessel ischemic disease, unchanged in extent. The ventricles and basal cisterns are normal in size and configuration. The skull and extracranial soft tissues are unremarkable. There are no abnormal enhancing foci.Dedicated coronal FLAIR imaging demonstrates a suggestion of increased T2 hyperintensity within bilateral hippocampi, however internal hippocampal architecture is preserved and hippocampal size is within normal limits. There is no preferential mesial temporal lobe atrophy.", "output": "1.Stable chronic small vessel ischemic disease.2.Dedicated coronal FLAIR imaging demonstrates a suggestion of increased T2 hyperintensity within bilateral hippocampi, however internal hippocampal architecture is preserved and hippocampal size is within normal limits. Given this nonspecific appearance, it is of uncertain clinical significance."}
{"instruction": "Generate impression based on findings.", "input": "Sclerotherapy of the right mandibular hemangioma. There is no significant interval change in the predominantly T2 hyperintense and enhancing right mandibular lesion, measuring up to approximately 55 mm. There is no evidence of significant cervical lymphadenopathy. There are multiple right thyroid nodules, the largest of which measures up to 16 mm and contains a punctate calcification. There also appear to be several punctate left thyroid nodules. The major salivary glands are unremarkable. There is scattered patchy cerebral white matter T2 hyperintensity. There are bilateral lens implants. There is a hemangioma in the C4 vertebral body and multilevel degenerative cervical spondylosis. There is also a hemangioma within the occipital bone.", "output": "No significant interval change in the previously treated right mandibular hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "66 years, Female, stage IV melanoma with brain metastases on treatment. Again seen is a hemorrhagic lesion in the right paramedian occipital lobe measuring approximately 11 x 6 mm, which is not significantly change in size on the T1 weighted sequences since prior MRI from 9/16/2015 (measured11x7 mm), but clearly smaller than 6/1/2015 (measured 16x13 mm). There is intrinsic T1 shortening without clear enhancement. There is mild increase in surrounding FLAIR hyperintensity without mass effect. No midline shift or herniation. No abnormal parenchymal or meningeal enhancement is seen elsewhere in the brain to suggest a new lesion. There are multiple nonspecific foci of scattered T2/FLAIR hyperintensity similar to prior. No hydrocephalus. No extra-axial collections. Diffuse low T1 marrow signal is again noted, which is nonspecific. No destructive calvarial lesions.", "output": "1. No new or enlarging lesions to suggest progression of metastatic disease. 2. Treated hemorrhagic right occipital lesion is not significantly changed in size compared to 9/16/2015. There is increase in surrounding FLAIR hyperintensity which may represent mild edema or gliosis from prior treatment."}
{"instruction": "Generate impression based on findings.", "input": "Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: left facial droop History: left facial droop Brain MRIThere is restricted diffusion lesion on the right internal capsule posterior limb without evidence of hemorrhagic conversion. Scattered multifocal T2/flair high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease are seen.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickening on the left maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate focal luminal stenosis at the proximal basal artery (about 60-70%).Otherwise, there is no evidence of intracranial arterial aneurysm. No other intracranial arterial luminal stenosis is seen.", "output": "1. Acute ischemic infarct involving right internal capsule posterior limb without evidence of hemorrhagic conversion.2. Nonspecific small vessel ischemic disease.3. Focal luminal stenosis of proximal basal artery (60-70%). "}
{"instruction": "Generate impression based on findings.", "input": "Pain. Question of cuff tear. ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis muscles and tendons appear normal, other than minimal enthesopathic changes along the humerus at the supraspinatus/infraspinatus insertionSUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. No fluid is seen within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild osteoarthritis of the glenohumeral joint with loss of articular cartilage along the superolateral aspect of the humeral head. Also, signal abnormality is seen within the superior labrum extending into the anterior labrum which likely represents tearing. The inferior labrum appears intact. A small amount of fluid is noted in the glenohumeral joint but no frank effusion.BICEPS TENDON: The long head of the biceps tendon is intact.", "output": "1. No evidence of rotator cuff tear.2. Osteoarthritis of the acromioclavicular joint.3. Osteoarthritis of the glenohumeral joint with labral tearing as described above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 42 yo F with history of sphincter of Oddi dysfunction s/p biliary sphincterotomy in 2007, with persistent abdominal pain. MRI/MRCP with gadolinium and secretin to assess for biliary or pancreatic stricture as cause of pain, also pancreatic parenchyma History: abdominal pain in setting of history of sphincter of Oddi dysfunction ABDOMEN:LIVER, BILIARY TRACT: Punctate hepatic dome T2 hyperintensity, likely a cyst. No suspicious enhancing lesions. No intrahepatic or extrahepatic biliary ductal dilatation. Status post cholecystectomy.Common bile duct is normal in caliber measuring 4 mm. No intrahepatic biliary ductal dilatation. Mild narrowing at the distal right hepatic duct without proximal dilatation may be technical. Incidentally noted is a draining branch from the right liver into the left hepatic duct.SPLEEN: No significant abnormality noted.PANCREAS: Main pancreatic duct appears normal. Pancreatic parenchyma is normal appearing. No suspicious pancreatic lesions. Normal response to secretin administration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are multiple dilated jejunal loops measuring up to 3.1 cm. There is apparent mass within the cecum at the level of the ileocecal valve which measures 3.8 x 2.6 cm which appears to enhance on postcontrast images (8/29).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid is present within the pelvis.", "output": "1. Multiple dilated jejunal loops. Small bowel obstruction may be considered although this is not well evaluated on this study. Recommend CT enterography for further evaluation.2.Suspected enhancing mass in the cecum can be further evaluated on subsequent CT.3.Apparent narrowing of the distal right hepatic duct is most likely technical, no upstream dilatation seen to suggest flow-limiting stricture. The biliary system and pancreas are otherwise unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "Asymmetrical SNHL, right more than left and right tinnitus. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is partially imaged probable small area of encephalomalacia in the right basal ganglia, which may represent a chronic lacunar infarct.", "output": "No evidence of retrocochlear or inner ear lesions."}
{"instruction": "Generate impression based on findings.", "input": "Assess for seizure focus: 2 GTCs. There is a subcentimeter focus of high T1 signal with susceptibility effect in the left posterior basal ganglia. There is mild scattered cerebral white matter T2 hyperintensity bilaterally. The hippocampi are unremarkable and there is no evidence of heterotopia. There is also no evidence of intracranial hemorrhage, mass, 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 paranasal sinuses and scalp soft tissues are grossly unremarkable. There is deformity of the nasal skeleton related to prior trauma. There are bilateral lens implants.", "output": "1. Nonspecific subcentimeter focus of mineralization in the left posterior basal ganglia, but otherwise no evidence of potential seizure foci. 2. Mild scattered cerebral white matter T2 hyperintensity bilaterally is nonspecific, but may represent chronic small vessel ischemic disease. "}
{"instruction": "Generate impression based on findings.", "input": "Breast cancer staging, known right breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right lower inner breast at anterior depth, the known cancer measures 4.3 x 3.8 x 3.8 cm. There is additional mass like and non-mass enhancement extending laterally and anteriorly from the main mass. Total extent is 8.4 x 6.6 cm. Some of the most lateral enhancement is non-specific in appearance. There are foci near the nipple and an anterior satellite mass that measures 1.2 x 0.8 x 0.8 cm. This anterior satellite lesion and the anterior foci are all within 0.5 cm of the nipple. Skin thickening measuring 0.5 cm is noted in the medial right breast.In the left breast, a typically benign enhancing lesion correlates to the focal asymmetry seen on mammography. This measures 1.0 x 0.5 x 0.3 cm. In the short term between the outside mammograms and this study (3 months) this size appears stable. No abnormal lymph nodes are identified in either axillary region.", "output": "1. Known right breast cancer measures up to 4.3 cm. Additional mass like and non-mass like enhancement in the right breast and skin thickening, with anterior satellite lesions that approach to within 0.5 cm of the nipple. 2. Normal axillary lymph nodes. 3. In the left breast, a typically benign enhancing area measures up to 1.0 cm and correlates to the mammographic focal asymmetry. Given the typically benign appearance, and how readily visible the finding is on mammography, a 6 month mammogram follow up is recommended. If the patient had any older mammograms and the finding could be proven stable, short term follow up would not be needed.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": " Left VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 92 ml/m2 (normal range: 65+/-11), the LVEDV is 142 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 62 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is enlargedRight VentricleThe right ventricle is normal. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 113 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 76 ml (normal range 35+/-13). Right AtriumThe right atrium is enlarged. Aortic ValveThere is a bi-leaflet mechanical prosthesis which appears well-seated. Ao Qflow analysis reveals a RF of 4-6%.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThere is evidence of a prosthetic ascending aortic graft. There is a left sided aortic arch with a normal brachiocephalic branching pattern.AO measurementsGraft 29mmAsc Ao above graft 30x32 mmMid Ao arch 29x32 mmDesc 19x19 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsPost sternotomy. 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. Lower normal LV systolic function2. Normal RV3. Mechanical bioprosthetic AV without evidence for significant AR4. Prosthetic ascending aortic graft with aortic measurements as above.Unchanged from 2013."}
{"instruction": "Generate impression based on findings.", "input": "History of uterine fibroids status post uterine artery embolization, follow-up examination. PELVIS:UTERUS, ADNEXA: The uterus is lobular in morphology and contains numerous fibroids. The uterus measures approximately 22 x 10 x 15 Ccm (CC by AP by TR), previously 24 x 11 x 17 cm when analogous measurement technique used.The endometrial stripe is normal in thickness and is distorted by numerous fibroids. Several nabothian cysts are again noted.There are numerous fibroids, most of which are intramural. Most of the fibroids demonstrate very low T2 signal with a few demonstrating more intermediate T2 signal. The largest fibroid is in the lower uterine segment on the right measuring up to approximately 6 x 7.5 cm in the axial plane, previously 7.3 x 8.8 cm. Overall, the fibroids have decreased in size. There is redemonstration of the small subserosal fibroid at the fundus. On postcontrast images, the majority of the fibroids no longer avidly enhance (as they did previously).The ovaries are normal in size and morphology and contain several follicles or small cysts.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": "Interval decrease in size and loss of enhancement enhancement involving the majority of the uterine fibroids following uterine artery embolization."}
{"instruction": "Generate impression based on findings.", "input": "50 year old presents for MRI research scan before her right breast biopsy. The study is performed for the Alan Penn research study. There is extreme amount of fibroglandular tissue in both breasts.Moderate to marked parenchymal enhancement is noted bilaterally. This includes prominent parenchymal edge enhancement and is a limitation to this study. There are a few scattered cysts in the breasts, right greater than left. In the right breast 12:00 position posteriorly, a bilobed irregular enhancing mass measures 0.8 x 0.8 x 1.3 cm and correlates to the mammogram and ultrasound. There is a thin fat plane between the mass and the pectoralis and the pectoralis enhances normally. No suspicious enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.A few scattered high T2 signal hepatic lesions are highly likely benign such as cysts or hemangiomas.", "output": "Suspicious enhancing mass in the right 12:00 position. This will be biopsied for clinical purposes today after this research MRI.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: Eval GBM. History: GBM. Prior ICH. Right temporal intra axial mass with peripheral enhancement is again demonstrated. Comparing to prior scan, maximum diameter of the mass appears to be slightly decreased in size (for example, previously 54mm of AP diameter on axial post contrast scan and now 49.4mm). However, the degree of mass effects appear to be unchanged.In addition, the enhancing rim of the lesion appears to be slightly smoother than before. However, this could also be related to the scan position and slice thickness differences.The enhancement pattern especially regarding ependymal enhancement is again seen, but unchanged since prior scan (lessen than Jan 29, 2016 scan).The right inferior parietal ICH appears to be unchanged in size and MR characteristics since prior scan. The other lesion located in the right parietal lobe just mesial aspect of ICH does not show any significant difference in size and enhancing characteristics.Multifocal periventricular and deep white matter confluent bihemispheric FLAIR high signal intensities are again seen, unchanged.There is no new enhancing lesion or new abnormal FLAIR or T2 signal intensity on this scan. The ventricles, sulci and cisterns are unchanged. 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. Measurement of the right temporal lobe mass appears to be slightly decreased in size and the pattern of peripheral enhancement has slightly changed since prior scan as described above. 2. However, the degree of mass effects toward adjacent brain parenchyme has not been changed. Right parietal ICH and another enhancing lesion do not show any interval change since prior scan.3. Confluent bihemispheric FLAIR high signal intensity lesions are redemonstrated, unchanged. 4. No new enhancing lesion is seen."}
{"instruction": "Generate impression based on findings.", "input": "88 year old with cardiomyopathy presenting for evaluation of left ventricular systolic dysfunction. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. There is a mild sigmoid septum. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 104 ml/m2 (normal range: 65+/-11), the LVEDV is 176 ml (normal range 109+/-23), the LV end systolic volume index is 62 ml/m2 (normal range 18+/-5), the LVESV is 106 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 98 g (normal range 114+/-24). There is hypokinesis of the mid to apical anterior and anteroseptal walls. There is a mid myocardial \"stripe\" of late gadolinium enhancement involving the basal septum. This is seen as a typical finding in nonischemic cardiomyopathy (dilated or previous myocarditis). Additionally, the native T1 times are elevated at 1150 ms (normal < 1050 ms) which suggests mild diffuse underlying myocardial fibrosis or edema. Left AtriumThe left atrium is mildly to moderately enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 110 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 52 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild to moderate atherosclerosis in the descending thoracic aorta.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 a trivial pericardial effusion. There is pericardial fat present. Extracardiac FindingsThere is a large pleural-based, heterogenous, mass (35 x 32 mm) on the right lateral mid lung and another smaller mass in right lung field. There is a right renal complex exophytic mass. 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. Lung and renal mass as above, recommend dedicated imaging if clinically indicated. 2. Moderate left ventricular dilation with moderately reduced systolic function (LVEF 40%) with mid to apical hypokinesis of the anterior and anteroseptal walls. There is additionally late gadolinium enhancement of the basal septum in the mid-wall stripe pattern, which is suggestive myocardial fibrosis or inflammation. The pattern has been described in both myocarditis and non-ischemic cardiomyopathy. 3. Normal right ventricular size and systolic function (RVEF 52%).4. Mild to moderate left atrial dilation. "}
{"instruction": "Generate impression based on findings.", "input": "Chronic knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The cruciate ligaments are normal. The medial and lateral collateral ligaments are normal.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Normal examination of the right knee."}
{"instruction": "Generate impression based on findings.", "input": " MRI Brain:There is a small area of restricted diffusion involving the left corona radiata which is compatible with an acute infarct, just cranial to a smaller old lacunar infarct. There is no associated mass effect or susceptibility. Again seen are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate to severe chronic small vessel ischemic changes. This includes patchy abnormal signal within the pons and scattered chronic lacunar infarcts.There are numerous scattered punctate foci of susceptibility abnormality throughout the cerebral hemispheres bilaterally with perhaps a few new foci compared to the prior exam. The ventricles and sulci are prominent but unchanged, consistent with moderate age-related volume loss. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Mucous retention cysts or polyps are seen in the maxillary sinuses bilaterally. There is patchy mucosal thickening involving the ethmoid air cells.MRA Brain: The intracranial internal carotid arteries are normal in course with mild dolichoectasia. There is mild focal narrowing of the left proximal M1 segment, unchanged. There is also scattered focal narrowing of bilateral M2 segments, just before entering the sylvian fissure, unchanged. The middle and anterior cerebral arteries are otherwise unremarkable. There is mild multifocal irregularity and narrowing of the left P2 segment, unchanged. The right posterior cerebral artery distal to the P1 segment is mildly diminutive compared to the contralateral side but this is stable. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is a medialized right carotid bifurcation and bulb, and moderate plaque along the left carotid bifurcation, minimal on the right. There is some tortuosity of the distal right cervical internal carotid artery. The remainder of the common carotid arteries and cervical internal carotid arteries are otherwise unremarkable. Both vertebral arteries are tortuous but patent. There is no evidence of stenosis or occlusion.", "output": "1.Acute infarct involving the left corona radiata but without significant mass effect or associated susceptibility.2.Moderate-severe chronic small vessel ischemic disease, unchanged. 3.Scattered foci of susceptibility likely relating to chronic hemosiderin deposition possibly from amyloid angiopathy or hypertensive microhemorrhages are similar in appearance.4.No significant flow limiting stenosis involving the intracranial or neck arteries."}
{"instruction": "Generate impression based on findings.", "input": "75 years, Male, Reason: eval pancreatic mass vs cyst History: noted on ERCP. Study limited due to patient motionABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is diffusely dilated to the ampulla. No cystic lesion is seen as there is extensive respiratory motion. No solid enhancing pancreatic masses are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Limited study due to patient motion. There is diffuse dilatation of the pancreatic duct, however previously seen cystic lesion is not identified, likely due to motion. Within the limitations of this exam, no solid enhancing pancreatic mass is identified."}
{"instruction": "Generate impression based on findings.", "input": " Cervical spine:The cervical spine that demonstrates no abnormal signal in the vertebral bodies. There is normal alignment of the vertebral bodies.The intervertebral disc space at C2-C3 is normal with no significant spinal stenosis.At the level of C3-C4 there is a disk bulge associated with loss of disc height and disc desiccation. There is associated posterior ligamentous hypertrophy. There is effacement of the spinal fluid ventral and dorsal to the spinal cord. Overall there is moderate spinal stenosis is seen. There are bilateral uncovertebral osteophytes present at this level associated with disc material and associated with encroachment of the exiting nerve roots bilaterally.At the level of C4-C5 there is a disk bulge associated with loss of disc height and disc desiccation. There is associated posterior ligamentous hypertrophy. There is effacement of the spinal fluid ventral and dorsal to the spinal cord. Overall there is moderate spinal stenosis is seen. There are bilateral uncovertebral osteophytes present at this level associated with disc material and associated with encroachment of the exiting nerve roots on the right side.At the level of C5-C6 there is a disk bulge associated with loss of disc height and disc desiccation. There is associated posterior ligamentous hypertrophy. There is partial effacement of the spinal fluid ventral and dorsal to the spinal cord. Overall there is mild to moderate spinal stenosis is seen. There are bilateral uncovertebral osteophytes present at this level associated with disc material and associated with encroachment of the exiting nerve roots on the right side.At the level of C6-C7 there is a disk bulge associated with loss of disc height and disc desiccation. There is associated posterior ligamentous hypertrophy. There is partial effacement of the spinal fluid ventral and dorsal to the spinal cord. Overall there is mild spinal stenosis is seen. There are bilateral uncovertebral osteophytes present at this level associated with disc material and associated with encroachment of the exiting nerve roots bilaterally.At the level of C7-T1 there is loss of disc space height, disc desiccation and a mild disc bulge. There is mild narrowing of the neural foramina bilaterally at this level as a result of disc material with some mild encroachment of the exiting nerve roots. There is no significant compromise to the spinal canal.MRI thoracic spine:The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. Mild disc bulges are seen in the intervertebral disc spaces of T1-T2 and T2-T3. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. Lumbar spine:The lumbar spine demonstrates loss of the normal lumbar lordosis. A 25 mm axial dimension well-circumscribed lesion in the left half of the C2 vertebral body most likely represents a vertebral body hemangioma it is bright on T1-weighted imaging and suppresses signal on the fat suppressed images.At the level of T12-L1 there is no significant disc abnormalities.At the level of L1-L2 there is loss of disc space height, diffuse disc bulge, disc desiccation and bilateral ligamentum flavum hypertrophy. Overall there is a moderate degree of spinal stenosis present at this level. This is at theAt the level of L2-L3 there is loss of disc space height, disc desiccation, endplate reactive changes of a chronic stage and a diffuse disc bulge. Overall there is a mild to moderate degree of spinal stenosis at this level and there is narrowing of the neural foramina bilaterally at this level.At the level of L3-L4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate osteophytes. There is bilateral facet hypertrophy and ligamentum flavum hypertrophy at this level. There is partial effacement of the fat within the neural foramina at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At the level of L4-L5 there is loss of disc space height, diffuse disc bulge and bilateral ligamentum flavum hypertrophy. There is fluid identified within the facet joints at this level. There is effacement of the fat at the lateral recesses sees at this level and mild narrowing of the neural foramina bilaterally at this level. Overall there is a mild degree of spinal stenosis at this level.At the level of L5-S1 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated with the mild ligamentum flavum hypertrophy. There is encroachment of the nerve roots at the right lateral recess at this level as a result of disc material. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level as a result of the disc material", "output": "1.There are multilevel degenerative changes present in the lumbar spine with mild to moderate spinal stenosis at L45, L3-4 and L2-3 and moderate spinal stenosis at L1-2.2.There are multilevel degenerative changes present in the cervical spine with moderate spinal stenosis at C2-3 and C3-4 and mild to moderate spinal stenosis at C5-6 and C6-7. There is multilevel neural foramen encroachment of exiting nerve roots in the cervical spine as detailed above3.There are mild degenerative changes present in the thoracic spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Headache, nausea, preoperative planning for craniotomy for tumor resection. Examination is limited to sequences for operative planning and intraoperative navigation. Again seen is an enhancing, predominantly solid fourth ventricular mass measuring approximately 3.6 x 4.2 x 4.2 cm in the AP, transverse, and craniocaudal dimensions. Mass demonstrated restricted diffusion on prior study. Again noted is obstructive hydrocephalus with dilated lateral, third, and upper aspect of the fourth ventricles similar to prior. Periventricular T2 hyperintensity is consistent with transependymal CSF flow. Distended optic nerve sheaths also again seen. No additional foci of parenchymal or meningeal enhancement are appreciated. No midline shift or uncal herniation. Mild inferior cerebellar tonsillar herniation again seen. Major flow-voids are preserved. Mucosal thickening in the maxillary sinuses, right worse than left again noted. Calvarium and extracranial soft tissues are otherwise unremarkable.", "output": "Examination for operative planning again demonstrates a fourth ventricular mass which is favored to represent a medulloblastoma. Associated obstructive hydrocephalus again seen."}
{"instruction": "Generate impression based on findings.", "input": " There are stable post surgical findings related to left parietal craniotomy. There is an avidly enhancing dural based mass along the left greater wing of the sphenoid that measures 1.3 x 1.2 cm, previously 1.3 x 1.3cm. There is minimal mass effect upon the inferior left frontal lobe and minimal surrounding edema. There are unchanged scattered nonspecific foci of cerebral white matter T2 hyperintensity. The ventricles and sulci are unchanged. There is no midline shift. The imaged portions of the paranasal sinuses and mastoid air cells are clear.", "output": "No significant interval change in the left greater wing of sphenoid meningioma with superimposed treatment effects.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 66 years old s/p OLT for HCC, 1.5 lesion with enhancement on CT but no washout, evaluate further with HCC. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of liver transplant.The previously described segment 6 lesion measures 1.3 x 1.3 cm (series 1203, image 2). It is hypointense on both T1 and T2-weighted images with avid arterial enhancement, mild venous enhancement and no washout. On the arterial phase there appears to be a right hepatic artery branch vessel leading into the lesion. Amorphus low T2 signal is also seen posterior to the lesion and on delayed postcontrast images only an amorphus hypointense artifact is seen in this same area. This artifact may be related to turbulent/pulsatile flow within the lesion.A tubular focus of hypointensity along the fissure is of uncertain significance. It may be related to artifact from surgery.No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances normally. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.The previously described segment 6 lesion is favored to represent a vascular anomaly, for example an aneurysm.2.No evidence of recurrent hepatocellular carcinoma."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o repeat meniscus tear History: pain MENISCI: There is linear increased signal abnormality within the body of the meniscus which extends to the tibial articular surface indicating a longitudinal tear, new from prior examination (image 28; series 701 and image 27; series 501). There is blunting and deformity of the posterior horn of the lateral meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage cleft with delamination along the weightbearing surface of the medial femoral condyle above the body of the meniscus. Note is made of a lesion along the medial aspect of the distal femoral metaphysis with sclerotic margins likely representing a benign nonossifying fibroma, appearing similar to the prior study.LIGAMENTS: There is thickening and foci of fluid signal intensity internally within the ACL likely representing mucoid degeneration. There are also foci of fluid signal intensity about the anterior and posterior aspect of the PCL which may represent mucoid degeneration as well. The ACL and PCL appear intact. The LCL and MCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Findings indicating a new tear of the body of the lateral meniscus as described above. There is blunting and deformity of the posterior horn of the lateral meniscus which also likely represents a re-tear, although some of this may be related to the patient's history of prior partial meniscectomy.2. Full-thickness articular cartilage cleft with delamination along the medial femoral condyle. 3. Moderate-sized joint effusion. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 51 years old. Constant right knee pain with no hx of trauma. MENISCI: There is thickening and increased signal intensity of the anterior horn of the lateral meniscus, particularly at its root, indicating moderate to severe degeneration and degenerative tearing. The body and posterior horn of the lateral meniscus appear normal. The medial meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patella particularly along the medial facet. There is a full thickness fissure at the median eminence with underlying subchondral cysts. There is focal degeneration of the femoral trochlea inferiorly. The remainder of the articular cartilage appears relatively normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism appears normal.ADDITIONAL", "output": "1.Patellofemoral osteoarthritis.2.Degeneration and degenerative tearing of the anterior horn of the lateral meniscus."}
{"instruction": "Generate impression based on findings.", "input": "Male, 35 years old, with history of grade 2 oligodendroglioma status post partial resection. A heterogeneous tumor is evident within the left frontal lobe spanning from the cortical surface to the lateral ventricular margin. Abnormal signal also spreads into the genu of the corpus callosum and along the margin of the left caudate nucleus.Evidence of interval partial tumor resection is seen with a small resection cavity in the central portion of the tumor. The margins of this cavity demonstrate a thin rim of discrete enhancement. Anterior to the cavity, there is a blush of mild enhancement within the tumor which appears similar to prior exams. Apart from the resection cavity, the overall size and morphology of the lesion have not significantly changed from prior exams.Mass effect from the lesion results in partial effacement of the left frontal horn and a very slight midline shift to the right. No other parenchymal lesions are seen. No other abnormal intracranial enhancement is detected. The ventricular system is otherwise normal in size and morphology.", "output": "Findings are seen compatible with partial resection of a left frontal lobe tumor. Apart from the resection cavity, there has been no significant interval change in the size of the lesion when compared to prior exams."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Kanoy is a 55-year-old female presenting for short term 6 month follow-up of a benign-appearing 4 mm lesion in the right breast seen on outside MRI. Family history of breast cancer in father, maternal grandmother, maternal uncle, two maternal aunts, and one maternal cousin. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Scattered foci of enhancement are seen bilaterally in both breasts, all of which appear similar in size and distribution when compared to prior examinations. Specifically, a focus seen in the right medial retroareolar breast, is stable when compared to prior examination from 11/17/2015, now measuring 0.4 x 0.4 cm, previously measuring 0.3 x 0.4 cm. No new abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "Stable benign focus of the right breast. No MRI evidence of malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Episodes of left sided weakness and occasional slurred speech. Family reports a stress test with triple vessel disease. Brain MRI: There is an area of high T2 signal and restricted diffusion in the right thalamocapsular junction that measures up to 25 mm. There is also a subcentimeter focus of high T2 signal and restricted diffusion in the right posterior putamen. There is no evidence of intracranial hemorrhage or mass. 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.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysm.Neck MRA: There is no evidence of significant steno-occlusive lesions.", "output": "1. Acute infarcts in the right thalamocapsular junction and putamen without evidence hemorrhagic transformation or midline shift.2. No evidence of significant steno-occlusive disease in the major head and neck arteries, within the limits of MRA.Discussed with nurse Valerio at 5PM on 9/21/15."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 57 y/o with seizure disorder, recently diagnosed cervical cancer and new cerebellar lesions on MRI. Study for biopsy planning Exam was obtained for surgical localization purposes. There is redemonstration of a 1.9 x 1.0 cm enhancing lesion in the left cerebellum with a small amount of surrounding vasogenic edema. Additionally, a 0.6 cm lesion in the anterior inferior right cerebellum also appears similar to prior examination.Redemonstrated are scattered areas of T1 hypointensity and T2 hyperintensity are demonstrated in the periventricular and subcortical white matter correlating to areas of T2/FLAIR hyperintensity seen on prior examination, likely secondary to chronic microvascular ischemic change. The cortical sulci are in proportion to the cerebral ventricles. No midline shift or mass effect is appreciated. Incidental empty sella is noted.", "output": "Stable left greater than right enhancing cerebellar lesions concerning for metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "44 years, Female, follow-up of a left retrocerebellar arachnoid cyst. Again seen is a left posterior fossa CSF signal lesion measuring approximately 7.0 x 3.3 x 5.5 cm (TV x AP x CC), which is unchanged when measured with a similar technique. Mild associated mass effect on the adjacent cerebellum. Mild scalloping of the occipital calvarium is also again noted. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Unchanged 4 mm pineal cyst. No suspicious intracranial mass. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.", "output": "Compared to outside MRI from 12/2/2013, left retrocerebellar arachnoid cyst is unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Vertigo. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, cerebellum, and pituitary gland appear 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.MRA: There is no evidence of significant cerebral steno-occlusive lesions or saccular aneurysms, within the limits of MRA. In particular, the posterior circulation appears to be intact. The major arteries in the neck also appear to be intact.", "output": "1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions of the head and neck arteries."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out cord compression; known lung cancer. Signs and symptoms: As above. Pre-and post enhanced lumbar MRI:The field of exam spans from the T10 through S3 levels. External there are multiple foci of marrow signal changes with subtle varying degree of enhancement and consistent with multiple foci of osseous metastatic disease. These findings were all present on prior CT of chest from February 11.There is no evidence of the spinal canal compromise or stenosis from T10 through L2 levels and without evidence of cord /conus/cauda equina compression.Metastatic T11 vertebrae demonstrate less than 50% compression deformity and mild expansion into the spinal canal however without central spinal stenosis.No evidence of any additional vertebral body fracture. There is no evidence of extension of metastatic lesion into the epidural space or the paraspinal soft tissues at any level.At L2 -- L3 there is a broad based central and rightward shadow disk protrusion with subtle mass effect on the thecal sac and mild central spinal stenosis.Extensive degenerative changes and L3 -- L4 however results in moderate central spinal stenosis and right neural foraminal compromise. Extensive degenerative changes at L4 -- L5 and including mild grade 1 anterolisthesis also results in significant central spinal stenosis and moderate left neural foraminal compromise.The signal intensity and caliber are normal as visualized thoracic cord, conus and cauda equina is within normal and without detectable abnormal enhancement.", "output": "1.Multiple osseous metastatic lesions involving multiple vertebral bodies from T10 through S2 as detailed with subtle varying degree of enhancement.2.Less than 50% compression fracture of metastatic T11 vertebrae with mild expansion into the spinal canal however without spinal compromise.3.There is no evidence of stapedial spread of tumor at any level and no evidence of spinal canal compromise secondary to metastatic disease.4.Degenerative changes at L3 -- L4 and L4 -- L5 levels results in moderate to severe central spinal stenosis at these levels. 5.No evidence of signal abnormality or enhancement of the lower most visualized thoracic cord, conus or the cauda equina."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Further evaluation for disc herniation. Signs and symptoms: Myelopathy, preop planning. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild degenerative disc disease with resultant moderate left and mild right neural foraminal compromise and no central spinal stenosis.C4-C5 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophic changes. Shallow mental hypertrophic spur on the left results in slight flattening and posterior displacement of the cord and moderate central spinal stenosis. Moderate bilateral neural foraminal compromise is also present.C5-C6 demonstrate a large disc extrusion extending superiorly to mid C5 level and inferiorly to mid C6. Although the prior exam was incomplete there is no significant change of this finding which results in significant central spinal stenosis. The extruded disc is more prominent to the left of midline. Significant bilateral neural foraminal compromise is also present. On sagittal T2 STIR there is evidence of increased T2/T2 STIR signal intensity of the cord at this level suggestive of myelitis.C6-C7 demonstrate moderate disc disease, loss of disc height, mild hypertrophic changes of facet and ligamentum flavum. There is a shallow bulging disc with resultant subtle flattening the ventral aspect of the cord and mild central spinal stenosis.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord to T3 level is unremarkable.", "output": "1.C5-C6 demonstrate a large disc extrusion with resultant significant central spinal stenosis and increased T2 signal intensity of the cord/myelitis.2.C4-C5 demonstrate degenerative changes with resultant moderate central spinal stenosis and neural foraminal compromise as detailed.3.C6-C7 demonstrate degenerative changes with resultant mild central spinal stenosis and neural foraminal compromise.4.See detailed report per level above."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with new onset tremor and gait disorder, concern for atherosclerotic Parkinson's disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is diffuse prominence of the ventricles and sulci indicating mild global atrophy.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Normal flow-voids are demonstrated in the major intracranial vascular structures.The sella and orbits appear within normal limits. There is partial opacification of the right posterior ethmoidal air cells, right frontal sinus as well as the right mastoid air cells. Chronic appearing opacification of the right sphenoid sinus. Bone marrow signal and extracranial soft tissues are within normal limits.", "output": ".1. Mild chronic small vessel ischemic disease involving the periventricular and subcortical white matter.2. Prominence of the ventricles and sulci compatible with mild global atrophy. 3. Chronic appearing paranasal sinus disease as described above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 60 years old, with dysarthria and gait disorder. Evaluate for cerebellar disease. One or two curvilinear, nonspecific foci of T2 hyperintensity are seen within the subcortical white matter of the right superior parietal lobule. No other focal lesions are detected. No edema or mass effect is observed. There are no diffusion restricting lesions. Cerebral volume is generally well preserved. However, the cerebellar fissures are disproportionately prominent, particularly along the vermis, suggesting underlying volume loss. The brainstem is within normal limits. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid is seen. The ventricular system is within normal limits.", "output": "Prominence of the cerebellar fissures, predominantly along the vermis, is out of proportion to sulcal caliber elsewhere and likely reflects underlying volume loss. The etiology for this finding is broad and includes inherited disorders, medication effect, toxic exposures and metabolic abnormalities. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 4 years old, with history of JPA, follow-up three month evaluation. Evidence of occipital craniotomy is again seen. A resection cavity centered on the cerebellar vermis has decreased in size from the prior exam. No evidence of surrounding edema or any significant T2 signal abnormality is seen. On postcontrast images, previously seen curvilinear enhancement along the cavity margins has diminished. There remains a small focus of curvilinear enhancement at the anterior margin of the cavity. No additional new intracranial lesions are seen. The fourth ventricle has reexpanded and the ventricular system has resumed normal caliber and morphology. Supratentorial parenchymal morphology and signal are within normal limits.", "output": "Expected postoperative findings compatible with resection of tumor from the posterior fossa. The resection cavity has decreased in size along with decreasing nonspecific curvilinear enhancement along the cavity margins. No evidence of any new or recurrent lesion is seen."}
{"instruction": "Generate impression based on findings.", "input": "Severe headaches with semiology consistent with migraine with aura and suspicion of autoimmune disease: bilateral nystagmus and peripheral neuropathy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several, at least 15, punctate foci of high T2 signal in the white matter of the bilateral frontal lobes, which may have progressed slightly since 2011. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter left posterior nasopharyngeal retention cyst. There are partially imaged postoperative findings in the cervical spine.", "output": "Punctate foci of T2 hyperintensity in the bilateral frontal lobe white matter are nonspecific, but may represent sequela of migraine, autoimmune, or chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with right femur Ewing's with retroperitoneal metastases receiving chemotherapy, evaluate disease status. Patient underwent right proximal femoral resection with right total hip arthroplasty on December 2015. Components of a total hip arthroplasty with adjacent metal artifact limiting evaluation of the immediate surrounding structures. The previously seen mass in the right anterior thigh is not definitively visualized. There are postsurgical changes in the lateral soft tissues of the right upper thigh with a linear tract extending from the skin to the thigh musculature, specifically the vastus lateral and intermedius, which demonstrates low signal intensity on T1 and bright signal on T2 and heterogeneous enhancement. There is generalized mild fatty atrophy of the thigh musculature. Small enhancing right inguinal lymph nodes are unchanged.", "output": "Surgical changes related to a right total hip arthroplasty with likely postsurgical and mild inflammatory changes in the right lateral soft tissues and thigh musculature. Adjacent metal artifact limits evaluation of the immediate surrounding tissues, however there is no discrete mass identified."}
{"instruction": "Generate impression based on findings.", "input": "43 year-old female with pituitary adenoma, assess interval change after discontinuing cabergolinr. There has been no significant interval change in the all size of the patient's pituitary lesion measuring 8 mm AP by 10 mm transverse by 9 mm craniocaudal. However, there has been slight decrease in thickness of a small hypointense portion located along its anterior aspect. The infundibulum remains deviated slightly to the left. There is no mass effect upon the optic apparatus or cavernous sinuses. Fluid is present in left mastoid air cells, which has been present dating back to 6/5/2013.", "output": "There has been no significant interval change in the all size of the patient's pituitary lesion. However, there has been slight decrease in thickness of a small hypointense portion located along its anterior aspect. "}
{"instruction": "Generate impression based on findings.", "input": " MRI brain:There has been interval resolution of previously seen multiple areas of bilateral T2/FLAIR hyperintensity predominantly involving the cortex and subcortical white matter. There are no areas of abnormal signal or pathologic enhancement. The ventricles and sulci are prominent, consistent with mild global volume loss greater than expected for the patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening of the frontal sinuses, ethmoid air cells and bilateral maxillary sinuses. MRA brain:The intracranial internal carotid arteries are normal in course and caliber. Slightly inhomogeneous areas of flow related enhancement in the cavernous carotids likely relates to turbulence and flow related artifact. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.", "output": "1. Interval complete resolution of previously seen scattered prominent areas of abnormal cortical and subcortical abnormal signal, presumably related to PRES as well as possible superimposed areas of seizure activity given history of status epilepticus.2. No evidence of acute infarct.3. Unremarkable MRA of the head."}
{"instruction": "Generate impression based on findings.", "input": "Aphasia [R47.01], Reason for Study: ^Reason: eval for pathology, s/p crani for R MCA and L ICA aneurysms. History: aphasia Due to metallic artifact, precise evaluation with diffusion-weighted imaging and gradient-echo imaging are limited.However, there is no evidence of acute ischemic lesion on the scan.There are localized and somewhat gyral pattern FLAIR/T2 high signal intensity lesions at the left anterior temporal lobe surface area (series 6, image 12,13,14). There are also associated FLAIR/T2 high signal intensity lesions at the left anterior and mesial temporal area. This lesion is likely to be intra axial and indicate possible hemorrhagic lesions as well as associated parenchymal edema likely related to prior operation.There is also extra dural fluid collection extending from the left frontal lobe 2 to temporal lobe and the maximum diameter was measured about 11 mm on axial T2 images with subtle effacement of underlying brain parenchyme. The maximum diameter measured on prior CT scan was about 10.1 mm, thus, considering different imaging modality, there is no significant interval change of extradural fluid collections.There is also scalp fluid collections with air signal intensities which are related to prior operation, unchanged since prior scan.Minimal (about 1-2mm) midline shift toward right side is again seen but unchanged since prior scan.The ventricles, sulci and cisterns are symmetric.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.", "output": "1. Left temporal lobe likely hemorrhagic lesion and edematous lesions, likely represent prior surgery related lesions as described above (series 6, image 12,13,14).2. No evidence of acute ischemic lesion.3. Unchanged extra dural fluid and air collections since prior scan with subtle effacement of underlying brain parenchyme since prior scan.4. Unchanged subgaleal fluid and air collection since prior CT scan."}
{"instruction": "Generate impression based on findings.", "input": "27 years Female (DOB:8/7/1988)Reason: 3T scanner, qsm/permeabiltiy, CCM Protocol History: yearly surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There are multiple lesions which have a ring of low signal compatible with hemosiderin ring and smaller central area of T2 signal hyperintensity present which appear to be stable compared to the prior exam. The largest one appears to be in the left basal ganglia and internal capsule and measures 14 x 11 mm axial dimensions and is unchanged. Other smaller lesions evident on T2 imaging are located in the left hippocampus left fusiform gyrus right inferior temporal lobe gyrus, right anterior medial temporal lobe left isthmus of the cingulate gyrus left frontal lobe subcortical white matter, right frontal lobe subcortical white matter and a right paracentral lobule subcortical white matter and another one in the gray matter in that location and right superior frontal gyrus. Additional lesions are also identified on susceptibility weighted imaging which are not clearly identified on the T2 and FLAIR images..Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "The patient has multiple cerebral cavernous malformations scattered in both hemispheres which are stable compared to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": " There are multiple scattered T2 hyperintense foci in the cerebral white matter, which appear to be similar in number and extent, accounting for differences in technique. There is no evidence of intracranial hemorrhage, mass, 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.", "output": "Multiple scattered nonspecific T2 hyperintense foci in the cerebral white matter appear to be similar in number and extent, accounting for differences in technique.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Low back pain radiating to the left leg. There is disc desiccation and bulge at L4-L5 with superimposed disc extrusion that extends into the left lateral recess with impingement upon the descending left L5 nerve roots. There is no significant neural foramen stenosis. There are trace effusions in the L4-L5 facet joints bilaterally with an associated subcentimeter posterior right synovial cyst. There is mild loss of the usual lumbar lordosis. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.", "output": "Disc desiccation and bulge at L4-L5 with superimposed disc extrusion that extends into the left lateral recess with impingement upon the descending left L5 nerve roots."}
{"instruction": "Generate impression based on findings.", "input": "Dizziness and giddiness [R42], Reason for Study: ^Reason: Are there brain metastases? History: Hearing loss. Left sided ear fullness. Vertigo. Dysequilibrium. Metastatic cancer There is single restricted diffusion lesion on the left cerebellar hemisphere without evidence of hemorrhagic conversion (series 4, image 8) indicating acute ischemic infarction.Underlying brain shows non specific small vessel ischemic disease. There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on bilateral ethmoid sinuses, frontal sinus and left maxillary sinus.", "output": "1. Acute ischemic infarction on the left cerebellar hemisphere without evidence of hemorrhagic conversion.2. Non specific small vessel ischemic disease.3. No evidence of abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Patient with metastatic melanoma. Signs and symptoms: Numbness, weakness bilateral lower extremities (left greater than right). Pre-and post-enhanced lumbar MRI:This examination extends from T10 inferiorly through S3 and demonstrates no evidence of osseous or leptomeningeal enhancement.Lower most visualized thoracic spine and thoracic cord is unremarkable with the exception of mild degenerative changes.T12 -- L1 demonstrate moderate disk disease and loss of disk height without spinal stenosis or neural foraminal compromise.L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foramina compromise.L2 -- L3 demonstrate mild degenerative changes and unremarkable otherwise.L3 -- L4 demonstrate mild disk disease and loss of disk height and mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis. Mild to moderate left neural foraminal compromise.L4 -- L5 demonstrate moderate disk disease and loss of disk height, mild to moderate bilateral facet and ligamentum flavum hypertrophy, mild bilateral widening of the facet spaces and with facet effusion. There is mild central spinal stenosis and moderate bilateral neural foraminal compromise.L5 -- S1 demonstrate moderate to advanced disk disease and loss of disk height, mild to moderate the right and mild left facet and ligamentum flavum hypertrophy. There is a central and left lateral disk protrusion projecting into the ventral epidural space with resultant left lateral recess compromise. No central spinal stenosis. Degenerative changes at this level results in significant (left greater than right) neural foraminal compromise.Unremarkable paraspinal soft tissues.", "output": "1.No evidence of osseous or leptomeningeal metastases.2.Mild-to-moderate degenerative changes of disks and the posterior elements with resultant mild central spinal stenosis only at L4 -- L5 level.3.Multiple levels of neural foramina compromise more significantly at L5 -- S1 bilaterally.4.Disk protrusion at L5 -- S1 with resultant mild left lateral recess compromise."}
{"instruction": "Generate impression based on findings.", "input": "Female, 75 years old, with seizures. Evaluate for brain metastases, subclinical status in the bifrontotemporal regions. Image quality is degraded by motion artifact. Within this limitation, no edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is observed. There are a few very small scattered foci of FLAIR hyperintensity which are nonspecific. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricles and sulci are slightly prominent compatible with mild underlying volume loss.", "output": "Within the limitations of a motion degraded examination, no evidence of brain metastases or any other specific finding is seen to account for the patient's seizures."}
{"instruction": "Generate impression based on findings.", "input": "History of breast cancer. Headache status post tumor resection. There are postoperative changes related to bilateral frontal craniotomy for resection of a lesion in the cingulate gyrus in the right posterior frontal lobe. There is resection of much of the solid component medially with residual lobular enhancement at the anterior, lateral and posterior margin of the resection cavity. There is slightly increased surrounding vasogenic edema. The tumor minimally extends across the midline and likely through the falx to the left. There is redemonstration of additional supratentorial and infratentorial enhancing lesions consistent with metastatic lesions. There is a second superficially located left frontal metastatic tumor with enhancement measuring approximately 11 mm, previously 12 mm, with minimal surrounding edema and regional mass effect. A third smaller metastatic lesion abutting the right falx in the left posterior parietal region measures 8 mm, previously 9 mm, with mild surrounding edema and mild mass effect.There is a parenchymal metastatic lesion in the right posterior cerebellum measuring 10 mm, previously 10 mm, without surrounding edema or appreciable mass effect. Ventricular system is within normal limits and without midline shift. The signal void of major intracranial arterial branches are identified. Calvarium is unremarkable without detectable abnormal enhancement. Paranasal sinuses demonstrate a small retention cyst in the dependent portion of right maxillary sinus and unremarkable otherwise.", "output": "Postoperative findings related to subtotal resection of a right posterior frontal cingulate gyrus lesion. No significant interval change in the size of the multiple other supratentorial and infratentorial metastatic lesions.   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, 53 years old, complaining of low back pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is seen.The distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.Incidental note is made of small multicystic kidneys. There are more cysts now when compared to the prior examination.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L3-4: No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L4-5: Mild facet arthropathy. No significant spinal canal or neuroforaminal narrowing. No interval changes. L5-S1: Mild facet arthropathy. Minimal foraminal narrowing bilaterally. No significant spinal canal stenosis. No interval changes.", "output": "No significant spinal canal stenosis is seen. Only minimal foraminal narrowing is evident at L5-S1, unchanged from prior. Multicystic appearance of the kidneys has progressed from prior."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for mets, staging of tumor History: Breast Ca MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple marrow replacing lesions throughout the calvarium. The largest one is adjacent to the superior sagittal sinus and is associated with some mild displacement of the superior sagittal sinus inferiorly. It measures approximately 36 by 10 mm sagittal dimensions and appears to have an epidural component.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment. The cervical spinal cord has normal signal characteristics and overall morphology. There are multiple marrow replacing lesions present throughout the cervical spine with near complete marrow replacement at C4, C5 and C6. There is mild loss of vertebral body height at C4.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There are endplate osteophytes and uncovertebral osteophytes at this level appear to be old but worse on the right side versus the left where there is narrowing of the right neural foramen.At C3-4 there is loss of disk space height and endplate osteophytes with bilateral narrowing of neural foramina and partial effacement of spinal fluid ventral, but not posterior to the spinal cord. There is a an infiltrating enhancing lesion extending into the left neural foramen and encroaching on the left-sided exiting nerve root at this levelAt C4-5 there is loss of disk space height, endplate osteophytes and bilateral uncovertebral osteophytes resulting in narrowing of neural foramina - right worse than left - with partial effacement of spinal fluid ventral, but not posterior to the spinal cord. There is encroachment of right-sided exiting nerve roots and to a lesser degree left-sided exiting nerve roots at this level. There is a an infiltrating enhancing lesion extending into the left neural foramen and encroaching on the left-sided exiting nerve root at this level and displacing the left vertebral artery.At C5-6 there is loss of disk space height and endplate osteophytes with mild bilateral narrowing of neural foramina. There is no significant compromise to the spinal canal or neural foramina. There is a an infiltrating enhancing lesion extending into the left neural foramen at this level.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.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment. There is a compression fracture present at T12 with mild retropulsion into the spinal canal.There are multiple marrow replacing lesions throughout the thoracic spine worse at T3 through T6. There is epidural extension of tumor extending from the C3-4 to the T5-6 level and resulting in spinal stenosis at the T5 vertebral body level with effacement spinal fluid compression of the spinal cord. There is additional infiltration of the neural foramina bilaterally at the C4-5, C5-6 and C6-7 and T7-T8.There is an infiltrating lesion extending into the right neural foramina at the T11-T12 and T12-L1 levels and affecting the exiting nerve roots appear infiltrating lesions extending to the left neural foramina at T9-10.There are small bilateral pleural effusions present", "output": "1.There are multiple marrow replacing lesions scattered throughout the cervical spine and thoracic spine. 2.There is associated epidural extension of the tumor into the spinal canal from the T3-4 disk space level to the T5-6 disk space level with spinal stenosis from epidural extension at the T5 vertebral body level. There is also associated multilevel neural foramen encroachment throughout the thoracic spine as detailed above.3.There a malignant compression fracture present at T12.4.There is a combination of degenerative changes present in the cervical spine and metastatic disease in the cervical spine resulting in mild spinal stenosis at C4-5 and there is muultilevel neural foramina encroachment present due to infiltrating tumor at multiple levels as detailed above.5.There are multiple calvarial-based lesions throughout the skull one of which displaces the superior sagittal sinus. There are no brain parenchymal metastases appreciated however.6.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 7.Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Stated history of anal fistula with bleeding. PELVIS:UTERUS, ADNEXA: The uterus is normal in morphology and size. The uterus measures 6.8 x 2.9 cm in sagittal plane. The endometrial cavity/fluid is normal in signal intensity and thickness. The inner myometrium/junctional zone is normal in thickness measuring 6 mm. No discrete uterine mass. The parametrial soft tissues and vaginal canal are unremarkable.There are numerous predominantly peripheral ovarian follicles which are mildly prominent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a very thin fluid tract extending from approximately the 3:00 of the lower anal canal extending inferiorly in the intersphincteric space and terminating along the left gluteal cleft. This is associated with mild restricted diffusion and postcontrast enhancement. No associated fluid collection. There are small adjacent vessels.There is suggestion of mild hyperenhancement of the visualized rectosigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Intersphincteric low perianal fistula terminating along the left gluteal cleft without associated fluid collection.2. Suggestion of colitis involving the visualized rectosigmoid colon; correlate for potential inflammatory bowel disease. 3. Numerous predominantly peripheral ovarian follicles which are mildly prominent; correlate for clinical signs and symptoms of polycystic ovarian syndrome."}
{"instruction": "Generate impression based on findings.", "input": "26 years, Male, brain biopsy planning.. Examination is limited to sequences for operative planning and intraoperative navigation. Fiducial markers are in place. Again seen are intensely enhancing masses involving the left cingulate gyrus as well as more posteriorly in the precuneus of the left parietal lobe. There is surrounding edema which is minimally increased since prior. Masslike T2 signal abnormality involving the bilateral posterior corpus callosum body is also again seen. Additional nonenhancing foci of T2 hyperintensity involving the bilateral frontal and parietal lobes are also again seen with focus in the left frontal lobe appearing slightly more confluent with the vasogenic edema more posteriorly. These areas demonstrated restricted diffusion previously. Mass effect including downward displacement of the corpus callosum and partial effacement of the lateral ventricles again seen. There is minimal rightward midline shift at the level of the cingulate gyrus with no significant midline shift at the level of the foramen of Monro or evidence of uncal herniation. No hydrocephalus.", "output": "Examination for operative planning again demonstrating enhancing left frontal and parietal masses with additional smaller nonenhancing lesions. There is minimal interval increase in edema when compared to 5/26/2016. Lymphoma is again very high in the differential."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are left digital mammographic images (3/9/15), ultrasound images of left breast (3/9/15), right digital mammographic images (3/11/15, 4/28/15), ultrasound images of right breast (3/11/15), images from ultrasound-guided biopsy of left breast and postprocedural left digital mammographic images (3/11/15), breast MRI (3/20/15) performed at Advocate Lutheran General Hospital. For comparison, digital mammographic images (10/24/15, 11/5/14), ultrasound images of right breast (11/5/14) are available. LEFT DIGITAL MAMMOGRAPHIC IMAGES (3/9/15):The breast parenchyma is heterogeneously dense. A spiculated mass is present in the retroareolar region, measuring 2 cm. A nipple retraction is associated. No suspicious calcifications are seen in the left breast.ULTRASOUND IMAGES OF LEFT BREAST (3/9/15):An irregularly shaped hypoechoic mass is present at retroareolar region measuring 12 x 10 x 15 mm. The mass is attached to the nipple. A few normal appearing lymph nodes are seen in the left axilla.RIGHT DIGITAL MAMMOGRAPHIC IMAGES (3/11/15, 4/28/15):The breast parenchyma is heterogeneously dense. Three circumscribed round masses are present at upper outer quadrant, likely cysts. They are confirmed benign cysts on the Utrasound study (3/11/15) and MRI (3/20/15). The asymmetry, measuring 2 cm, at posterior superior aspect on ML and MLO view. In addition, there is a cluster of amorphic calcifications at posterior lower outer quadrant in the right breast, seen on the magnification views on 4/28/15. Those two lesions need additional work-up.ULTRASOUND IMAGES OF RIGHT BREAST (3/11/15):Two simple cysts at 9:00 position-10:00 position are present in the right breast, corresponding to the mammographic findings.IMAGES FROM ULTRASOUND-GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT DIGITAL MAMMOGRAPHIC IMAGES (3/11/15):Ultrasound guided needle biopsy was performed for the left retroareolar mass, with appropriate needle placement. Postprocedural left on graphic images show a marker clip within the left retroareolar mass.Per outside report, the result was malignant.BREAST MRI (3/20/15):Breast MRI was performed with a protocol outlined in the outside radiology report.Known carcinoma is visualized at left retroareolar region as a spiculated mass measuring 26 x 18 x 31 mm (AP x LR x CC). The mass abuts the nipple, which is enhancing with this mass, suspicious for invasion.A linear non-mass enhancement, measuring 21 x 6 x 11 mm, is seen in the right breast at far posterior upper outer quadrant. This enhancing lesion likely corresponds to the asymmetry on the mammogram.Three simple cysts are seen in the right breast.No abnormal axillary lymph nodes are identified in either axillary region.", "output": "1. Biopsy proven left breast malignancy, suspicious for invading to the nipple.2. Linear enhancing lesion in the right far posterior upper outer quadrant. This lesion could correspond to the asymmetry on mammogram. Additional work-up for right breast, including the asymmetry at posterior upper outer quadrant and cluster of calcifications at lower outer quadrant is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "70 years Male (DOB:7/7/1946)Reason: Eval grade 2 astrocytoma. Pt on CCNU. History: grade 2 astrocytoma.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is T2 and FLAIR signal hyperintensity involving right basal ganglia, thalamus, insular cortex and adjacent right frontal lobe which extends to involve gray and white matter of the insular cortex and right orbital gyrus and right inferior frontal gyrus as well as the anterior aspect of the right temporal lobe. It does not display any contrast enhancement. On the current exam there is new T2 signal hyperintensity which extends further superiorly and posteriorly into the right frontal lobe white matter and further posteriorly in the right temporal lobe white matter. This is a new T2 signal hyperintensity is higher signal than the rest of the lesion. There is an associated cystic component measuring 35 x 28 mm axial dimension in size within which on the March exam measured 12 x 17 mm axial dimensions. There is an enhancing component which is enlarged relative to the prior exam and encircles a cystic component. It measures 52 x 42 mm axial dimensions on the current exam and previously was rather patchy. The enhancing component demonstrates elevated cerebral blood volume.The patient status post right frontal craniotomy.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus and mucosal thickening elsewhere in the paranasal sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There is an infiltrating mass involving right frontal lobe, anterior temporal lobe, insular cortex, right thalamus and basal ganglia. Since the prior exam T2 and FLAIR signal hyperintensity associated with the lesion has progressed. It is possible this represents vasogenic edema with or without tumor infiltration. Additionally, the contrast enhancing component of the lesion associated with a cystic lesion which has enlarged since the prior exam and is associated with elevated blood volume suggesting recurrent higher grade infiltrating astrocytoma."}
{"instruction": "Generate impression based on findings.", "input": "Male 60 years old Reason: osteomyelitis History: same No significant skin thickening is evident. There is diffuse reticulation of the subcutaneous fat, particularly along the lateral aspects of both thighs compatible with edema. There is also diffuse symmetric intramuscular and intermuscular edema of the bilateral upper thighs. No drainable fluid collection is evident.There is no joint effusion. The bone marrow signal is normal, and there is no evidence of osteomyelitis. Focus of gas within the bladder likely reflects prior presentation.", "output": "Nonspecific edema of the subcutaneous fat and muscular compartment of both thighs, without evidence of osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: assess for strokes History: right sided weakness and expressive aphasia Brain MRIThere are scattered restricted diffusion areas involving left basal ganglia and frontal and parietal lobe especially left inferior lobule indicating acute ischemic infarct. There is no evidence of susceptibility lesions within the restricted diffusion area indicating no MR evidence of hemorrhagic conversion.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate more than 90% segmental stenosis of the left MCA proximal M1 segment. In addition, there is a suspicious about 50-70% of luminal stenosis on the left internal carotid artery cavernous sinus segment.There are multifocal luminal narrowings involving proximal right MCA M1 segment and proximal right MCA M2 segment.Constellation of above findings indicate intracranial arthrosclerotic disease with significant (more than 70%) arterial luminal stenosis at right MCA proximal M1 segment. Though the possibility of partially recanalized embolus cannot be completely excluded.Vertebrobasilar system appears to be normal.", "output": "1. Acute ischemic infarct without evidence of hemorrhagic conversion involving left basal ganglia, left frontal lobe and left parietal lobe which is left MCA territory.2. Intracranial arthrosclerosis are seen with the multifocal areas degree arterial luminal stenosis. In particular, left MCA proximal M1 segment shows more than 90% luminal segmental stenosis. Differential diagnosis of this stenosis include partially recanalized embolus. "}
{"instruction": "Generate impression based on findings.", "input": "Pain. Question of rotator cuff tear. ROTATOR CUFF: No rotator cuff tear is identified.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "No evidence of rotator cuff tear. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Left pulsatile tinnitus. Signs and symptoms: Left pulsatile tinnitus. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates few tiny foci of flair hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres which appear more conspicuous compared to prior study. Although nonspecific considering patient's stated age of 71 findings are suspected of very mild chronic nonhemorrhagic small vessel ischemic strokes.The anatomical morphology as well as the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences. Unremarkable study cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of major intracranial arterial branches are identified. There is uniformly smaller size of basilar artery which is believed to be secondary to presence of prominent posterior communicating arteries. Unremarkable calvarium and soft tissues of the scalp. Unremarkable orbits, paranasal sinuses and mastoid air cells.Post-enhanced images demonstrate no detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium or the orbits.Pre-and post-enhanced brain MRA:The visualized aortic arch and the origins of major vessels are unremarkable.Unremarkable brachial cephalic and bilateral subclavian arteries.Patent and unremarkable bilateral vertebral arteries and including their origins.Patent bilateral common carotid arteries, bilateral internal carotid arteries as well as the external carotid arteries.Minimal vascular lumen irregularity of the left upper cervical internal carotid artery which could represent atherosclerotic disease. There is no evidence of vascular lumen compromise.", "output": "1.Pre-and post-enhanced brain MRI demonstrate no evidence of acute intracranial process. Findings suggestive of very mild nonhemorrhagic chronic small vessel ischemic strokes.2.Unremarkable neck MRA."}
{"instruction": "Generate impression based on findings.", "input": "64 years, Female, Reason: NF1 History: unsteadiness. Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss slightly prominent for age. Encephalomalacia is also noted involving the left inferior cerebellar hemisphere as well as evidence of chronic infarct involving the left dorsal medulla. There is small focus of gliosis involving the left anterior aspect of the gyrus rectus. Focus of cortical encephalomalacia is also noted in the left anterior temporal lobe. There is susceptibility effect compatible with chronic blood products involving the foci in the left inferior frontal lobe and the left cerebellum compatible with chronic hemorrhage. Several additional foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease and stable to minimally progressed since 6/8/2009.. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Prominent enhancing soft tissue is noted involving the suboccipital and upper cervical posterior paraspinous soft tissues which may represent a large neurofibroma or perhaps enhancing soft tissue related to prior surgery if there is such history. There is susceptibility artifact related to previously seen coiled embolization involving the left vertebral artery aneurysm at the C1 level.There appears to be enlargement involving the left optic nerve which is not well evaluated but grossly similar to 6/8/2009. Minimal mucosal thickening in the paranasal sinuses.Cervical spine: There is evidence of dural ectasia with scalloping involving the dorsal aspect of the cervical vertebral bodies. There are degenerative changes with small disc osteophyte complexes, relatively more prominent at the C3-C4, and C5-C6 levels, with no evidence of spinal canal stenosis at any level. Differences in technique limit comparison however there is stable to slight enlargement of T2 signal abnormality involving the dorsal aspect of the cervical cord in the midline at the C4-C5 level compared to 6/8/2009. Unchanged exaggerated lordosis of the cervical spine.Left vertebral artery flow-void is severely diminished with evidence of stenosis and prior coil embolization for aneurysm better assessed on prior CT angiogram.No appreciable masses involving the cervical spinal canal or neural foramina to suggest neurofibromas.Multiple small neurofibromas involving the subcutaneous soft tissues are seen with the large lesion extending from the suboccipital soft tissues to the lower C2 level. There is mild right-sided neural foraminal narrowing at the C5-C6 level.", "output": "1. Again seen is evidence of multiple infarcts including the left cerebellum and left dorsal medulla with additional areas of cortical injury involving the left inferior frontal lobe and left anterior temporal lobe. There is also evidence of chronic small vessel ischemic disease which appears stable to minimally progressed since 6/8/2009. No evidence of acute infarct or intracranial mass effect.2. Suspected mild enlargement of the left optic nerve which appears to be present on prior studies. This finding is not well evaluated on this brain MRI study however given history of NF 1 raises suspicion for an optic glioma. Dedicated orbital MRI may be considered for better assessment if clinically indicated.3. Stable to slight enlargement of nonenhancing T2 cord signal involving the cervical cord at the C4-C5 level in the midline compared to 6/8/2009. Finding may represent sequela of prior injury but is nonspecific. No masses involving the cervical spinal canal or neural foramina to suggest neurofibromas. No evidence of spinal canal stenosis at any level.4. Prominent enhancing soft tissue involving the suboccipital and upper cervical posterior paraspinous soft tissues presumably representing a neurofibroma and similar to prior from 2009. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with history of PNET status post Whipple (11/2015) with hepatic masses. ABDOMEN:LIVER, BILIARY TRACT: Susceptibility artifact from coils in the right hepatic lobe, cholecystectomy clips, and common bile duct stent.Unchanged, 6.2 x 6.0 cm arterially enhancing mass in hepatic segment eight with a central scar that is T2 hyperintense and demonstrates delayed enhancement compatible with focal nodular hyperplasia. A smaller, adjacent segment 8 arterially enhancing lesion is also unchanged and may represent a focal nodular hyperplasia. Redemonstrated are segment 3 and segment 6 lesions compatible with hemangiomas, unchanged. Two segment 2 lesions are again noted compatible with hemangiomas, unchanged.Moderate intrahepatic biliary ductal dilation in the left liver lobe, increased from the prior examination. Cavernous transformation of the portal vein is again noted. Paraesophageal and gastric varices. SPLEEN: Spleen size is top normal. Splenic vein thrombosis. PANCREAS: Postsurgical changes in the head of the pancreas. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintense cyst. No hydronephrosis or mass lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diastasis of the abdominal musculature.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free fluid in the pelvis. Bilateral adnexal cysts likely physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Multiple hepatic lesions with the largest lesion in hepatic segment 8, unchanged and compatible with FNH. 2.Additional hepatic lesions are unchanged as detailed above. 3.Interval increase in intrahepatic ductal dilation, raises concern for stent patency; correlation with patient's clinical history and laboratory values recommended. 4.Other findings as above. "}
{"instruction": "Generate impression based on findings.", "input": "History of right intraocular retinoblastoma s/p intraocular chemotherapy x 2: disease status evaluation. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There is a lesion that measures approximately 2 x 6 mm in cross section along the posterolateral aspect of the right globe, which is not significantly changed. The right optic nerve appears to be intact and the rest of the right intraorbital structures appear to be unremarkable. The left orbit appears to be unremarkable.", "output": "1. Unchanged treated subcentimeter right intraocular retinoblastoma. 2. No evidence of left orbital tumor.3. No evidence of intracranial tumor to suggest trilateral retinoblastoma."}
{"instruction": "Generate impression based on findings.", "input": "History of surgery for pituitary tumor, yearly follow up for change. There is a T2 hyperintense, enhancing lesion within the right anterolateral aspect of the sella, which displaces and compresses the normal pituitary tissue posteriorly, and measures up to 12 x 11 x 9 mm in the AP, transverse, and craniocaudal dimensions. There is no significant change in size allowing for differences in technique. The lesion bulges slightly into the medial aspect of the right cavernous sinuses and abuts the supraclinoid portion of the right internal carotid artery, without clear evidence of cavernous sinus invasion. There is no mass effect upon the optic apparatus. The pituitary infundibulum is intact, but displaced to the left, as before. The posterior pituitary bright spot is diminished but present. Limited evaluation of the brain again demonstrates scattered foci of T2 hyperintensity in the white matter which are nonspecific but compatible with mild small vessel ischemic disease.", "output": "Enhancing pituitary mass involving the right anterior lateral aspect of the sella demonstrates no significant change in size since 1/21/2015 and is compatible with residual macroadenoma. There is interval increased enhancement evident within this lesion, which is favored to be related to differences in contrast dose and timing. "}
{"instruction": "Generate impression based on findings.", "input": "History of gallstone pancreatitis and pancreatic pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Mild central intrahepatic and extrahepatic ductal dilatation. The duct tapers smoothly in the pancreatic head without a discrete mass lesion or filling defect suggesting a benign stricture.No suspicious hepatic lesion. The hepatic vasculature is patent.SPLEEN: The spleen is normal in size. Chronic thrombosis of the splenic vein with collateral vessel formation. There is a stable arterial enhancing lesion measuring 2.6 cm (series 16/52) and the anterior aspect of the spleen which demonstrates T1 weighted isointensity and T2 weighted hypointensity relative to the spleen. This is nonspecific but may represent a sclerosing angiomatoid nodular transformation of the spleen.PANCREAS: Findings suggesting pancreas divisum. Demonstrated again is marked atrophy, decreased intrinsic T1 weighted signal and postcontrast enhancement of the pancreatic neck, body and tail. The pancreatic head is relatively preserved.The pancreatic duct is mildly prominent tortuous and irregular in contour likely reflecting multifocal strictures of chronic pancreatitis. Smooth focal pancreatic ductal narrowing at the pancreatic neck/body. Numerous cystic foci throughout the pancreas likely represent dilated side branch ducts related to chronic pancreatitis and less likely IPMNs.The 1.5 cm simple cystic lesion in the pancreatic head may represent a dilated side branch and is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable findings consistent with chronic pancreatitis with relative sparing of the pancreatic head. The multiple cystic foci likely represent dilated side branch ducts due to multifocal stricturing of the main pancreatic duct and are not significantly changed; small IPMNs without suspicious imaging features cannot be entirely excluded. No evidence of acute inflammation or significant drainable fluid collection. Findings suggesting pancreas divisum. No suspicious pancreatic lesion is evident. Stable additional findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: vertigo with vertical nystagmus, headache; eval brainstem ischemia History: s/p nephrectomy, s/p stem cell tx for multiple myeloma. MRI of the brainNo diffusion weighted abnormalities are appreciated. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is mild mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is no evidence for intracranial aneurysm or cerebrovascular occlusion. There is no evidence of abnormality within the anterior posterior arterial circulation. The vertebrobasilar system appears normal, with patent vertebral arteries, PICAs, AICAs, SCAs, and PCAs bilaterally.", "output": "Normal MRA and MRI of the brain. No pathologic findings to explain patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "History of known benign brain/calvarial tumor. Vision changes and motor impairment. There is a destructive calvarial mass involving the left greater than right parietal calvarium measuring 4.5 x 5.9 x 3.1 cm in the AP, transverse, and craniocaudal dimensions. Mass is predominantly low on T1 and T2 weighted images with small areas of cystic change and diffuse enhancement. There is mild mass effect on the adjacent brain parenchyma which includes the left pre and post central gyri. There is also mass effect on the adjacent cortical veins and superior sagittal sinus which is otherwise patent. There is an additional subcentimeter lesion which demonstrates T1 hyperintensity more inferiorly in the midline seen on the sagittal T1-weighted images. No additional enhancing calvarial lesions however are appreciated. Images of the brain parenchyma demonstrate no abnormal parenchymal or meningeal enhancement to suggest intracranial metastatic disease. No other intracranial mass or mass effect. No midline shift or uncal herniation. No extra-axial collections or hydrocephalus. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild age-related white matter changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Sella and orbits are grossly unremarkable.", "output": "1. Destructive calvarial mass measuring 4.5 x 5.9 x 3.1 cm involving the left greater than right posterior parietal calvarium. There is mass effect on the underlying brain parenchyma which includes the medial aspect of the left pre and post central gyri. No associated intraparenchymal edema. Mass is reportedly benign per medical records and signal features are compatible with a benign osseous lesion such as fibrous dysplasia; recommend correlation with CT however to make this determination.2. No abnormal enhancement within the brain is seen to suggest intracranial metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Multiple myeloma not having achieved remission [C90.00], Reason for Study: ^Reason: New dx MM, lumbar vertebral fracture, eval for disease burden History: see above C-Spine:Loss of normal cervical lordosis was seen.Spinal cord signal intensity is normal.Multi-level intervertebral disc dessication with osteophytes indicating degenerative changes which includeC23: within normal limitsC34: diffuse bulging of disc with posterior longitudinal ligament calcifications. no spinal canal stenosisC45: Central to left disc protrusion which abuts thecal sac and shows mild spinal stenosis.C56: diffuse bulging of disc associated with central to left disc protrusion which abuts thecal sac and shows mild spinal canal stenosis.C67: diffuse bulging of disc, otherwise unremarkable.C7T1: diffuse bulging of discThoracic spine:There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. L Spine:There are vertebral body lesions involving L1 and S1 which replacing normal fatty marrow. Especially the S1 lesion shows about10-20% of compression.There is about grade 1 spondylolisthesis of L5 on S1.Degenerative changes show;L1-L2: There is myeloma lesion on the posterior superior aspect of the L1 vertebral body. Otherwise unremarkable.L2-L3: Diffuse bulging of disc.L3-L4: Diffuse bulging of disc.L4-L5: Diffuse bulging of disc with bilateral ligamentum flavum thickening results mild spinal cord stenosis.L5S1: Grade 1 spondylolisthesis of L5 on S1 with pseudobulging of disc results mild spinal stenosis.S1-S2: Diffuse bulging of disc.", "output": "1. Degenerative changes of cervical spine with multilevel various degree spinal canal narrowing. Normal spinal cord signal intensity.2. Normal thoracic spine MRI4. Myeloma involvement of the L1 and S1 vertebral body with pathologic compression fracture of S1.5. Degenerative changes of lumbar spine/Comment: if S1 compression fracture is symptomatic, percutaneous cement augmentation can be considered. If indicated, please contact neurointerventional radiology service."}
{"instruction": "Generate impression based on findings.", "input": "Severe right shoulder pain The exam is limited by motion artifact and by the patient's body habitus which prevented the use of an optimal shoulder coil.ROTATOR CUFF: There is thickening and increased signal intensity the supraspinatus tendon indicating moderate tendinosis. There is a 5 mm tear involving the insertional fibers of the anterior supraspinatus tendon which may focally disrupt the bursal surface fibers but this is equivocal. The articular surface fibers appear spared. There is an additional 4 mm tear within the supraspinatus tendon more proximally at the 12:00 position which may also focally disrupt the bursal surface fibers but again this is equivocal. The supraspinatus muscle is normal in signal and caliber.The above-mentioned tendinosis of the supraspinatus extends posteriorly to affect the anterior fibers of the infraspinatus tendon but we see no discrete tear of the infraspinatus tendon. The infraspinatus muscle is normal in signal and caliber. The teres minor tendon and muscle are normal. Small cysts are noted on the humeral head at the insertion of the teres minor which are of doubtful clinical significance. There is increased signal intensity of the distal fibers of the subscapularis tendon indicating insertional tendinosis. There is perhaps minimal fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is more focal edema of the distal clavicle which may be degenerative in nature but could also represent a stress fracture in the appropriate clinical context.GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior labrum appears attenuated suggesting degenerative tearing. Alignment of the glenohumeral joint is normal and there is no joint effusion.BICEPS TENDON: Evaluation of the intra-articular portion of the biceps tendon is limited by internal rotation; however within the limits of a non-arthrographic study, the biceps appears intact.", "output": "1. Moderate rotator cuff tendinosis with small focal partial-thickness tears of the supraspinatus tendon that may disrupt the bursal surface fibers.2. Mild osteoarthritis of the acromioclavicular joint with more focal edema of the distal clavicle which may be degenerative in nature but could also represent a stress fracture in the appropriate clinical context.3. Additional findings described above."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status, unspecified [R41.82], stroke? Infection? Seizure? Mass? Examination is limited by extensive motion artifact. The cortical sulci are in proportion to the cerebral ventricles. The gray-white matter differentiation is preserved. There is no evidence for hydrocephalus. No diffusion abnormality is identified to suggest ischemia. There is no evidence for acute intracranial hemorrhage. Multiple scattered punctate foci of T2/FLAIR hyperintensity are demonstrated in the subcortical and periventricular white matter. There is no midline shift appreciated.", "output": "No acute intracranial abnormality. Multiple punctate foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter, greater in number than expected for patient's age. Differential considerations are broad and include demyelinating disease, chronic microvascular ischemic change, and/or inflammatory processes such vasculitis."}
{"instruction": "Generate impression based on findings.", "input": "Spinal stenosis Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal anterolisthesis of L3 on L4. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is borderline low at the L2-L3 level. Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is mild spinal canal stenosis. There is mild left and minimal right narrowing of the neural foramina. L3-L4: There is a disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening contributing to moderate to severe spinal canal stenosis. There is mild bilateral neural foraminal stenosis. L4-L5: There is disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy with severe spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.L5-S1: Mild disc bulge and bilateral facet arthropathy. No significant spinal canal stenosis. There is minimal narrowing of the neural foramina.Paraspinous soft tissues are within normal limits.", "output": "1. Multilevel degenerative changes in the lumbar spine with severe L4-L5 and moderate to severe L3-L4 spinal canal stenoses. 2. Neural foraminal stenoses is relatively worse at the L4-L5 level where there is mild-to-moderate bilateral neural foraminal stenosis.3. Borderline low conus at the L2-L3 level."}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval rotator cuff History: R shoulder pain/weakness ROTATOR CUFF: Although fibers of the supraspinatus tendon can be followed to their insertion on the greater tuberosity, the tendon itself is markedly thinned, to the point of being barely perceptible just proximal to the greater tuberosity, suggesting chronic attritional tearing. Furthermore, the anterior fibers of the supraspinatus tendon are replaced with intermediate signal intensity at their insertion on the greater tuberosity, which we suspect represents a full thickness tear filled with granulation tissue. There is moderate atrophy of the supraspinatus muscle. The infraspinatus tendon can be followed to its insertion on the greater tuberosity, but there is moderate to severe atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear intact. There is increased signal intensity within the distal fibers of the subscapularis tendon, suggesting insertional tendinosis. The subscapularis muscle is unremarkable.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is trace fluid in the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Severe osteoarthritis affects the glenohumeral joint, with flattening and fragmentation of the humeral head medially, as well as with underlying signal abnormality in the marrow indicating osteonecrosis. Deformity of the humeral neck may also reflect sequela of old healed fracture. We see no glenohumeral joint effusion. There is degenerative tearing of much of the labrum. BICEPS TENDON: Evaluation of the tendon of the long head of the biceps is limited due to lack of intraarticular contrast, but the tendon is grossly intact.", "output": "1. Severe osteoarthritis of the glenohumeral joint with deformity and fragmentation of the underlying humeral head suggesting prior fracture and avascular necrosis. 2. Marked thinning of the supraspinatus tendon likely reflects chronic attritional tearing, with findings suspicious for full-thickness insertional disruption of the anterior fibers. 3. Other findings as described above. "}
{"instruction": "Generate impression based on findings.", "input": " There is no diffusion abnormality. There are many punctate and oval T2/FLAIR hyperintense foci within the periventricular white matter, brainstem, and cerebellum. Some of these are oriented perpendicular to the long axis of the lateral ventricles. A lesion within the right posterior parietal lobe demonstrates corresponding T1 hypointensity. There is no significant mass effect, midline shift or herniation. No abnormal enhancement is identified. The ventricles and sulci are are prominent age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.MRA HEAD", "output": "1.Multiple T2/FLAIR hyperintense foci within the white matter including involvement of the cerebellum, suspicious for demyelinating disease. There is mild T1 burden and moderate T2 burden of disease, with infratentorial involvement. No evidence of acute infarct.2.Patchy T2 hyperintensity within the cervical spinal cord, probably also demyelinating disease.3.Mild cervical spondylosis.4.Normal MRA of the head and neck."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with left knee pain and swelling. Evaluate meniscus tear versus ligamentous injury Motion artifact limits examination. The high definition coil could not be utilized secondary to patient's body habitus resulting in slightly suboptimal image quality.MENISCI: The lateral meniscus appears intact. There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. There are foci of increased signal abnormality which extend to the tibial articular surface consistent with undersurface fraying. There is no linear signal abnormality which extends to either articular surface or fluid filled defects to suggest an unstable tear.ARTICULAR CARTILAGE AND BONE: Suboptimal evaluation of the articular cartilage of the patellofemoral joint articular cartilage secondary to the aforementioned limitations. No overt full-thickness or near full-thickness articular cartilage defects are identified. Heterogeneous bone marrow signal abnormality likely represents residual islands of red marrow. There is increased signal abnormality within the posterior aspect of the tibial plateau with a subcentimeter focus of fluid signal intensity at the insertion site of the PCL which may reflect degenerative signal abnormality.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is mild increased signal abnormality within the distal fibers of the patellar tendon just proximal to its insertion on the tibial tubercle which may reflect a very mild tendinosis.ADDITIONAL", "output": "1. Undersurface fraying and degeneration of the medial meniscus as described above.2. Small joint effusion."}
{"instruction": "Generate impression based on findings.", "input": "49 year old woman with a history of possible adriamycin cardiomyopathy and prior history of breast cancer. She presents with fatigue and is referred to rule out ischemia and evaluate cardiac structure and function.MEDICATIONS: aspirin, lisinopril First Pass PerfusionDuring hyperemia, no perfusion defects were present. A dark rim artifact was noted on the basal slice.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 106 ml/m2 (normal range: 65+/-11), the LVEDV is 174 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 39 g/m2, and the LV mass is 64 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with normal systolic function. The shape of the right ventricular base is distorted by compression from the sternum; however, there is no evidence that this is causing a hemodynamic problem. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 112 ml/m2 (normal range 69+/-14), the RVEDV is 185 ml (normal range 110+/-24), the RV end systolic volume index is 48 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 FindingsMild sternal deviation (but enough to describe it as pectus excavatum) is noted. 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. No perfusion defects/ \"ischemia\" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Moderate LV dilation with normal wall thickness and systolic function (LVEF 62%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Moderate RV dilation with normal systolic function (RVEF 57%). The shape of the right ventricular base is distorted by compression from the sternum; however, there is no evidence that this is causing a hemodynamic problem. 5. Moderate biatrial dilation. "}
{"instruction": "Generate impression based on findings.", "input": "Adenoid cystic carcinoma of the right pterygopalatine fossa with right V 2 numbness. Pituitary: The pituitary gland is normal in size and displays normal signal and enhancement characteristics. There is no evidence of mass lesions within the pituitary gland or elsewhere in the sella. The optic apparatus is intact. However, there is enhancing tumor within the right cavernous sinus extending from the right foramen rotundum and pterygopalatine fossa. Brain: There is no evidence of intracranial hemorrhage or acute cerebral 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 are grossly unremarkable.", "output": "1. No evidence of pituitary gland lesions.2. Perineural tumor spread along the second division of the right trigeminal nerve into the cavernous sinus."}
{"instruction": "Generate impression based on findings.", "input": "Memory decline. Assess for structural cause. There is mild diffuse cerebral and cerebellar volume loss. There are mmild scattered foci of subcortical and periventricular white matter T2 hyperintensity. There is also a punctate focus of susceptibility in the right occipital lobe compatible with a small prior microhemorrhage. There are mildly prominent perivascular spaces in the bilateral basal ganglia. There is no evidence of acute intracranial hemorrhage, mass, or acute infarction. The expected intracranial vascular flow voids are present. There is mild scattered paranasal sinus mucosal thickening and retention cyst in the right sphenoid sinus. There are bilateral lens implants.", "output": "1. Mild scattered cerebral white matter T2 hyperintensities which are nonspecific, but likely represent chronic small vessel ischemic disease.2. Nonspecific diffuse cerebral and cerebellar volume loss. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old woman with personal history of benign left breast biopsy in 2012. She has family history of breast cancer in a paternal cousin diagnosed in her 40s She presents with lumps in the right axilla for about 6 months. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Pelvic pain The examination is limited by motion artifact and inability to optimally position the patient. Tendons: The gluteus medius and gluteus minimus tendinous insertions on the greater trochanter are intact. The iliopsoas tendon is intact. There is increased signal at the attachment of the right hamstring tendons at the ischial tuberosity although the tendinous insertions appear intact.Joints: The hip joints are normal. The sacroiliac joints appear unremarkable and without evidence of erosion or significant degenerative change. There is increased signal within the right pubic symphysis although no discrete fracture is appreciated. Joint effusion/Bursa: No evidence of joint effusion. No significant trochanteric bursitis present.Muscles: There is diffuse atrophy of the pelvic musculature, particularly the gluteal. Increased signal is seen surrounding the hamstring tendons and there is a focus of increased signal with susceptibility artifact overlying the right posterior thigh representing the area of known decubitus ulceration.Bone marrow: No focal marrow replacing lesions are identified. There is no fracture.", "output": "1. Essentially normal appearance of the sacrum and hips without evidence of acute osseous abnormality.2. Increased signal at the origin of the hamstrings and surrounding the right posterior thigh which is likely reactive given the known decubitus ulceration in the sacrum."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old man with non-small cell lung cancer with metastases to brain. Presented with seizure and right-sided paralysis. No new seizures on medications. Improved right sided strength with Decadron. Evaluate status of brain. The left frontal metastasis (series 2 image 23) now measures 1.0 x 0.8 cm compared to 1.0 x 0.9 cm on study dated 6/30/2008. The amount of peritumoral edema is stable from CT dated 7/31/2008 slightly increased from the study dated 6/30/2008. A smaller left frontal lesion visible on MRI is once again not seen on the CT.The right frontal metastasis (series 2 image 18) now measures 1.2 x 0.8 cm compared to 1.4 x 0.8 cm on the prior study. The amount of peritumoral edema is stable from the study dated 7/31/2000.The left temporal metastasis seen on the MRI is still not clearly visible on CT. The associated peritumoral edema has stable CT appearance from the prior study.The metastatic lesion in the cerebellar vermis is not visible on CT.There is no mass-effect, midline shift, hydrocephalus, or CT evidence of hemorrhage. 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": "1. Multiple brain metastases with peritumoral edema stable from study dated 7/31/2008. Peritumoral edema remains increased from study dated 6/30/2008."}
{"instruction": "Generate impression based on findings.", "input": " BRAIN: There are numerous (greater than 15) supratentorial and infratentorial T2 hyperintense periventricular and subcortical oval as well as punctate white matter lesions predominantly showing high DWI signal without corresponding low ADC signal. However, a few lesions demonstrate a partial peripheral rim of subtle diffusion restriction, located in the right centrum semiovale and medial right periatrial white matter. Overall, there has been interval improvement with decrease in size of multiple lesions including the left brachium pontis lesion, confluent T2 hyperintense lesion in the right centrum semiovale, left frontal lobe subcortical white matter lesion adjacent to the left frontal horn. A large right medullary lesion is also again identified. There is slight increased size of the lesion in the right posterior temporal lobe deep white matter on 601/15 and 701/18 and also involving the diffusion restricting right periatrial lesion.Most of the lesions do not enhance except a lesion adjacent to the atrium of the right lateral ventricle on series 2901 image 15 which did not show enhancement previously, and a lesion in the right centrum semiovale on series 2901 image 21 which showed enhancement previously, correlating with areas of mild diffusion restriction noted above. On delayed post contrast orbital images, there is also suggestion of faint enhancement associated with a right frontal deep white matter lesion as seen on 3401/33.There is no acute infarct. The ventricles and basal cisterns are prominent, consistent with mild global volume loss slightly greater than expected for patient's stated age. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. ORBITS: The globes and extraocular muscles are intact with normal signal intensity and caliber. The lens are not dislocated. The optic sheaths and optic nerves are within normal limits in caliber and signal intensity without enhancement. There is no suspicious enhancement within the orbits. There is no proptosis. The pituitary gland is not enlarged. There is no mass effect on the optic chiasm. The pituitary stalk is midline. The cavernous sinuses are symmetric in enhance normally. There is no enlargement of the superior ophthalmic veins.CERVICAL: There is normal alignment, vertebral body and disk heights, as well as normal osseous marrow and cord signal. There is no suspicious enhancement in the cervical spine. There is no significant disk herniation or spinal stenosis at any level in the cervical spine. There is partial visualization of the focal right medullary demyelinating lesion.", "output": "1.Numerous supratentorial and infratentorial T2 hyperintense white matter lesions consistent with known underlying disease, many of which have decreased in size. Many of these lesions which were enhancing on the prior exam and no longer enhance with the exception of one right centrum semiovale lesion demonstrating persistent enhancement as described above. Associated incomplete diffusion restriction in this location as well as in the right periatrial lesion which demonstrates new enhancement, with additional incompletely evaluated right sided corona radiata enhancing lesion only seen on delayed post contrast orbital images. Slight increased extent of abnormal signal associated a few right-sided supratentorial lesions. Overall, minimal T1 and mild-moderate T2 burden of disease.2.No signal abnormality or enhancement in the optic apparatus or cervical cord to suggest involvement by demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female, 50 years old, with epilepsy, functional MRI requested for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical activation maps along the bilateral calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the verb generation and sentence completion paradigms. Language laterality is left dominant. Cortical activation representing the putative Broca's area maps as expected to the left inferior frontal gyrus (primarily pars orbitalis). Cortical activation representing the putative Wernicke's area maps as expected along the posterior aspect of the left superior temporal sulcus.", "output": "Successful functional MRI for sensorimotor and language mapping. The sensorimotor and visual cortices are identified. Language laterality is left dominant with Broca's and Wernicke's areas identified in their customary locations."}
{"instruction": "Generate impression based on findings.", "input": "Right leg pain. There is facet joint arthropathy in the lower lumbar spine and ligamentum flavum thickening with associated mild neural foraminal narrowing at L4-5 and L5-S1 bilaterally, but no significant spinal canal stenosis. There is also a subcentimeter posterior synovial cyst associated with the left L5-S1 facet joint. There is no significant neural foraminal or spinal canal stenosis at the other lumbar spine levels. The lumbar vertebral column alignment is anatomic without subluxations. The vertebral bone marrow signal is unremarkable. The vertebral body heights are maintained. The conus is normal in signal and morphology and terminates at the L1-2 level. There is no intraspinal hematoma or mass. The paraspinal structures are unremarkable.", "output": "Facet joint arthropathy in the lower lumbar spine and ligamentum flavum thickening with associated mild neural foraminal narrowing at L4-5 and L5-S1 bilaterally, but no significant 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": "Left C8 radiculopathy. There is straightening of the cervical lordosis, which may relate to patient position. The vertebral bodies are preserved in height. Marrow signal show no suspicious abnormality. There is loss of the disc heights from C3-C4 through C6-C7 associated with disc-osteophyte complexes indenting the anterior aspect of the thecal sac as described below. The spinal cord shows no abnormal signal or significant compression. Major neck vessels are patent. Small lymph nodes in the upper neck are nonspecific.C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: Disc osteophyte complex minimally indents the thecal sac. Right more than left uncovertebral and facet proliferative changes result in mild-to-moderate right foraminal stenosis.C4-C5: Disc osteophyte complex mildly narrows the spinal canal. There is mild to moderate bilateral foraminal stenosis by uncovertebral and facet proliferative change.C5-C6: Disc osteophyte complex also mildly narrows the spinal canal. Left more than right uncovertebral proliferative change is associated with severe left and moderate right foraminal stenosis.C6-C7: Disc osteophyte complex causes no significant spinal canal narrowing. Mild uncovertebral and facet reactive change cause mild-to-moderate left and mild right foraminal narrowing.C7-T1: There is a disc bulge that mildly indents the anterior aspect of the thecal sac causing mild narrowing of the canal. There is left more than right facet and uncovertebral proliferative change associated with mild left foraminal stenosis. T1-T2: There is no spinal canal or foraminal stenosis.", "output": "Multilevel cervical spondylosis is most pronounced at C5-C6 where there is severe left and moderate right foraminal stenosis. At C7-T1, there is mild left foraminal stenosis. Spinal canal narrowing is at most mild, as described above."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male. Evaluate for prostate cancer. Most recent PSA was 6.9 on 11/24/2015. He underwent TRUS biopsy on 1/8/2016 which revealed the following:\u00a0RBM - Gleason 3+3=6 adenocarcinoma of the prostate, 2.0mmRBL - HGPINRMM - Gleason 3+3=6 adenocarcinoma of the prostate, 3.0mmRML - HGPINRAM - Gleason 3+3=6 adenocarcinoma of the prostate, 3.0mmRAL - Gleason 3+3=6 adenocarcinoma of the prostate, 1.0mmLBM - benign prostateLBL - Gleason 3+3=6 adenocarcinoma of the prostate, <1.0mmLMM - small foci of atypical glandsLML - HGPINLAM - benign prostateLAL - benign prostate PELVIS:PROSTATE:Prostate Size: The prostate measures 5.3 cm in transverse, 4.1 cm in AP, and 5.4 cm in length.Peripheral Zone: Suspicious subcentimeter focus in the right paramedian mid gland with ADC and T2 hypointense signal intensity (series 901 image 16, series 503 image 304). Suspicious subcentimeter focus in the right lateral apex with ADC and T2 hypointense signal intensity (series 901 image 10, series 503 image 24). Central Gland: In the anterior midline, there is a dominant lesion demonstrating ADC and T2 hypointense signal intensity (series 503 image 344, series 901 image 18) measuring 18 x 14 mm. There is loss of the capsular margin to the left of the midline (series 901 image 14) concerning for extracapsular extension.Seminal Vesicles: No significant abnormality noted. Extracapsular Extension: As described above.BLADDER: No significant abnormality noted.LYMPH NODES: No suspicious pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Dominant lesion demonstrating ADC and T2 hypointense signal intensity in the anterior midline transitional zone with suspected left paramedian extracapsular extension.2.Suspicious subcentimeter ADC and T2 hypointense signal foci in the right paramedian mid gland and right lateral apex."}
{"instruction": "Generate impression based on findings.", "input": "64 years Female (DOB:1/8/1952)Reason: evaluate for lumbar disc disease History: left lumbar radiculopathyPROVIDER/ATTENDING NAME: MAGDALENA ANITESCU MAGDALENA ANITESCU Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is a left lateral recess and neural foramen disc protrusion present which compresses the nerve root at the left neural foramen and mildly displaces the nerve that the left lateral recess. The nerve root at the left neural foramen is displaced inferiorly and courses along the inferior aspect of the neural foramen; above the nerve root within the neural foramen is foraminal fat. There is also some displacement of the nerve roots at the left lateral recess at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, loss of disc space height and a disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, loss of disc space height and a minor disc bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, loss of disc space height and a disc bulge at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.There is a Schmorl's node present at superior endplate of T12.", "output": "1.There is a disc protrusion at the left neural foramen at L5-S1 which compresses the nerve root within the neural foramen. This particular nerve root is displaced inferiorly within the neural foramen. The disc protrusion also displaces the nerve roots at the left lateral recess at this level.2."}
{"instruction": "Generate impression based on findings.", "input": "Primary CNS lymphoma status post chemotherapy and transplant. There are otherwise unchanged post-treatment and post-biopsy findings with patchy T2 hyperintensity and associated susceptibility effect in the right cerebellar hemisphere and left anterior cingulate gyrus. There is also unchanged focal susceptibility effect in the right globus pallidus. There are unchanged areas of high T2 signal in the cerebral white matter. There is no evidence of acute intracranial hemorrhage, mass, or 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 skull, orbits, and scalp soft tissues are unremarkable. There is mild mucosal thickening in the left maxillary sinus.", "output": "1. No evidence of recurrent central nervous system lymphoma with stable post-treatment findings in the right cerebellar hemisphere and left cingulate gyrus.2. Unchanged areas of cerebral white matter signal abnormality in the cerebral white matter are otherwise nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "Male 74 years old Reason: rectal cancer History: rectal cancer Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: There is a small lymph node within the left posterior lateral mesorectal fat measuring 0.8 x 0.7 cm (5/26), 4 mm from the mesorectal fascia. From this node, there is extension of soft tissue nodularity along vessels in the mesorectal fat, likely representing lymphovascular invasion (5/20). This soft tissue extends 5 mm from the mesorectal fascia.Lymph nodes outside the mesorectal fascia: NoneBOWEL, MESENTERY: Rectal Tumor:Size: Circumferential thickening distally measuring 1.3 cm in thickness (4/19). There is a more nodular component along the right anterolateral aspect measuring 2.4 x 1.7 cm (5/29).Tumor appearance on T2-weighted images: Hyperintense with areas of susceptibility artifact distally, likely reflecting hemosiderin deposition from prior biopsy.Tumor location: Middle-third(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 8 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 4 cmCircumference of the rectum involved: Entire circumference.Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): The tumor invades through the muscularis propria at the mid aspect of the tumor, approximately 7 mm into the mesorectal fat, both along the left lateral aspect and posterior aspect (5/29). There is no involvement of the mesorectal fascia. There is no involvement of the prostate, seminal vesicles or bladder. MRI T-stage: T3c - Tumor invades >1cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: 1.1 cm (image 29/series 5).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Circumferential rectal cancer measuring 5 cm in length, invading into the mesorectal fat, consistent with a stage 3c tumor by MR.2.Enlarged mesorectal lymph node 4 mm from the mesorectal fascia with soft tissue extending along small vessels in the mesorectal fat, likely representing lymphovascular invasion."}
{"instruction": "Generate impression based on findings.", "input": "Syncope.IMAGE ACQUISITIONS: 5-mm contiguous axial CT sections of the brain without contrast infusion. No acute intracranial hemorrhage, mass effect or shift of midline structures.There are multiple patchy areas of low attenuation in cerebral white matter both in deep white matter and in juxtacortical white matter, a nonspecific finding but atypical for age, either representing chronic ischemic/degenerative change or possibly demyelination. Consider follow-up MRI of the brain for further evaluation, as indicated clinically.There is no depressed calvarial fracture. Craniofacial structures are unremarkable.", "output": "Extent of patchy white matter low attenuation is greater than expected for patient's age. If there is underlying risk for accelerated atherosclerosis such as diabetes or hypercholesterolemia, or if the patient has hypertension, the finding could be explained by this. Demyelination is not excluded. Follow-up as indicated clinically."}
{"instruction": "Generate impression based on findings.", "input": "48 years Female (DOB:11/23/1967)Reason: low back pain History: as abovePROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a broad-based central disc protrusion at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There are some mild to moderate facet hypertrophy at this level. There is also some ligamentum flavum hypertrophy at this level. There is some narrowing of the thecal sac at this level resulting from the facet hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is facet and ligamentum flavum hypertrophy at this level associated with a mild disc bulge and some triangulation of the thecal sac with some mild crowding of the nerve roots. Overall there is a mild degree of spinal stenosis.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a mottled appearance of the marrow signal with foci of low signal on T1 and some foci of high signal on T1 spinal marrow. It is nonspecific. An MRI of the cervical spine from 6/9/2015 demonstrates similar findings.", "output": "1.There are multilevel degenerative changes present in the lower lumbar spine with mild degrees of spinal stenosis at L3-4 and to a lesser degree L4-5. This canal narrowing is predominantly due to facet hypertrophy. There is a broad-based central disc protrusion at L5-S1."}
{"instruction": "Generate impression based on findings.", "input": "Female, 34 years old, with bilateral upper extremity weakness and dysphagia, evaluate for central lesion. Brain:Again noted is severe crowding of the foramen magnum, suprasellar cistern, and perimesencephalic cistern, unchanged. Artifact secondary to right frontal approach ventriculostomy catheter limits evaluation of adjacent structures. Ventriculostomy catheter tip is located at the level of the right foramen of Monro. No abnormal enhancement is noted intracranially. Overall the size of the ventricles appears similar to prior CT from 12/1/2016.Fluid intensity is noted in bilateral mastoid air cells and middle ears. Bilateral prior glands demonstrate a nodular appearance.Cervical spine:Again noted is diffuse central T2 hyperintensity is seen within the visualized cervical spinal cord beginning at the C2 level, with a more focal area of abnormal signal intensity at the C2-C3 level, extending beyond the field of view inferiorly but grossly appearing similar to prior exam. The signal changes appear to be predominantly in the gray matter of the spinal cord. The cord is expanded diffusely. No significant enhancement is associated with the signal abnormalities.As noted on prior examinations, the posterior fossa is crowded with a tapered appearance of the cerebellar tonsils which appear to herniate below the foramen magnum, demonstrating 20 mm of caudal extension of pointed cerebellar tonsils beyond the foramen magnum.Straightening of the cervical lordosis is likely positional. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or edema is seen. There is only minimal disc degeneration is seen which causes no significant spinal canal or foraminal stenosis.Note is made of prominence of soft tissues along the pharynx, with narrowing of the airway, likely due to reactive lymphoid tissue.", "output": "1.Crowding of foramen magnum and basal cisterns, similar to prior exam and with no abnormal intracranial enhancement or mass.2.Diffuse abnormal signal affects the central portion of the spinal cord beginning at C2 and continuing throughout the remainder of the visualized spinal cord which is expanded, grossly appearing similar to prior exam. The differential diagnosis remains broad and would include infectious, postinfectious or autoimmune phenomena, or related to altered CSF dynamics in the context of Chiari I malformation."}
{"instruction": "Generate impression based on findings.", "input": "30 years, Male, Reason: recurrent pancreatitis evl for ductal abnormalities. PLEASE PERFORM W GADOLINIUM + SECRETIN History: recurrent pancreatitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No focal hepatic lesions. No evidence of cholelithiasis or choledocholithiasis. SPLEEN: No significant abnormality noted.PANCREAS: There is diffusion restriction within the pancreatic neck and body suggesting inflammation. A minimal rim of enhancement is noted along the anterior aspect of the pancreas in this region.The main pancreatic duct is normal in caliber measuring 3 mm and dilates to 5 mm following the administration of secretin, within normal limits. There is conventional ductal anatomy. No strictures are evident. There is normal excretion of secretion to the third portion of the duodenum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Diffusion restriction within the pancreatic neck and body suggests underlying inflammation.2.A minimal rim of enhancement is present on which may be seen in the setting of autoimmune pancreatitis. Recommend correlation with IgG-4 levels."}
{"instruction": "Generate impression based on findings.", "input": "57 year old man with no significant cardiac history and recent dyspnea with exertion, found to have new systolic dysfunction on echocardiogram with question of non-compaction. He was referred for cardiac MRI to evaluate for etiologies of his cardiomyopathy. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 23%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 249 ml (normal range 142+/-34), the LV end systolic volume index is 98 ml/m2 (normal range 25+/-9), the LVESV is 192 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). There is global hypokinesis. There is no apical thrombus. The ratio of non-compacted to compacted myocardium is 1.5, which is not consistent with a diagnosis of ventricular non-compaction. T2 STIR sequences do not demonstrate evidence of myocardial edema. There is subepicardial late gadolinium enhancement noted in the anteroseptum and inferoseptum, from the basal to mid portion. Additionally there is possible subepicardial late gadolinium enhancement in the anterolateral wall. This is atypical for infarction, but is consistent with an underlying fibrosing, infiltrative, or inflammatory process, such as prior myocarditis.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 20%, the RV end diastolic volume index is 120 ml/m2 (normal range 82+/-16), the RVEDV is 237 ml (normal range 142+/-31), the RV end systolic volume index is 96 ml/m2 (normal range 31+/-9), and the RVESV is 189 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve is trileaflet and opens widely and there is no significant aortic regurgitation.Mitral ValveThere is bileaflet tethering and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to 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 mildly dilated (31mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a 12 x 12 mm rounded area of increased signal intensity in the lateral aspect of the liver, which is non-enhancing and may warrant further dedicated imaging. 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. Moderately dilated left ventricle with severely reduced systolic function (EF 23%).2. No evidence of LV noncompaction.3. There is subepicardial late gadolinium enhancement noted in the anteroseptum and inferoseptum, from the basal to mid portion. Additionally there is possible subepicardial late gadolinium enhancement in the anterolateral wall. This is atypical for infarction, but is consistent with an underlying fibrosing, infiltrative, or inflammatory process. The constellation of findings could be consistent with a prior myocarditis.4. Mildly dilated right ventricle with severely reduced systolic function (EF 20%).5. Mild to moderate mitral and tricuspid regurgitation.6. Biatrial enlargement 7. Mildly dilated main PA8. See extra cardiac findingsI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "78 year old male with metastatic colon cancer in lung and liver. Staging. CHEST: LUNGS AND PLEURA: Scarlike opacities and postsurgical changes are seen in both lungs. In the left upper lobe, there is a 1.5 x 1.4 cm nodule consistent with metastatic disease. A smaller and more irregularly shaped nodule in the right lower lobe measures 1.1 x 1.4 cm, consistent with a metastasis. Small right pleural effusion has resolved. MEDIASTINUM AND HILA: Atherosclerotic calcifications in the thoracic aorta and coronary arteries. Normal heart size. No pericardial effusion. Borderline enlarged right hilar lymph node. Small mediastinal lymph nodes.CHEST WALL: Right chest wall Port-A-Cath with the tip in the superior vena cava. There is possibly partial collapse of the L1 vertebral body which is incompletely visualized on this study. Right-sided venous access device is in expected position.ABDOMEN:LIVER, BILIARY TRACT: Intra- and extra-hepatic biliary ductal dilatation to the level of the ampulla. No obstructing mass is identified.Large mass noted in the right lobe of the liver without enhancement. This mass has an exophytic component. It measures 4.7 x 7.7 cm (image 82, series #3). A second, smaller lesion with similar characteristics is noted inferior to the dominant mass that also is compatible with a metastasis. Additional, subcentimeter lesions are scattered throughout the liver with typical features of benign cysts on the MRI exam. Cholelithiasis noted.SPLEEN: No significant abnormality noted. Calcified splenic granulomata. PANCREAS: Prominent pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression deformity at the superior endplate of L1.OTHER: IVC filter is in the expected position. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sigmoid diverticulosis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Benign calcifications in the left groin and left spermatic cord.", "output": "1. Minimal intra- and extra-hepatic biliary ductal dilatation to the level of the ampulla. No obstructing mass is identified; however, cannot rule out obstructing ampullary stricture.2. Hepatic metastases are stable since the prior MRI exam."}
{"instruction": "Generate impression based on findings.", "input": "Female, 66 years old, history of brain metastases, assess for new lesion. Evidence of prior right parietal craniotomy and tumor resection are again seen. The resection bed is stable in size and morphology. Curvilinear enhancement within the resection bed is unchanged.Mild patchy gyriform diffusion restriction is seen along the right central sulcus and within the posterior right temporal lobe and right occipital lobe. The cortex is mildly edematous in these areas with at least one area of corresponding gyriform enhancement in the right occipital lobe.No additional new enhancing lesions are seen. Extensive confluent T2 hyperintensity within the periventricular white matter of the cerebral hemispheres, contiguous with abnormal signal surrounding the right parietal resection bed, have otherwise not significantly changed. No generalized mass effect is detected. Ventricular size and morphology are unchanged.", "output": "1.Redemonstrated are postoperative findings compatible with resection of tumor from the right parietal region. The operative bed has not significantly changed.2.Scattered areas of mild diffusion restriction and cortical edema are seen involving the parenchyma along the right central sulcus, the posterior right temporal lobe and the right occipital lobe. Mild corresponding enhancement is also seen within the right occipital lobe. The differential for these findings would include ischemic injury, probably subacute; an inflammatory or infectious etiology; or perhaps an atypical presentation of recurrent disease. A close interval follow-up can be considered to help distinguish these possibilities."}
{"instruction": "Generate impression based on findings.", "input": "61 year old with history of congestive heart failure and valvular heart disease requiring mitral and tricuspid valve surgery, COPD, CKD and coronary artery disease presenting for cardiac evaluation prior to implantable cardioverter defibrillator. Left VentricleThe left ventricle is moderately dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 108 ml/m2 (normal range: 65+/-11), the LVEDV is 188 ml (normal range 109+/-23), the LV end systolic volume index is 69 ml/m2 (normal range 18+/-5), the LVESV is 120 ml (normal range 31+/-10), the LV mass index is 81 g/m2 (normal range 67+/-11), and the LV mass is 140 g (normal range 114+/-24). The systolic dysfunction is global with regional variation. There is an apical inferior subendocardial late gadolinium enhancement (LGE) (60-80% thickness) and basal-mid anterolateral LGE (40-50% thickness) consistent with myocardial infarction. No left ventricular thrombus. 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 30%, the RV end diastolic volume index is 133 ml/m2 (normal range 69+/-14), the RVEDV is 231 ml (normal range 110+/-24), the RV end systolic volume index is 93 ml/m2 (normal range 22+/-8), and the RVESV is 161 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is consistent with previous surgery. There is evidence of mitral regurgitation that appears valvular.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a common trunk with right innominate and left common carotid (normal variant). The aortic root is normal in size, the ascending aorta is ectatic (40 x 42 at ascending aorta, not orthogonal dimension).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated (40 mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. The coronary sinus is dilated. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a stable right adrenal nodule and right hepatic calcified cyst (better characterized on previous cross-sectional imaging)", "output": "1. The left ventricle is moderately dilated with moderate-severely reduced systolic function (LVEF 36%). There is an apical inferior subendocardial and basal-mid anterolateral LGE consistent with myocardial infarction.2. The right ventricle is severely dilated with severely reduced systolic function (RVEF 30%)3. Severe Biatrial enlargement4. Dilated pulmonary artery5. Ectatic ascending aorta. "}
{"instruction": "Generate impression based on findings.", "input": "Follow-up of thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.4 x 1.6 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.0 x 1.6 cmISTHMUS MEASUREMENTS: 1 mmRIGHT LOBE: Slightly heterogeneous echotexture with no dominant nodules.LEFT LOBE: Slightly heterogeneous echotexture with an unchanged inferior nodule measuring 0.6 x 0.6 x 0.4 cmISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted. LYMPH NODES: Small nonpathologic bilateral lymph nodes as noted previously.OTHER: No significant abnormality noted.", "output": "Stable exam."}
{"instruction": "Generate impression based on findings.", "input": "Female, 58 years old, with low back and leg pain. History of lumbar fusion. Artifact related to an interspinous fusion device is evident at L4-5 and L5-S1.Trace retrolisthesis of L5 relative to S1 is seen. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. Fatty endplate degenerative changes are seen at L5-S1. Otherwise, marrow signal characteristics are unremarkable.The visualized distal spinal cord, conus and cauda equina are within normal limits except as discussed below. No epidural abnormalities are suspected. The spinal canal is congenitally slender and this becomes particularly exaggerated at lower lumbar levels.T12-L1: Progressive right facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, unchanged.L1-2: Mild facet arthropathy, unchanged . No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet arthropathy, unchanged. No significant spinal canal or foraminal stenosis. L3-4: Moderate facet arthropathy, unchanged minimal disc bulging. Prominence of the dorsal epidural fat. Mild narrowing of the thecal sac, unchanged. No significant foraminal narrowing. L4-5: Bulky facet hypertrophy and postoperative changes of the posterior elements. Disc bulging with a superimposed right paracentral/foraminal protrusion which is new. Severe spinal canal stenosis with crowding of the cauda equina nerve roots which has progressed. Moderate right foraminal narrowing, unchanged. L5-S1: Moderate facet arthropathy and postsurgical changes of the posterior elements. Bulging disc. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing, unchanged.", "output": "1.Postoperative findings compatible with interspinous fusion are seen at L4-5 and L5-S1.2.Since the prior examination, bulky facet hypertrophy has progressed at L4-5 and there is a new right paracentral/foraminal disc protrusion. These findings contribute to worsening of the severe spinal canal stenosis at this level.3.Facet arthropathy on the right at T12-L1 has progressed. Significant foraminal narrowing at L5-S1 is unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain, fistulizing ileocolonic Crohn's disease 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: Wall thickening and enhancement involving approximately 20 cm of the distal ileum with focal areas of stricturing compatible with acute inflammatory bowel disease. There are chronic changes involving a long segment of the ileum with straightening of the mesenteric border and fibrofatty proliferation. The distal ileum abuts a segment of markedly angulated sigmoid colon in the right lower quadrant without discrete evidence of fistula. Status post ileocecectomy.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Intrauterine contraceptive device.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening and enhancement of the rectosigmoid.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "1.Acute on chronic inflammatory bowel disease involving the distal ileum with focal areas of stricturing as described above.2.Wall thickening and enhancement the rectosigmoid compatible with acute inflammatory bowel disease."}
{"instruction": "Generate impression based on findings.", "input": "Arachnoid cyst fenestration. There are recent postoperative findings related to left frontal convexity arachnoid cyst fenestration, with an air-fluid level and a punctate focus of blood products posteriorly within the cyst cavity. There is decreased mass effect upon the underlying brain parenchyma, where there is mild edema. However, there is no evidence of acute territorial cerebral 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. There is mild swelling of the left frontal scalp related to the craniotomy procedure.", "output": "Recent postoperative findings related to left frontal convexity arachnoid cyst fenestration, with an air-fluid level in the cyst cavity and decreased mass effect upon the underlying brain parenchyma. "}
{"instruction": "Generate impression based on findings.", "input": "65 years Female (DOB:6/17/1950)Reason: 65 yof with h/o renal transplant with persistent headaches, on prograf - r/o PRES History: headachePROVIDER/ATTENDING NAME: SHANNON K MARTIN SHANNON K MARTIN The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense punctate foci are present in the brainstem. This is minimally/mildly progressed since the prior exam.On susceptibility weighted imaging there are multiple punctate foci of signal loss in the periventricular and subcortical white matter. These were also present on the prior exam and have not changed substantially.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Periventricular and subcortical white matter lesions as well as lesions in the brainstem of a mild degree are nonspecific. At this age they are most likely vascular related. This has only mildly progressed since the prior exam2.There is redemonstration of multiple microhemorrhages scattered throughout the periventricular and subcortical white matter. This is somewhat nonspecific given its distribution. One possibility is related to hypertensive episodes. The pattern may be representative of other cause of microhemorrhages including amyloid angiopathy."}
{"instruction": "Generate impression based on findings.", "input": "Resected right parietal grade 2 meningioma: post-operative scan for RT planning. Left sided weakness. There are postoperative findings related to right frontoparietal convexity meningioma resection with a small amount of residual extradural hemostatic agent and fluid deep to the craniotomy flap. There is residual tumor in the adjacent superior sagittal sinus that measures up to approximately 4.5 cm in length. There is intrinsically T1 hyperintense material along the margins of the resection cavity, which may likely represent blood products. The linear enhancement along the periphery of the resection cavity has diminished. There is no evidence of acute territorial infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is unchanged pronounced mineralization of the basal ganglia. 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": "Postoperative findings related to right frontoparietal convexity meningioma resection with residual tumor in the adjacent superior sagittal sinus."}
{"instruction": "Generate impression based on findings.", "input": "10-year-old female with history of hemangiomas. LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL", "output": "1. Decrease in size of infiltrative palmar mass.2. Unchanged tortuous vessels along the dorsum of the hand."}
{"instruction": "Generate impression based on findings.", "input": "Female, 39 years old, with paresthesias. Evaluate for demyelinating disease. Brain:No areas of pathologic parenchymal signal are detected. No edema or mass effect is observed. There are no abnormal extra-axial extra-axial fluid collections. Ventricular size and morphology are within normal limits. Brain volume is normal.C-spine:The spinal cord demonstrates normal signal intensity and morphology throughout. No focal lesions are seen. No epidural abnormalities are suspected.Straightening of the cervical lordosis is likely positional. Sagittal alignment is otherwise unremarkable. No pathologic marrow replacement or edema is seen.Mild disc osteophyte formation is seen from C3-4 through C6-7. No significant resulting spinal canal or foraminal stenosis is identified.", "output": "1.No lesions are seen in the brain or cervical spinal cord to suggest demyelinating disease.2.No additional specific intracranial or spinal abnormalities are identified which would account for the patient's symptoms.3.Mild degenerative findings are seen in the cervical spine."}
{"instruction": "Generate impression based on findings.", "input": "Patient submitted outside studies for review. Submitted for review are:-bilateral diagnostic mammogram (02/17/2016)-bilateral breast ultrasound (02/17/2016) -US guided biopsy of left breast with postprocedural left mammographic images (02/22/2016)-bilateral breast MRI (03/03/2016) performed at Adventist Hinsdale Hospital.-Images from ultrasound-guided biopsy of the right breast (03/29/2016)-Specimen radiograph of stereotactic biopsy of left breast (03/29/2016)-MR guided biopsy of right breast (03/29/2016)-Postprocedural mammogram of both breasts (03/29/2016)performed at Rush University Medical Center. BILATERAL DIAGNOSTIC MAMMOGRAM (02/17/2016):The breast parenchyma is heterogeneously dense (BiRADS Density Category C). A triangular marker is placed at posterior upper outer quadrant of left breast, denoting the area of palpable lump.Ill-defined focal asymmetry is seen at upper outer quadrant in the left breast, at the site of palpable marker. There is a small cluster of amorphous calcifications at upper inner quadrant in the left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. BILATERAL BREAST ULTRASOUND (02/17/2016):There is an ill-defined hypoechoic mass measuring 13 x 10 mm at 2:00 position in the left breast, corresponding to the area of palpable lump. In the left axilla there is one normal appearing lymph node. In the right breast at 4:00 position, there is an anechoic 5 x 3 mm simple cyst.US GUIDED BIOPSY OF LEFT BREAST WITH POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (02/22/2016):Ultrasound guided biopsy of the left breast mass at 2:00 position is performed with appropriate needle placement. Postprocedural mammographic images demonstrate a marker clip at posterior aspect of the focal asymmetry in the left upper outer quadrant.Per outside report, the pathology result was malignant; invasive ductal carcinoma grade 2.BILATERAL BREAST MRI (03/03/2016):Breast MRI was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.In the left posterior 2:00 position, there is an enhancing mass, measuring 16 x 16 x 22 mm (AP x LR x CC), with susceptibility artifact from a marker clip. This is the proven IDC. There is an enhancing focus anterior to the index mass, suspicious for satellite lesion. Overall AP distance of index mass and focus is 31 mm.In the right breast at 12:00 position, there is an indeterminate enhancing mass, measuring 8 x 6 x 7 mm.No abnormal lymph nodes are identified in either axillary region.IMAGES FROM ULTRASOUND-GUIDED BIOPSY OF THE RIGHT BREAST (03/29/2016):Ultrasound guided biopsy was performed for an oval mass, measuring 5 mm, at 9:00 position, 3 cm from nipple, in the right breast. Needle placement appears appropriate. Post-procedural mammographic images show a marker clip at anterior 9:00 position in the right breast. Pathology result is not available.SPECIMEN RADIOGRAPH OF STEREOTACTIC BIOPSY OF LEFT BREAST (03/29/2016):Per outside radiology report, stereotactic biopsy was performed for a cluster of calcifications in the left upper inner quadrant. Specimen radiograph demonstrates target calcifications within one of the cores. Post-procedural mammographic images show a marker clip at anterior upper inner quadrant in the left breast. Pathology result is not available. MR GUIDED BIOPSY OF RIGHT BREAST (03/29/2016):MR guided biopsy was performed for an enhancing mass in the right breast at 12:00 position. Post-biopsy MR images show biopsy changes with hematoma at the site of the enhancing mass. Post-procedural mammographic images show a marker clip at anterior 11:30 position in the right breast. Pathology result is not available.", "output": "1. Biopsy proven IDC in the left breast at posterior 2:00 position, with possible satellite located anteriorly.2. Status post US guided biopsy of right breast mass at 9:00 position, stereotactic biopsy of calcifications at upper inner quadrant in the left breast, and MR guided biopsy of right breast mass at 12:00 position. Pathology results of these biopsies are not available at the time of this dictation.3. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Nasopharyngeal cancer. Head CT:There is no evidence of intracranial mass, hemorrhage or infarction. No enhancing abnormality is seen intracranially.Neck CT:There is a nasopharyngeal mass at the fossa of Rosenmueller on the left, measuring approximately 3.0 x 1.6-cm. extends to the left infratemporal fossa, at the region of the left foramen lacerum, causing erosion of the floor of the left carotid canal (image #19 of series 5). The soft tissue lesion is suspected to be partially encasing the left internal carotid canal, which can be better defined with MRI of the neck. There is no definite intracranial extension. There is adenopathy involving the left lateral retropharyngeal lymph nodes, and level 2 on the left.", "output": "Left nasopharyngeal mass with extension to the left infratemporal fossa and skull base destruction. It is likely partially encasing the left internal carotid canal. Adenopathy involving left lateral retropharyngeal node and left level 2. No definite intracranial extension."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old male with pain. Evaluate for medial meniscus injury MENISCI: There is branching signal abnormality within the posterior horn and body of the medial meniscus indicating a complex but predominantly horizontal tear that extends to the femoral articular surface and also extends to the periphery of the posterior horn, decompressing into a small parameniscal cyst. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patella with multiple partial and near full-thickness clefts/defects. There is also superficial degeneration of the articular cartilage of the femoral trochlea, centrally. We see no full-thickness articular cartilage defects of the tibiofemoral compartments. There is minimal subchondral bone marrow edema within the posteromedial aspect of the tibial plateau perhaps related to the overlying meniscal tear.LIGAMENTS: There is edema noted along the MCL which is nonspecific, but could represent a sprain in the correct clinical context. The ligament itself appears intact. The ACL and PCL appear intact. The LCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Medial meniscus tear as described above.2. Degeneration of the articular cartilage of the patellofemoral joint.3. Edema along the MCL is nonspecific but could represent a sprain in the correct clinical context.4. Moderate size joint effusion other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: new onset prolonged seizure History: prolonged seizure x 1 hour. This exam is limited by motion artifact.The corpus callosum appears thin, but fully formed, without evidence of structural abnormality. The septum pellucidum is present. The lateral ventricles are irregular and undulating in contour, with prominent atria and angular ventricular margins. There is generalized loss of periventricular white matter volume. There is mild patchy periventricular hyperintensity on T2-weighted and FLAIR images.Except for the periventricular regions, myelination is adequate for the patient's age. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. There is no evidence of cortical dysplasia, mass lesions, or migration abnormalities. The temporal lobe structures appear normal. 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 appear clear.", "output": "1. No evidence of acute hemorrhage, edema, or mass effect. There is no evidence of cortical dysplasia or migration abnormalities.2. Constellation of findings is suggestive of periventricular leukomalacia."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old male with recent code, hypotension, on pressors. Rule out stroke Exam limited by motion artifact.Again seen is a low-attenuation lesion in the left frontal deep white matter that extends to the basal ganglia. This is seen on previous studies dating back to an MRI from 2/05 and is consistent with chronic ischemic changes.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The mastoid air cells are normally pneumatized.", "output": "Chronic ischemic changes unchanged. No CT finding suggesting acute ischemia. Recommend MRI exam once the patient is clinically stable to rule-out acute ischemia as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Multiple Sclerosis- Tysabri maintenance- follow up progression. There is no significant interval change in the multiple intracranial T2 hyperintense white matter lesions. Many of the lesions are also T1 hypointense. There is no evidence of intracranial mass. 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": "1. No significant change in the demyelinating lesions.2. No evidence of PML."}
{"instruction": "Generate impression based on findings.", "input": "22 years Female (DOB:4/28/1994)Reason: MS, f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of corpus callosum FLAIR signal hyperintense lesions extending to the centrum semiovale bilaterally . These were also present on the previous exam and do not appear to have changed substantiallyNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "Periventricular white matter lesions of a mild degree are stable and compared to the prior exam. There is no new lesion appreciated on the current exam."}
{"instruction": "Generate impression based on findings.", "input": "Back pain and leg pain. Acquired spondylolisthesis, evaluate for nerve impingement. Five lumbar type vertebral bodies are presumed to be present. There is multilevel degenerative changes involving the vertebral bodies including endplate sclerosis and increased T2 STIR signal at L1-L2 endplate level compatible with mild bone marrow edema. There is minimal depression of superior endplate of L2 vertebra without definite height loss. Constellation of above findings are more likely represent degenerative disc disease related changes, however, L2 vertebral body non-height loss, partial compression fracture cannot be completely excluded.There is a grade 1 spondylolisthesis of L4 on L5. There is no infiltrative marrow process or worrisome lesions. The conus medullaris is normal in position and terminates at L1 level.Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease or neural foraminal or spinal canal stenosis.L1-L2: There is mild disc bulge. There is bilateral facet arthropathy. There is no neural foraminal narrowing or significant spinal canal stenosis.L2-L3: This is diffuse disc bulging. There is facet arthropathy. There is no neural foraminal stenosis or significant stenosis.L3-L4: There is mild diffuse disc bulge. This doesn't have a particularly There is no significant neural foraminal narrowing or spinal canal stenosis.L4-L5: There is pseudo bulging of the disc due to spondylolisthesis. There is facet arthropathy and ligamentum flavum hypertrophy. This is left facet joint effusion. There is no significant neural foraminal stenosis. There is mild to moderate spinal canal stenosis.L5-S1: Mild diffuse disc bulge. Ligamentum flavum hypertrophy and facet arthropathy. There is mild bilateral neural foraminal narrowing. No significant spinal canal stenosis.Paraspinous soft tissues are within normal limits.", "output": "1. Multilevel degenerative disc changes involving the lumbosacral spine including endplate marrow signal changes at L1-L2 consistent with acute to subacute degenerative changes. Non height loss partial compression fracture of L2 cannot be completely excluded but less likely.2. Mild to moderate spinal canal stenosis at L4-L5.3. Grade 1 spondylolisthesis of L4 over L5."}
{"instruction": "Generate impression based on findings.", "input": "History of Li Fraumeni syndrome. Surveillance examination. NECK AND SKULL BASE: No mass lesion is evident. The visualized intracranial contents are within normal limits. There are normally sized lymph nodes throughout the cervical chain bilaterally.CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Normally sized bilateral hilar lymph nodes. No significant abnormality noted.CHEST WALL: Normally sized axillary lymph nodes bilaterally.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 upper abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Normally sized sized pelvic and inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.THIGHS:No soft tissue mass lesion. Normal-sized popliteal fossa lymph nodes.", "output": "Normal examination without evidence of tumor."}
{"instruction": "Generate impression based on findings.", "input": "Incontinence, weakness. Metastatic prostate cancer. There are multiple vertebral body osseous lesions related to known sclerotic metastases, particularly the L2, L3, and L4 levels with the L3 lesion demonstrating extension involving the posterior elements on the left. Additional small scattered lesions are present more superiorly including T3, T8, and T11 levels as well as inferiorly involving the left iliac bone which is partially imaged. Lesion involving the left-sided posterior elements at the T2 level is also noted. Large left femoral metastases also noted on the coronal survey sequence. There is corresponding sclerosis on recent CT. Burden of osseous metastases is better assessed on recent bone scan. Vertebral body heights are maintained. Alignment is maintained. There is mild developmental narrowing of the spinal canal without high-grade stenosis in the cervical, thoracic, or lumbar spine. No gross evidence of epidural tumor.", "output": "1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2. Multiple scattered osseous metastases, particularly in the lumbar spine. No gross evidence of epidural tumor or pathologic fracture.3. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine."}
{"instruction": "Generate impression based on findings.", "input": "40 year-old male status post fall. Experiencing left-sided numbness/tingling. Evaluate for ICH/C-spine fracture There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Mucosal thickening in the ethmoid sinuses representing mild sinus disease. Mastoid air cells are normally pneumatized.Cervical spine demonstrates normal alignment and no fracture. Neuroforamina are patent. No prevertebral soft tissue swelling. Questionable disc protrusion at the C5/C6 level to the left of midline. An MRI would be warranted if clinically indicated.", "output": "1. No evidence of intracranial process or cervical spine fracture.2. Questionable protruding disc to the left of midline at the level of C5/C6. MRI would provide more detail if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": " There is flattening of the skull base/platybasia and a high riding anterior arch of C1. The tip of the dens situated posterior to the anterior lip of the foramen magnum, but there is no evidence of basilar invagination. The lateral masses of the atlas appear fused with the occipital condyles, although please note that detailed evaluation of the osseous anatomy is limited by MRI. Degenerative changes are noted at the atlantoaxial joint. There is straightening of the cervical spine. The cervical vertebral bodies are appropriate height. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Uncovertebral joint hypertrophy with mild to moderate right and mild left neuroforaminal narrowing. No spinal canal stenosis.C4-5: Mild degenerative disk disease and uncovertebral joint hypertrophy with mild bilateral neuroforaminal stenosis. Mild spinal canal stenosis.C5-6: Moderate degenerative disk disease and moderate right neuroforaminal narrowing. No significant spinal canal stenosis.C6-7: Moderate degenerative disk disease with a central and left paramedian disk protrusion. Mild bilateral neuroforaminal narrowing, as well as mild anterior flattening of the spinal cord indicating moderate spinal canal stenosis.C7-T1: Mild degenerative disk disease and moderate facet and ligamentum flavum hypertrophy. Mild bilateral left greater than right uncovertebral joint hypertrophy. Moderate left greater than right neuroforaminal stenosis and mild spinal stenosis. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "1. Atlanto-occipital fusion with associated platybasia but no basilar invagination or cord signal abnormality. Evaluation of the bony anatomy is limited by MRI and CT would be recommended for further evaluation if clinically warranted. 2. Multilevel degenerative changes with mild to moderate multilevel neuroforaminal narrowing and mild spinal canal stenosis, as described above."}
{"instruction": "Generate impression based on findings.", "input": "2-year-old status post C7 neurofibroma resection. Compared to 4/21/2015, interval postsurgical changes of laminotomies from C5 to T1 are seen. Interval resection of previously seen enhancing tumor involving the spinal canal at the C7 level and multiple neural foramina below C5-C6 on the left. No residual intraspinal tumor is appreciated. Previously seen rightward displacement of the cord has resolved. Expected postsurgical changes include small amount of fluid in the surgical bed as well as epidural enhancement; there is partial effacement of the thecal sac without significant spinal canal stenosis. No cord signal abnormality.Postsurgical changes of left-sided thoracotomy are also noted related to debulking of previously seen extensive neurofibroma involving the thoracic cavity, supraclavicular fossa, and axilla.", "output": "Interval postsurgical changes of C7 neurofibroma resection. No residual tumor within the spinal canal is demonstrated. "}
{"instruction": "Generate impression based on findings.", "input": "18-year-old female with pain. Evaluate for fifth metatarsal stress fracture. There is abnormal bone marrow signal within the fourth metatarsal shaft demonstrate hyperintense STIR signal intensity and relatively lower signal intensity on T1-weighted sequences when compared to the other metatarsals of the right foot. There is mild periosteal edema. This is most compatible with a stress reaction. There are no focal additional linear changes to suggest a fracture. The surrounding soft tissues, including the extensor and flexor compartment tendons and muscles appear normal.", "output": "Findings most compatible with a stress reaction of the fourth metatarsal shaft."}
{"instruction": "Generate impression based on findings.", "input": "History of distal esophageal cancer and chronic pancreatitis. PET CT demonstrated a hypermetabolic focus in the pancreatic head/neck. Evaluate this lesion. ABDOMEN:LIVER, BILIARY TRACT: Demonstrate again is marked intrahepatic and extrahepatic biliary ductal dilatation. A biliary stent is noted.No suspicious liver lesion. The liver is normal in morphology. The hilar portal vein is patent. At the level of the pancreatic head is markedly attenuated. The hepatic veins are patent.Cholelithiasis.SPLEEN: Normal splenic size.PANCREAS: The pancreas is prominent with marked irregular pancreatic ductal dilatation/ectasia with multiple signal voids compatible with calcifications as seen on recent CT. These findings are consistent with severe chronic pancreatitis, although a main duct intrapancreatic mucinous neoplasm cannot be excluded.There is soft tissue enhancement of the pancreatic head/uncinate process which may represent residual pancreatic parenchyma although underlying neoplasm cannot be excluded given the marked parenchymal abnormality.There is a enhancing thick-walled focus along the anterior caudal aspect of the pancreatic head measuring 1.4 x 0.7 cm (series 12/179), which may represent a small pseudocyst or necrotic lymphadenopathy.A 1.8 cm lesion near the pancreatic tail may represent the mobile rim calcified pseudoaneurysm as seen on recent CT.There is no significant peripancreatic acute inflammatory changes/fluid.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal simple appearing cysts and too small to characterize hypointensities.RETROPERITONEUM, LYMPH NODES: Prominent gastrohepatic adenopathy is better characterized on recent CT.BOWEL, MESENTERY: The stomach is distended with heterogeneous debris to the level of the transverse duodenum without a discrete mass lesion seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Markedly distended main pancreatic duct may reflect stigmata of severe chronic pancreatitis although a main duct intrapancreatic mucinous neoplasm cannot be entirely excluded. Heterogeneous soft tissue enhancement of the pancreatic head may represent residual parenchyma although an underlying neoplasm cannot be excluded. ERCP/US correlation is recommended.2.Thick rim enhancing small lesion anterior and caudal to the pancreatic body may represent a pseudocyst versus necrotic lymphadenopathy.3.Probable mobile arterial pseudoaneurysm measuring 1.8 cm, better seen on the recent CT."}
{"instruction": "Generate impression based on findings.", "input": "History of rheumatoid arthritis and motor vehicle collision presenting with intermittent neck pain and bilateral cervical radiculopathy. Cervical spine:Straightening of the cervical lordosis related to spondylitic changes. There is mild loss of vertebral body height affecting multiple levels from C3 to C6 without frank compression fracture. No sequela of rheumatoid arthritis are identified. There is no significant pannus formation or erosions involving the dens. Flexion and extension sagittal images do not indicate atlantoaxial instability. The cervical spinal canal measures between 9 and 11 mm in AP dimension which is borderline for congenital canal narrowing. A superimposition of multiple disc osteophyte complexes and hypertrophy of the ligamentum flavum from C2 to C7. Diffuse mild spinal canal stenosis. While there is mild distortion of the cord at multiple levels, no abnormal cord signal is identified.Level by level findings are as follows:C2-C3: Small disc osteophyte complex and mild thickening of the ligamentum flavum. Minimal bilateral neural foraminal stenosis.C3-C4: Small disc osteophyte complex, uncovertebral joint hypertrophy, and hypertrophy of ligamentum flavum. Mild left neural foraminal stenosis.C4-C5: Moderate disc osteophyte complex, thickening of the ligamentum flavum, and uncovertebral joint hypertrophy. No significant foraminal stenosis.C5-C6: Mild disc osteophyte complex, hypertrophy of the ligamentum flavum, uncovertebral joint hypertrophy. Mild left neural foraminal stenosis.C6-C7: Mild disc osteophyte complex and hypertrophy of ligamentum flavum. Moderate spinal canal stenosis. Mild right neural foraminal stenosis.C7-T1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.", "output": "1. Multilevel spondylitic changes superimposed on a borderline congenitally narrow cervical spinal canal result in diffuse mild cervical canal stenosis2. Mild multilevel neural foraminal narrowings as described.3. No erosions, transformation, atlantoaxial instability, or other sequela of rheumatoid arthritis in the cervical spine."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid eye disease versus multiple sclerosis: diplopia. Orbits: The bilateral inferior rectus muscles are enlarged, particularly on the right side, where there is hyperenhancement and edema. The right medial rectus muscle may also be slightly enlarged. In addition, there is mild crowding towards the right orbital apex without evidence of optic nerve compression. Indeed, the bilateral optics nerves appear to be intact, without evidence of signal abnormality or contour deformity. There is no evidence of orbital mass lesions or abnormal enhancement. The optic nerves display normal signal and morphology. The globes and ocular adnexa are unremarkable. The orbital walls appear to be intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a mildly ectatic and tortuous right vertebral artery. The skull and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.", "output": "1. Findings suggestive of thyroid associated orbitopathy, with inflammatory changes involving the right inferior rectus muscles and mild crowding of the right orbital apex, but no discernible optic nerve impingement. 2. No evidence of demyelinating lesions."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with pain. Evaluate for cuff tear after fall. ROTATOR CUFF: There is mild tendinosis of the supraspinatus tendon. There is also a small 2 to 3 mm focus of relatively increased signal intensity within the supraspinatus tendon at its insertion, likely representing a concealed insertional tear. There is also mild irregularity of the bursal surface of the tendon suggesting fraying. There are small cysts in the humeral head at the insertion of the infraspinatus tendon, but the tendon and muscle itself appear normal. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. No fluid is identified within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is minimal increased signal intensity within the superior labrum which may reflect degeneration, but we see no evidence of a labral tear, given the limitations of a non arthrogram study. There is no glenohumeral joint effusion.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is a small amount of circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the joint. ADDITIONAL", "output": "Mild supraspinatus tendinosis and bursal surface fraying and probable concealed insertional tear with other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male presents with right knee pain, evaluate for a meniscal tear. MENISCI: There is extensive linear and globular signal abnormality within the body and posterior horn of the medial meniscus indicating mucoid degeneration with extension through the periphery of the posterior horn of the medial meniscus. There is decompression into a multilobulated parameniscal cyst posteriorly. Additional smaller parameniscal cysts are noted along the anterior margin of the medial meniscus. There is a equivocal extension of the intrameniscal signal to the femoral articular surface of the knee. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: The medial and lateral compartments are normal. There is a small full-thickness cleft of the articular cartilage of the median eminence of the patella.LIGAMENTS: The cruciate and lateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "Extensive mucoid degeneration of the medial meniscus with decompression into parameniscal cysts, but with equivocal extension to the femoral articular surface. Additional findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 35 years old, with hearing loss on the left. Evaluate for pathology in the left ear. The visualized brainstem is unremarkable. The seventh/eighth nerve complexes are well visualized and show normal morphology. No pathologic enhancement is seen along the cranial nerves, within the IACs or in the CP angles. No masslike lesions are detected. The fluid filled structures of the inner ears show normal morphology.", "output": "Unremarkable evaluation of the IACs with no specific findings to account for the patient's left-sided hearing loss."}
{"instruction": "Generate impression based on findings.", "input": "66 years, Male, Reason: evaluate for upcoming biopsy History: Elevated PSA, large prostate. PELVIS:PROSTATE:Prostate Size: 4.6 x 6.0 x 5.0 (AP x TR x SI)Prostate: There is an anterior apical lesion measuring 1.4 x 1.1 cm (604/164) which is low signal on ADC and T2 and enhances. On postcontrast images, there appears to be extracapsular extension from this lesion. An additional lesion in the right apex measures 1.0 x 0.6 cm (604/184) which is also low signal on ADC/T2 and enhances.Multiple heterogeneous lesions are compatible with BPH.Seminal Vesicles: No significant abnormalities.Extracapsular Extension: YesBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Two apical lesions are identified, one of which is in the anterior prostate, that are suspicious for prostate adenocarcinoma. There appears to be extracapsular extension from the anterior lesion."}
{"instruction": "Generate impression based on findings.", "input": "10-year-old female with sacral agenesis. Evaluate for female reproductive organs and vaginal patency. PELVIS:UTERUS, ADNEXA: The uterus is identified (for example series 1301, image 17 and series 1601, image 19). The vaginal vault appears patent (for example series 901, image 26). Both ovaries are identified are normal in appearance (series 1101, image 15 and 16). BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No specific evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No free fluid is identified.", "output": "Normal appearance of the uterus and ovaries, within the limitations described above."}
{"instruction": "Generate impression based on findings.", "input": "incontinent bowel/bladder, decreased leg strength, prior mri from osh reviewed by neurosurgery. Evaluate for hematoma vs lymphoma. Thoracic spine:There are multilevel degenerative changes throughout the thoracic spine without evidence of high-grade central canal stenosis. The thoracic spine is in normal alignment. No worrisome focal marrow signal abnormality is appreciated. Within the limits of a motion degraded exam, there is no obvious cord signal abnormality.Mild disc bulges are noted at the T2-3, T5-6, T6-7, T7-8, T8-9, and T9-10 levels but there is no significant compromise to spinal canal or neural foramina.At the T10-11 level there is a mild disc bulge, facet arthropathy and ligamentum flavum thickening as well as minimal retrolisthesis of T10 and T11 which causes mild central canal stenosis and moderate to severe left neuroforaminal stenosis. No significant right neural foraminal stenosis.At the T11-12 level there is loss of disc height and a 14 mm of superior extrusion of disc material. There is minimal arthrosis at this level but no significant compromise to spinal canal or neural foramina. Lumbar Spine:There is mild exaggerated lordosis and grade 1 anterolisthesis of L3 on L4 and L4 on L5. There is some loss of disc height at the L3-4 and L4-5 levels. The vertebral body heights are preserved. The vertebral bone marrow signal is heterogeneous which is nonspecific. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is mild facet arthropathy but no significant compromise to spinal canal or neural foramina.L2-L3: There is mild facet arthropathy but no significant compromise to spinal canal or neural foramina.L3-L4: There is anterolisthesis of L3 on L4 which causes uncovering of the disc, a superimposed disc bulge and advanced facet arthropathy which cause moderate to severe central canal stenosis. A 9 x 7 x 15 cm low T1/high T2 ovoid structure extending from the L3-4 level to the mid L4 level within the posterior spinal canal, likely represents a synovial cyst and this along with prominent posterior epidural fat contributes to the moderate to severe stenosis at this level. This is best seen on sagittal STIR images series 23, image 11. There is also moderate to severe right and moderate left neuroforaminal stenosis.L4-5: There is anterolisthesis of L4 on L5 with advanced facet arthropathy and prominence of the posterior epidural fat which causes moderate to severe central canal stenosis. There is also moderate right and moderate to severe left neuroforaminal stenosis.L5-S1: There is no significant compromise to spinal canal or neural foramina.A large T2 hyperintense cystic structure is noted involving the left renal pelvis and most likely represents a parapelvic cyst.", "output": "Thoracic spine:1.Multilevel degenerative changes without evidence of high-grade central canal stenosis.2.No evidence of an epidural hematoma or neoplasm.3.Within the limits of a motion degraded exam, there is no obvious cord signal abnormality.Lumbar spine: 1.Advanced degenerative changes with moderate to severe central canal stenosis at L3-4 and L4-5 with neural foraminal stenosis as detailed above.2.Cystic structure dorsal to the thecal sac at the L4 level likely represents a synovial cyst, which contributes to the moderate to severe central canal stenosis at this level."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Post TACE/RFA, evaluate for new or recurrent HCC; Evaluate IPMN History: HCV cirrhosis, SVR; HCC s/p TACE/RFA, IPMN ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic liver morphology.The segment 8 ablation cavity measures approximately 1.8 x 1.3 cm, compared to 1.8 x 1.3 cm previously. There is again a punctate nodular focus of arterial enhancement along the anterior aspect of the ablation cavity without definite washout. Minimal thin enhancement around the ablation cavity is unchanged.There is plaque-like enhancing focus at the gallbladder fundus measuring 0.4 x 0.8 cm, not significantly changed back to 1/6/2015, with associated T2-weighted cystic intensity on prior exams, likely focal adenomyomatosis. Cholelithiasis without cholecystitis. Recanalized umbilical vein. The common hepatic artery originates from the aorta. The vessels are patent.Cholelithiasis without evidence of cholecystitis. No biliary ductal dilatation.SPLEEN: Stable mild splenomegaly, measuring 14 cm in length.PANCREAS: Lobular cystic focus in the pancreatic head measuring approximately 1.3 cm is unchanged, likely communicates with a normal caliber pancreatic duct. No suspicious postcontrast imaging features.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.", "output": "1.Cirrhotic liver with evidence of portal hypertension.2.Punctate nodular enhancement along the anterior aspect of the segment 8 ablation cavity not significantly changed and which may be a posttreatment change. Attention to this on follow-up imaging is recommended. No new suspicious liver lesions.3.Stable cystic lesion in pancreatic head suggestive of a side branch IPMN without suspicious imaging features."}
{"instruction": "Generate impression based on findings.", "input": "Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: pre op planning - no fiducials needed History: ams The exam was performed with pre-operative stealth protocol.There are ill-defined low signal intensity lesions with significant surrounding edema on T2 images, one on the right parietal and the other is on the left parietal lobes (right side lesion is bigger than the left).The right lateral ventricle occipital horn shows effacement due to mass effect. However, there is no midline shift.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "Multiple various size intra-axial masses with surrounding edema (right side lesion is bigger than that of the left). Differential diagnosis include brain abscess, metastatic lesions, or primary malignant brain tumor. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of seizure and AVM History: seizure in 1980's MRI of the brainThere is a 38 x 19 mm sagittal dimension sellar and suprasellar mass which displaces the optic chiasm superiorly.There is subcortical signal hyperintensity on T2 and flair MRI along the inferior and lateral aspect of the right postcentral gyrus is also adjacent right inferior parietal lobule.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is adjacent widening of sulciNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening of the minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.", "output": "1.There is a large sellar and suprasellar mass which displaces the optic chiasm superiorly. This most likely represents pituitary adenoma. Prior studies are not available for comparison.2.There is encephalomalacia present along the right parietal lobe as detailed above3.There is no evidence for a true venous malformation this exam. Please note that conventional angiography is more sensitive in detection of residual arteriovenous malformation.4.An alphanumeric page was sent to pager 2356 (Sandra Rose) at the time of this dictation. The findings were discussed."}
{"instruction": "Generate impression based on findings.", "input": "77 year old female with diabetes, hypertension, hyperlipidemia, and reported history coronary artery disease and angioplasty.MEDICATIONS: Metoprolol, Lisinopril, Aspirin, Metformin, Allopurinol, Glipizide First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is high signal at mid-wall noted in the basal inferior wall, which is atypical for prior myocardial infarction. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 89 ml/m2 (normal range: 65+/-11), the LVEDV is 171 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 69 ml (normal range 31+/-10), the LV mass index is 63 g/m2, and the LV mass is 122 g. There are no regional wall motion abnormalities present. No intracardiac thrombus.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 179 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 71 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is aortic regurgitation, visibly trace or mild.Mitral ValveThe mitral valve opens widely. There is mitral regurgitation which appears mild. Dedicated quantification was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation which appears mild. Dedicated quantification was not performed.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 pericardial effusion.Extracardiac FindingsBilateral renal cysts, cholelithiasis.", "output": "1. No perfusion defects/ \"ischemia\" present during hyperemia.2. There is apparent mid-wall high signal at the basal inferior wall, which is atypical for prior myocardial infarction and may be artifactual. The possibility of prior inflammation in this location cannot be excluded. In the absence of wall motion abnormality, active inflammation is not suspected. The entire myocardium is viable. 3. Normal LV size and systolic function (LVEF 59%).4. Normal RV size and systolic function (RVEF 61%)."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with history of hepatitis B. HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Multiple enlarged porta hepatis lymph nodes again seen. Subcentimeter nonenhancing simple cysts are scattered about the liver. No suspicious lesions.Cholelithiasis.There is a nonocclusive thrombus within the distal SMV extending into the proximal portal vein appearing similar to prior.SPLEEN: Splenomegaly measuring up to 17 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal simple cyst.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.Cirrhosis without evidence of suspicious hepatic lesion.2.Cholelithiasis.3.Nonocclusive distal SMV thrombus extending the main portal vein appearing similar to prior."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rotator cuff tear History: pain, decreased ROM ROTATOR CUFF: Complete tear of the supraspinatus with approximately 2.5 cm of retraction. There is extension of the tear posteriorly to involve the anterior fibers of the infraspinatus. There is also extension of the tear anteriorly to involve the posterior fibers of the subscapularis. The subscapularis tendon appears diffusely thinned likely representing chronic attritional tearing. There is marked fatty atrophy of the supraspinatus and superior subscapularis.SUPRASPINATUS OUTLET: Severe osteoarthritis affects the acromioclavicular joint with an associated large osteophyte/spur projecting from the inferior margin of the acromion process. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degeneration/degenerative/degenerative changes affecting the glenoid labrum. There is partial thickness degeneration of the glenoid articular cartilage.BICEPS TENDON: There is complete disruption of the long head of the biceps tendon at the level of its transition from the rotator interval to the bicipital groove. The intraarticular portion of the tendon is poorly visualized likely reflecting retraction of the tendon.ADDITIONAL", "output": "1. Complete tear of the supraspinatus with retraction with extension of the tear to involve the anterior fibers of the infraspinatus and posterior fibers of the subscapularis. Marked atrophy of the supraspinatus and subscapularis muscles.2. Complete rupture of the long head of the biceps tendon with retraction."}
{"instruction": "Generate impression based on findings.", "input": "Female, 27 years old, with migraines and HIV. No restricted diffusion is seen. No evidence of parenchymal edema or mass effect is detected. There are no focal areas of parenchymal signal abnormality. No findings to suggest acute intracranial hemorrhage are demonstrated. No pathologic parenchymal or extra-axial enhancement is seen. An incidental cavum vellum interpositum is suspected. The ventricles are normal in size and morphology.", "output": "No acute intracranial abnormalities and no specific findings to account for the patient's headaches."}
{"instruction": "Generate impression based on findings.", "input": "Left upper extremity weakness/triceps, finger extension. Suspect C6 -- C7 foramina stenosis. CT of the cervical spine without the infusion:3-mm axial images of the entire cervical spine were obtained. Sagittal and coronal reformatted images were obtained.Reformatted images demonstrate straightening of cervical lordosis. This finding may be positional. Mild degenerative disk disease and shallow ventral hypertrophic spurs are noted.Foramina magnum.Examination of this level is unremarkable.C2 -- C3.No central spinal stenosis or neural foramina compromise. C3 -- C4.Minimal degenerative changes which appears to be more pronounced on the left. There is minimal sclerotic changes of the left uncovertebral and articulating facet on the left (axial image 37). The left neural foramina appears slightly smaller than the right and is believed to be partially compromised.C4 -- C5.No central spinal stenosis or neural foramina compromise. Very minimal hypertrophic and sclerotic changes of the left uncovertebral on axial image 42. The left neural foramina appears minimally smaller than the right. This finding was also noted on prior MRI examination on axial T2 weighted image 15.C4 -- C5.Minimal degenerative changes. The left neural foramina appears minimally smaller than the right secondary to hypertrophic changes.C5 -- C6.Degenerative disk disease and hypertrophic changes of the posterior elements are noted. There is evidence of hypertrophic changes of bilateral uncovertebral with resultant compromise of bilateral neural foramina. This finding was also appreciated on axial T2-weighted image 23 of prior MRI of cervical spine. Large anteriorly located hypertrophic spurs at this level projects into the soft tissues of the prevertebral space. Reformatted images demonstrate a shallow ventral hypertrophic spur with minimal bulge of disk material. Review of prior MRI examination demonstrates no central spinal stenosis at this level.C6 -- C7.Mild degenerative disk disease and minimal hypertrophic changes of posterior elements. There is compromise of bilateral neural foramina secondary to above changes. This finding may be slightly more pronounced on the left. These findings were noted also on prior MRI examination cervical spine on axial T2-weighted image 27. No central spinal stenosis.C7 -- T1.Minimal asymmetrical hypertrophy changes on the left is suspected on axial image 57. This includes hypertrophied and minimally calcified ligamentum flavum on the left. Minimal compromise of the left neural foramina is suspected.", "output": "1.Degenerative changes of cervical spine with multilevel neural foramina compromise as detailed above.2.Prior MRI examination of cervical spine is also reviewed which shows similar findings as described above. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Pedrido is a 50-year-old female with newly diagnosed left breast cancer (IDC, grade 2, mucinous type). She presents for MRI imaging evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.In the left medial breast, there is an irregular enhancing mass identified measuring 2.8 x 2.0 x 1.9 cm (AP x ML x SI). This mass demonstrates increased T2 signal intensity, characteristic for mucinous carcinoma. Two biopsy marker clips are seen, one of which is centrally located (ribbon clip) and one of which is located antero-medial to the mass (hydromark clip). Associated post-biopsy changes are seen, including minor skin thickening/enhancement at biopsy entry site. There is no abnormal enhancement identified in the right breast. There are numerous cysts of varying T2 signal intensity identified bilaterally.No abnormal axillary lymph nodes are identified in either axillary region.Few subcentimeter T2 hyperintense cysts are identified in the liver.", "output": "(1) Unifocal malignancy of the left breast. If breast conservation therapy is desired, the ribbon clip can be used for preoperative localization. (2) No MR evidence of malignancy of the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "72 years Female (DOB:8/9/1944)Reason: s/p crani for tumor History: s/p crani for tumorPROVIDER/ATTENDING NAME: KRUPA G ANDALKAR PETER C. WARNKE Since the prior examination patient is undergone parietal craniotomy for removal of an extra-axial mass involving the superior sagittal sinus. The lobulated enhancing component remaining along the anterior aspect of the mass measuring 33 x 19 mm in axial dimensions the superior sagittal sinus appears to be patent adjacent to it.Within the brain parenchyma adjacent to the craniotomy site there is signal change within the subcortical white matter in a contiguous fashion which has not changed substantially since the prior preoperative exam.There are are some small foci of diffusion restriction adjacent to the surgical site within the brain parenchyma. There are some blood products which are hyperintense on T1 at the surgical site. There is soft tissue swelling present involving the scalp tissues.Incidental note is made of partial empty sella.There is mild anterior subluxation of C1 on C2.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacification of the right mastoid air cells. The visualized portions of the orbits are intact.", "output": "1.Since the prior examination the patient is undergone partial removal of an extra-axial mass adjacent to the falx and superior sagittal sinus. There are associated postoperative changes present.2.There is mild anterior subluxation of C1 on C2 which appears unchanged since the prior exam"}
{"instruction": "Generate impression based on findings.", "input": "Male 68 years old Reason: RECURRENT RECTAL CANCER AT 10 CM AND SYNCHRONOUS BLADDER CANCER. STAGE RECTAL CANCER AND COMMENT ABOUT RELATION TO PROSTATE AND BLADDER History: RECTAL CANCER Overall image quality: Very goodPELVIS:PROSTATE/SEMINAL VESICLES: Benign prostatic hypertrophy. No lesions suspicious for prostate cancer. Right seminal vesicle and base of the prostate on the right side are indicated by the patient's known rectal cancer.BLADDER: Asymmetric early enhancement on the right side of the bladder wall compatible with patient's no history of bladder cancer.LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: NoneLymph nodes outside the mesorectal fascia: NoneBOWEL, MESENTERY: Rectal Tumor:Size: 2.8 x 2.3 cm mass arising from the right anterolateral aspect of the rectum invading the right seminal vesicle and base of the prostate, best seen on image number 34, series number 541. The mass is located at 8-cm of the rectum.Tumor appearance on T2-weighted images: HypointenseTumor location: 8-cm of the rectum): MRI T-stage: T4 there is evidence of extramural vascular invasion, best seen on image number 162, series number 1701.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Large rectal cancer invading the right seminal vesicle and prostate base with extramural extravascular invasion.2.Right bladder wall thickening compatible with patient's known history of bladder cancer."}
{"instruction": "Generate impression based on findings.", "input": "Reason: cuff tear? History: pain ROTATOR CUFF: There is partial thickness tearing of the articular surface fibers of the supraspinatus just proximal to the level of its insertion on the greater tuberosity involving approximately 50% of the tendon width, measuring approximately 2 cm in AP dimension. There is no significant retraction. There is also thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. There is undersurface fraying of the subscapularis just proximal to its insertion on the lesser tuberosity.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a full-thickness articular cartilage cleft along the inferior margin of the glenoid with underlying degenerative subchondral signal abnormality and cyst formation. There is degeneration/degenerative tearing of the inferior labrum within the limitations of a non arthrogram study.BICEPS TENDON: There is deformity and increased signal abnormality within the intra-articular portion of long head biceps tendon consistent with a longitudinal split tear. There is a small amount of circumferential fluid within the tendon sheath which may reflect fluid extension from the joint versus a tenosynovitis. ADDITIONAL", "output": "1. Tendinosis and partial thickness tearing of the supraspinatus without evidence of a full-thickness rotator cuff tear or retraction.2. Osteoarthritis of the shoulder and degeneration/degenerative tearing of the glenoid labrum.3. Longitudinal split tear of the intra-articular portion of the long head of the biceps tendon and probable biceps tendon tenosynovitis. Other findings as described."}
{"instruction": "Generate impression based on findings.", "input": "Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: eval for vessel narrowing/pathology given evidence of ischemic CVA History: eval for vessel narrowing/pathology given evidence of ischemic CVA on head CT Brain MRI:Multifocal bihemispheric acute ischemic infarct including right frontal lobe, right caudate nucleus head, right occipital lobe and left posterior temporal lobe. On gradient echo technique, there are subtle blooming artifacts on the right frontal lobe acute ischemic infarct lesion indicating possible hemorrhage transformation.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.", "output": "1. Multifocal bihemispheric acute ischemic infarcts as described above with possible focal hemorrhagic conversion especially on the right frontal lobe lesion.2. Normal brain MRA."}
{"instruction": "Generate impression based on findings.", "input": "60 y/o female w/ IgG kappa multiple myeloma, left lower back pain, numbness/tenderness, left lower pelvic area pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5. Alignment is otherwise maintained. Bone marrow signal is benign with no areas of edema or enhancement to suggest active myeloma lesions. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or right neural foraminal stenosis. Cystic enhancing lesion described below involves the inferior lateral aspect of the neural foramen on the left with minimal narrowingL2-L3: Disc bulge and facet arthropathy with suggestion of a small left foraminal disc protrusion. No significant spinal canal or right neural foraminal stenosis. Mild left neural foraminal narrowing. L3-L4: Disc bulge and bilateral facet arthropathy and prominence of the dorsal epidural fat. There is associated mild central spinal canal stenosis as well as mild bilateral neural foraminal stenosis.L4-L5: Disc bulge, moderate bilateral facet arthropathy, and ligamentum flavum thickening contribute to mild spinal canal stenosis. There is mild to moderate bilateral, left greater than right, neural foraminal stenosis.L5-S1: There is minimal disc bulge and mild to moderate bilateral facet arthropathy. There is no significant spinal canal or neural foraminal stenosis. Additional disc bulges are present in the partially imaged lower thoracic spine without high-grade spinal canal stenosis.There is a large cystic structure measuring greater than 7.5 cm in diameter inferior lateral to the right kidney without clear correlate on prior abdominal CT from 5/18/2012. There is a larger pelvic mass likely related to uterine fibroids which is partially imaged and demonstrates mass effect on the left psoas muscle.There is a peripherally enhancing tubular lesion along the posterior aspect of the left psoas muscle which measures approximately 7 x 10 mm in the axial plane and approximately 2.5 cm in the craniocaudal dimension. The lesion appears to course along the extraforaminal left L1 nerve root.There are 3 subcentimeter foci of enhancement involving the bilateral iliac bones and left sacrum.", "output": "1. No evidence of active multiple myeloma in the lumbar spine. There are 3 subcentimeter foci of osseous enhancement in the pelvis which are nonspecific but may be related to multiple myeloma.2. Peripherally enhancing fusiform cystic lesion involving the left psoas muscle at the L2 level (7x10 mm in axial plane) may represent an abscess. Neoplasm such as nerve sheath tumor with cystic degeneration (associated with the left extraforaminal L1 nerve root) and resolving hematoma are other considerations. Relative lack of inflammation involving the surrounding left psoas muscle or adjacent discitis-osteomyelitis argue against abscess. 3. Multilevel degenerative changes include grade 1 anterolisthesis at L4 and L5 and mild spinal canal stenosis at the L3-L4 and L4-L5 levels. There is also mild multilevel neural foraminal stenoses. No high-grade spinal canal or high-grade neural foraminal stenosis. Please see additional details above.4. Partially imaged large pelvic mass is compatible with uterine fibroids. There is also a cystic appearing mass inferior lateral to the right kidney without clear correlate on remote abdominal CT from 2012. Consider dedicated abdominal CT for better evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Female, 64 years old, with new onset headache. Evaluate for metastasis, bladder cancer primary. MRI brain:No evidence of restricted diffusion, edema or mass effect is seen. No pathologic intracranial enhancement is observed. There are numerous scattered small foci of T2 hyperintensity within the cerebral hemispheres which are nonspecific. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits.MRA brain:No evidence of significant vascular stenosis or occlusion is seen. No aneurysm or vascular malformation is suspected.MRA neck:Conventional aortic branching is seen. The origins of the great vessels are patent. Moderate atherosclerotic disease is present at the carotid bifurcations and proximal ICAs but without significance by NASCET criteria. The vertebral arteries are free of significant vascular stenosis.", "output": "1.No evidence of intracranial metastatic disease is seen. Scattered small foci of signal abnormality are favored to represent chronic microvascular ischemia.2.No significant vascular abnormalities are detected intracranially.3.Atherosclerotic disease is seen at the carotid bifurcations and proximal ICAs. However, no areas of critical stenosis are suspected."}
{"instruction": "Generate impression based on findings.", "input": "History of ulcerative colitis and primary sclerosing cholangitis with worsening right upper quadrant pain. Several sequences mildly limited by patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: There is mild segmental narrowing of the right and left hepatic ducts just proximal to the confluence of the common duct appearing similar to prior. Additional mild scattered intrahepatic biliary ductal irregularity/beading overall appear slightly less prominent. Mild scattered intrahepatic biliary ductal dilatation appears not significantly changed. There is again slight tortuosity of the distal common bile duct without high-grade stenosis/stricture. No abnormal biliary duct enhancement is identified. The gallbladder is contracted.There is a subcentimeter T2 hyperintense structure within segment 4B which demonstrates discontinuous peripheral nodular enhancement and is compatible with a benign hemangioma. No additional focal hepatic lesions are identified. The hepatic vasculature appears patent. SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter cysts, significantly changed.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": "Findings consistent with early primary sclerosing cholangitis appearing similar to prior examinations."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Patient with anoxic brain injury now with increasing seizure frequency. Evaluate for new bleed or focus of seizure. Nonenhanced CT of brain:There is prominence of cortical sulci and significant dilatation of ventricular system with interval worsening since prior study. Prominence of cortical sulci may indicate underlying parenchymal volume loss. Enlarged lateral ventricles and third ventricle are highly concerning for hydrocephalus. There is significant ballooning of the frontal horns bilaterally.There is also evidence of significant interval increase in extra-axial bilateral temporal, frontal and parietal CSF density subdural collections. Further follow-up with an MRI is recommended. There is no evidence of acute hemorrhage, edema or midline shift.", "output": "1. Interval increase in bilateral large CSF density subdural collections in temporal -- frontal and parietal regions and2.significant interval increase in the size of the supratentorial ventricular system concerning for hydrocephalus.3.No evidence of acute intracranial hemorrhage, edema or midline shift.4.Prominence of cortical sulci is concerning for underlying volume loss."}
{"instruction": "Generate impression based on findings.", "input": "Gait abnormality. Evaluate for radiculitis. Alignment is notable for 3 mm of anterior subluxation of L4 relative to L5 as a result of facet degenerative disease. This is associated with mild height and T2 signal loss at L4-L5 disc. Alignment is otherwise anatomic and the other discs are preserved in height and T2 signal. Vertebral bodies are preserved in height. Foci of fat-signal are present in L2, L4 and S1 bodies. Otherwise, marrow signal heterogeneity is associated with complete suppression on the fat suppressed sequences and therefore most likely of no significance. The spinal canal is moderately to severely narrowed at L4-L5 level. It is preserved at the other levels. Only on the sagittal STIR images, there is a small focus of increased signal in the posterior aspect of the spinal cord at T11-T12 intervertebral level. This is not covered on the axial images and is not conspicuous on the other sagittal sequences and therefore may very likely be artifactual. Otherwise, the conus medullaris has normal morphology and signal. The tip of the conus medullaris is at the L1-L2 level.T12-L1: There is no central or foraminal stenosis.L1-L2, L2-L3 and L3-L4: Disc bulges are minimal. There is no central or foraminal stenosis.L4-L5: Anterior subluxation is associated with uncovering of the disc. There is also facet hypertrophic change and ligamenta flava buckling. Together, these result in moderate to severe central spinal narrowing. The subarticular recesses are also narrowed and there is mild right and left foraminal narrowing.L5-S1: There is mild facet hypertrophic change but no central or foraminal narrowing. Small renal lesions are not completely assessed though likely cysts.", "output": "1.Moderate to severe narrowing of the central and lateral spinal canal at L4-L5 is caused by spondylolisthesis/disc uncovering and posterior element hypertrophy/thickening as described above. Moderate right and mild left foraminal narrowing.2.Spondylosis at the other levels is minimal.3.A focus of apparent signal abnormality in the lower spinal cord seen only on the sagittal STIR sequence is likely artifactual."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female patient with uterine fibroids. Three month follow-up imaging status post uterine fibroid embolization. PELVIS:UTERUS, ADNEXA: The uterus measures 14.8 x 8.5 cm. Multiple uterine fibroids are again identified, the largest of which have decreased in size and no longer enhance. The largest measures approximately 7.4 x 6.1 cm (image 21, series 501), previously 8.9 x 7.3 cm. This fibroid demonstrates decreased T2 signal compared to the prior exam. An additional relatively large fibroid on the left side of the uterus extending to the left adnexa now measures 4.9 x 3.2 cm (image 26, series 501), previously 6.2 x 5.1 image. Multiple other fibroids also no longer demonstrate enhancement. The endometrial stripe is unremarkable. 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: A small amount of free fluid is present in the pelvis.", "output": "Interval decrease in size and enhancement of multiple uterine fibroids. "}
{"instruction": "Generate impression based on findings.", "input": "14-year-old male with soft tissue sarcoma of the left thigh status post resection. Evaluate At the medial aspect of the left vastus lateralis muscle below the greater trochanter (at the site of the skin marker), there is infiltrative/linear region of increased T2/STIR signal (series 8, images 45 through 51). This region demonstrates infiltrative/linear enhancement (series 10, images 43 through 50). Additionally, there is increased T2/STIR signal in the overlying subcutaneous tissues consistent with inflammatory changes. Areas of metallic susceptibility artifact correspond to the surgical clips present on the recent radiograph. No abnormality of the visualized left femur.", "output": "Infiltrative/linear T2 hyperintensity with enhancement involving the left vastus lateralis muscle. These findings are more likely secondary to postoperative changes and granulation tissue than residual tumor."}
{"instruction": "Generate impression based on findings.", "input": "History of meningioma and breast cancer; subacute development of vertigo, imbalance, diplopia, and subjective coordination issues. There is mild high T2 signal and mildly restricted diffusion in the right caudate head and perhaps in the anterior right putamen without mass effect or enhancement. There is no evidence of intracranial hemorrhage or enhancing tumors. There are a few scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. The cerebellum appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is an arrested pneumatization variant of the sphenoid. There is mild scattered paranasal sinus mucosal thickening. There are bilateral lens implants.", "output": "1. High T2 signal and mildly restricted diffusion in the right caudate head and perhaps in the anterior right putamen may represent a recent lacunar infarct or a paraneoplastic encephalitis, for example.2. No evidence of meningioma or brain metastases. 3. The cerebellum appears unremarkable.4. A few scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter may represent chronic small vessel ischemia."}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval for rotator cuff tear History: shoulder pain for months with mild adhesive capsulitis. ROTATOR CUFF: Mild intermediate signal intensity along the undersurface fibers of the supraspinatus tendon near its insertion may reflect fraying, but we see no discrete fluid signal tear. The supraspinatus muscle appears normal. The infraspinatus tendon and muscle appear normal. The teres minor muscle and tendon appear normal. Minimal increased signal intensity within the subscapularis tendon may reflect mild tendinosis but we see no discrete tear. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Minimal increased signal intensity within the anterior aspect of the subdeltoid bursa could conceivably reflect mild inflammation but we see no frank fluid.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage is within normal limits. Although we see no fluid signal intensity entering the glenoid labrum, intermediate signal intensity within the superior labrum is suggestive of a tear, which possibly extends into the biceps anchor. Mild increased signal intensity within the anterior inferior labrum may reflect degeneration, but we see no fluid-filled tear. No joint effusion.BICEPS TENDON: Other then the possible aforementioned SLAP tear, the long head of the biceps tendon is unremarkable.ADDITIONAL", "output": "1.Possible mild tendinosis/fraying of the rotator cuff as described above, but we see no discrete rotator cuff tear.2.Possible mild inflammation of the subdeltoid bursa anteriorly.3.Although no fluid enters the glenoid labrum, intermediate signal intensity within the superior labrum is suggestive of a tear with possible extension into the biceps anchor.4.Slight thickening of the coracohumeral ligament with partial replacement of the adjacent fat, which has been described in patients with adhesive capsulitis."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old male with concern for left hip labral tear. ACETABULAR LABRUM: Acetabular labrum is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact.SOFT TISSUES: No significant abnormality noted. ADDITIONAL", "output": "1.Asymmetric sacroiliitis, right greater than left, correlation with HLA-B27 is suggested as clinically warranted.2.Intact articular cartilage and acetabular labrum.3.Mild cam deformity, please see dedicated CT FAI protocol for relevant measurements."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female status post Chiari decompression complicated by CSF leak subsequently repaired started on high dose Bactrim IV, now with persistent nausea and vomiting. Evaluate for any bleed or reason for persistent nausea/vomiting. Postoperative changes status post suboccipital craniectomy are again evident. An ovoid fluid density structure is seen superficial to the operative site within the subcutaneous tissues, which appears more prominent compared to the prior CT, grossly unchanged from recent MRI. No definite communication with the posterior fossa is evident. No acute hemorrhage or extra-axial fluid collections are evident. A new focus of hypodensity is seen in the postero-medial aspect of the right cerebellar hemisphere, corresponding to focus of restricted diffusion on recent MRI. The remainder of the cerebral and cerebellar hemispheres demonstrate normal morphology and density. The ventricles are midline, with normal morphology and volume. No abnormal extra-axial fluid collections are evident.Apart from postoperative changes status post suboccipital craniectomy, the remaining calvaria and osseous structures are intact. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. Subcutaneous fluid collection superficial to the operative site, with no clear communication with the posterior fossa to suggest a pseudomeningocele.2. Subacute infarction in the right cerebellar hemisphere."}
{"instruction": "Generate impression based on findings.", "input": "Female, 46 years old, with history of T4a N2c M0 oral tongue cancer. Mild deformity of the oral tongue is seen which may be posttreatment in nature. However, no tumor-like lesion is identified within the tongue or floor of mouth.Findings compatible with prior right rim mandibulectomy are seen. Abnormal T2 hyperintense signal and mild hyperenhancement is evident within the residual right mandible. In addition, there appears to be progressive erosion of the buccal mandibular cortex centered at approximately the level of the right mandibular foramen (see image 28 series 901).The mucosa of the pharynx and supraglottic larynx is edematous compatible with treatment change. No pathologic adenopathy is detected in the neck by size criteria. The salivary glands and the thyroid are unremarkable. Bone marrow signal characteristics are otherwise unremarkable. Mild cervical degenerative disc disease is seen.", "output": "1.Signal abnormality, mild hyperenhancement and progressive cortical erosion are seen within the residual right mandible centered at approximately the level of the mandibular foramen. The differential for this finding would include osteoradionecrosis, infection and perineural tumor spread. Further evaluation with CT may better characterize the osseous features of the abnormality.2.No evidence of primary tumor recurrence in the tongue or floor of mouth. No pathologic adenopathy is detected in the neck."}
{"instruction": "Generate impression based on findings.", "input": "Right knee pain and swelling MENISCI: There is horizontal tearing of the anterior horn of the lateral meniscus which extends into the body. There is a small associated para meniscal cyst. There is obliquely oriented tearing of the posterior horn of the medial meniscus which extends into the body. There is mild extrusion of the medial meniscus into the gutter with mild associated reactive marrow changes in the medial compartment.ARTICULAR CARTILAGE AND BONE: There is diffuse articular cartilage loss of the medial compartment with more moderate diffuse loss of the lateral compartment. The articular cartilage of the lateral femoral condyle is preserved while there is full-thickness loss of the medial compartment.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Tears of the anterior horn/body of the lateral meniscus and posterior horn/body of the medial meniscus.2. Diffuse tricompartmental articular cartilage loss, worst in the medial compartment."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral hip impingement syndrome. ACETABULAR LABRUM: There is a horizontal area of increased signal involving the anterior superior labrum compatible with a labral tear. There is also some degeneration of the superior labrum but no discrete tear. There is no chondral-labral detachment or associated paralabral cyst formation. ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL", "output": "Tear of the anterior superior labrum. No evidence of chondral injury."}
{"instruction": "Generate impression based on findings.", "input": "Left temporal/occipital lobe metastasis from a salivary gland malignancy treated via SRS. There is minimal residual patchy T2 hyperintensity, but no residual abnormal enhancement at the site of the treated left temporo-occipital region brain metastasis. There are a few scattered nonspecific foci of T2 hyperintensity without associated enhancement. 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, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid within the left mastoid air cells and mild mucosal thickening within the bilateral maxillary sinuses.", "output": "Interval involution of the treated left temporo-occipital region metastasis."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with decreased appetite and abdominal pain. Evaluate extent and severity of Crohn's disease (ileocolonic). 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: There is marked wall thickening of the distal and terminal ileum over a length of approximately 20 cm with alternating areas of narrowing and dilation and surrounding fibrofatty proliferation, most compatible with acute on chronic inflammatory bowel disease. There is complex fistulization seen in the lower abdomen with a large fistula between the rectum and cecum (series 14/42) and a smaller fistula between the rectum and sigmoid colon (series 14/50). There are two small interloop abscesses also seen in this area anteriorly (series 14/45).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Findings most compatible with active on chronic inflammatory bowel disease of the distal and terminal ileum. There is also complex fistulization with colocolic fistulas and interloop abscesses, as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Attention deficit, memory loss No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or 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": "Normal brain MRI.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female with history of Hodgkin's disease. Status post auto stem cell therapy about day 30.IMAGE ACQUISITION: Contrast enhanced CT of the head and soft tissue neck was performed. 60 mL of Omnipaque 350 was injected intravenously. CT HEAD:No acute intracranial abnormality is evident. Specifically, there is no evidence for focal mass lesion, edema, midline shift, hydrocephalus, or abnormal enhancement. Gray white matter differentiation is preserved. The ventricles are normal in size and configuration. No abnormal fluid collections seen.A focal lucent lesion in the left frontal bone with sclerotic margins is noted, previously characterized by MRI and was felt to likely represent a benign process such as hemangioma.The visualized paranasal sinuses demonstrate a right maxillary retention cyst.CT NECK:There is no cervical lymphadenopathy based on CT imaging. The reference right level 2 lymph node measures 0.8 x 0.6 cm (image 35 demonstrates 4), previously measuring 1.2 x 0.8 cm. No new or enlarging lymph nodes are identified. No neck mass or fluid collection is seen. The aerodigestive tract is unremarkable without evidence for exophytic mass or effacement. The paraspinal soft tissues and musculature are within normal limits. The submandibular, parotid, and thyroid glands are within normal limits. The orbits are unremarkable.The carotid and jugular vessels are patent. Right anterior chest port.Limited views of the lung apices demonstrate no significant abnormality, however please refer to the dedicated CT of the chest report for complete details.", "output": "1. No CT evidence for lymphadenopathy in the neck. Slight interval decrease in size of reference node with measurements as above.2. No intracranial mass lesion. Sclerotic lesion in the left frontal bone, characterized on prior MRI and felt to represent a benign process such as hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "72 year old woman with history of heart failure with preserved ejection fraction, hilar lymphadenopathy admitted for heart failure exacerbation, and now referred for cardiac MRI to evaluate for possible etiologies of her cardiomyopathy. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 55 ml/m2 (normal range: 65+/-11), the LVEDV is 104 ml (normal range 109+/-23), the LV end systolic volume index is 20 ml/m2 (normal range 18+/-5), the LVESV is 37 ml (normal range 31+/-10), the LV mass index is 52 g/m2 (normal range 67+/-11), and the LV mass is 98 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There was significant motion artifact on late gadolinium imaging, but the following observations were made: there is late gadolinium enhancement in the basal inferolateral and lateral wall which is subendocardial and atypical for previous myocardial infarction. In addition there is a mid-myocardial stripe in the basal septum. The native myocardial T1 relaxation is abnormal (1142-1197ms), which could suggest underlying diffuse myocardial fibrosis or inflammation. The extracellular volume fraction is slightly elevated at 31%, which also suggests some degree of diffuse myocardial fibrosis or inflammation. There is no evidence for myocardial edema on T2-STIR imaging.Left AtriumThe left atrium is moderately dilated. The interatrial septum is bowed towards the right, suggestive of elevated left atrial pressures.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 81 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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 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 no pericardial effusion. There is no evidence of pericardial edema or inflammation.Extracardiac FindingsThere is bilateral hilar lymphadenopathy. There is a small well-circumscribed lesion at the posterior pole of the liver. 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. Normal sized left ventricle with normal systolic function (LVEF 65%)2. There was significant motion artifact on late gadolinium imaging, but the following observations were made: there is late gadolinium enhancement in the basal inferolateral and lateral wall which is subendocardial and atypical for previous myocardial infarction. In addition there is a mid-myocardial stripe in the basal septum. These findings could be consistent with an underlying inflammatory, infiltrative or fibrotic process. Sarcoid is included in the differential for this pattern of late gadolinium enhancement; however, given the quality of imaging a repeat study in 6 months could be considered. 3. Normal sized right ventricle with mildly reduced systolic function (RVEF 45%). 4. Biatrial dilation.5. See extracardiac findings.  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, 59 years old, history of smoldering multiple myeloma. Assess for myelomatous lesions. Cervical:No evidence of concerning marrow replacement or pathologic marrow enhancement is seen.The C5 and C6 vertebral bodies are small with a partially formed C5-6 intervertebral disc suggesting congenitally anomalous development. Vertebral body morphology is otherwise unremarkable. Alignment is anatomic.The visualized spinal cord demonstrates normal morphology and signal characteristics. No pathologic intraspinal enhancement is seen.Facet hypertrophy and disc osteophyte formation are evident at C4-5. Mild spinal canal stenosis is seen. Moderate bilateral foraminal narrowing is seen.The other cervical levels are free of significant degenerative disc disease.Thoracic:No evidence of concerning marrow replacement or pathologic marrow enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic intraspinal enhancement is detected.No significant disc disease, spinal canal or neuroforaminal stenosis is seen. Ligamentum flavum thickening is evident on the right at T10-11.Lumbar:The sacral marrow is mildly heterogeneous. However, no definite evidence of concerning marrow replacement or pathologic marrow enhancement is seen.The visualized conus and cauda equina are within normal limits. No pathologic intraspinal enhancement is seen.No significant spinal canal or neuroforaminal stenosis is demonstrated. Mild loss of disc height is evident at L5-S1 with very slight disc bulging.", "output": "No findings to suggest active myelomatous lesions in the spine."}
{"instruction": "Generate impression based on findings.", "input": "Other malaise and fatigueClinical question: ischemic CVASigns and Symptoms: left-sided weakness x 3 days MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The cervical spinal canal is small. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this levelAt C3-4 there is no significant compromise to the neural foramina. There is a mild disc bulge present at this level and partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree of spinal stenosis presentAt C4-5 there is no significant compromise to the neural foramina. There is a small central disc protrusion present at this level associated with mild posterior ligamentous hypertrophy and partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree of spinal stenosis present at this level.At C5-6 there is no significant compromise to the neural foramina. There is a small central disc protrusion present at this level associated with mild posterior ligamentous hypertrophy and partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree of spinal stenosis present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.", "output": "1.There are some degenerative changes present in the cervical spine superimposed on a small cervical spinal canal. There is only mild spinal stenosis present at multiple levels resulting predominantly from disc disease.2.There is no evidence for acute ischemic cerebral infarction3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Exam is mildly degraded due to some patient motion which may obscure more subtle abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "Left vertebral artery and proximal basilar artery occlusion. Right sided weakness. Acute brainstem stroke.IMAGE ACQUISITIONS: Precontrast head CT followed by dynamic bolus contrast enhanced CTA of the head 0.9-mm source images. Sagittal and coronal and 3-D reformats were also obtained. There is complete occlusion of the dominant left vertebral artery. Right vertebral artery is congenitally small and predominantly supplies PICA with minimal if any contribution to basilar flow. Right V4 segment is very small. There is questionably a very thin lumen along the right side of the proximal basilar artery, possibly supplied by the right V4 segment. Most of the flow to the mid and distal basilar artery appears to be from posterior communicating arteries from the carotid arteries.There is intraluminal thrombus of indeterminate age in the left vertebral artery to the level of the proximal basilar artery.There is no other evidence of intracranial arterial stenosis. There is no evidence of intracranial aneurysm or intracranial pseudoaneurysm. There is no acute intracranial hemorrhage. Brain stem and corpus callosum infarcts that were demonstrated on MRI are not yet demonstrable on CT.", "output": "Complete occlusion and thrombosis of dominant left vertebral artery to the level of the proximal basilar artery, with minimal if any antegrade flow from the distal right vertebral artery and likely substantial retrograde collateral flow from posterior communicating arteries.Findings were discussed by telephone with Dr. Yallapragada on 06/06/2009 approximately 1930 hrs."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old African-American male with left-sided weakness. Possible CVA. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity in the periventricular and subcortical white matter distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered.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": "Small vessel disease, age indeterminate. If there is clinical concern for ischemia, MRI may be considered."}
{"instruction": "Generate impression based on findings.", "input": " There are multilevel various degree degenerative changes of the cervical spine with exaggerated cervical lordosis. Multilevel anterior osteophytes are seen. The marrow signal is heterogenous. In particular, the C6 inferior endplate and C7 superior endplate show T1 and T2 hypointensity suggestive of sclerotic changes. There is no evidence of Gad enhancement of the vertebral bodies.C2-C3: There is trace disc bulge with no neural foraminal or spinal cord compromise.C3-C4: No spinal or foraminal compromise.C4-C5: There is diffuse disc bulge with minimal to mild spinal canal stenosis and no neural foraminal compromise.C5-C6: There is diffuse disc bulge with mild spinal canal stenosis. There is right-sided mild to moderate neural foraminal stenosis and mild left-sided neural foraminal stenosis.C6-C7: There is mild disc bulge without evidence of spinal stenosis. No neural foraminal compromise.C7-T1: No neural foraminal or spinal compromise.There are multiple areas of disc bulge in the upper thoracic spine with no evidence of spinal stenosis.Note is made of bulla in the right apex.", "output": "1. No evidence of abnormal enhancement or focal abnormal signal intensity lesion on cervical vertebral bodies suggesting metastatic disease.2. Multilevel degenerative changes including mild to moderate right neural foraminal stenosis and mild left-sided neural foraminal stenosis at the level of C56 with mild spinal stenosis3. Diffuse disc bulging with minimal to mild spinal stenosis at the level of C4-C5.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " CERVICAL SPINE: The vertebral body heights are preserved. There is mild to moderate loss of disc height at multiple levels. There are subcentimeter cystic foci in the posterior aspects of the C3 and C7 vertebra, which are likely degenerative in nature. There is loss of the usual cervical lordosis and a congenitally narrow spinal canal. In conjunction with multilevel degenerative spondylosis, there is spinal canal stenosis with mild impingement of the spinal cord. However, the spinal cord displays normal signal. The paravertebral soft tissues are unremarkable. Additional findings by level:C2-C3: Posterior disc osteophyte complex with effacement of the ventral CSF space, flattening of the ventral cord and thickening of the ligamentum flavum contribute to moderate spinal canal stenosis, but no significant neural foramen stenosis.C3-C4: Posterior disc osteophyte complex, central to slightly asymmetric to the right, with flattening of the ventral cord and thickening of the ligamentum flavum contribute to moderate spinal canal stenosis and mild bilateral neural foramen stenosis. C4-C5: Posterior disc osteophyte complex with mild flattening of the ventral cord, bilateral uncinate spurs and thickening of the ligamentum flavum contribute to moderate spinal canal stenosis and moderate right and mild left neural foramen stenosis.C5-C6: Posterior disc osteophyte complex, bilateral uncinate spurs, thickening of the ligamentum flavum and right greater than left facet arthropathy contribute to moderate spinal canal stenosis and moderate bilateral neural foramen stenosis.C6-C7: Posterior disc osteophyte complex, bilateral uncinate spurs, and thickening of the ligamentum flavum contribute to mild spinal canal stenosis and mild bilateral neural foramen stenosis.C7-T1: No significant spinal canal or neural foramen stenosis.THORACIC SPINE: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is mild multilevel loss of disc height. The vertebral bone marrow signal is unremarkable. There are mild disc bulges of the thoracic spine. There is a small central disc protrusion at T6-T7 with mild indentation of the ventral cord. There is no associated spinal cord signal abnormality. The paravertebral soft tissues are unremarkable.LUMBAR SPINE: There is a compression fracture of the L1 vertebral body with approximately 50% loss of height centrally and mild posterior retropulsion. There is linear enhancement and high T2 signal within the vertebral body. There is no significant central spinal stenosis at this level. There is a compression fracture of the L5 vertebral body with approximately 75% loss of height centrally and 10 mm of posterior retropulsion, contributing to severe central spinal stenosis and compression of the cauda equina nerve roots. There is linear enhancement along the fracture cleft. There is also diffuse high T2 signal within the vertebral body, which extends into the posterior elements as well. There is soft tissue T2 hyperintensity and enhancement at the L4-L5 level, adjacent to the spinous processes, but no discrete fluid collection. Additional findings by level:T12-L1: L1 vertebral body fracture with mild retropulsion and moderate bilateral facet arthropathy and thickening of ligamentum flavum with minimal spinal canal and bilateral neural foramen stenosis.L1-L2: Mild disc bulge and moderate bilateral facet arthropathy, but no significant spinal canal or neural foramen stenosis.L2-L3: Mild disc bulge, thickening of the ligamentum flavum and moderate bilateral facet arthropathy, contributing to minimal bilateral neural foramen stenosis, but no significant spinal canal stenosis.L3-L4: Mild disc bulge, thickening of the ligamentum flavum and moderate bilateral facet arthropathy, contributing to mild spinal canal narrowing and mild bilateral neural foramen stenosis.L4-L5: L5 vertebral body compression fracture with moderate retropulsion. Disc bulge, thickening of the ligamentum flavum and moderate bilateral facet arthropathy, contributing to severe spinal canal stenosis, compression of the cauda equina and severe right and mild left neural foramen stenosis.L5-S1: Vacuum disc phenomenon, bilateral facet hypertrophy, and ligamentum flavum thickening with mild bilateral neural foramen stenosis, but no significant spinal canal stenosis.", "output": "1. L5 vertebral compression fracture with edema, 75% loss of height, and 10 mm of retropulsion superimposed upon underlying degenerative changes, contributing to severe spinal canal stenosis with compression of the cauda equina and severe right and moderate left foraminal stenosis at the L4-L5 level.2. L1 vertebral compression fracture with mild edema, 50% loss of height, and slight retropulsion, but no significant spinal canal stenosis.3. Multilevel degenerative cervical spondylosis and a congenitally narrow spinal canal, contributing to moderate spinal canal stenosis at C2-C3 to C5-C6 and variable degrees of multilevel foraminal stenosis.Findings discussed with Dr. Zimmerman on 12/31/2014 at 11:35 a by Dr. Wu. "}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female patient with right foot and ankle pain. Right ankle: There is mild soft tissue swelling about the ankle, but we see no ankle fracture. There is mild spurring of the fibular tip, which may represent old trauma. Right foot: There is mild soft tissue swelling about the foot without acute fracture. A small ossicle along the lateral aspect of the cuboid bone may represent prior injury, however, cannot exclude retraction of an os peroneum from a peroneus longus tendon tear. If there is clinical concern for a tendon rupture, MRI can be obtained. Mild osteoarthritis affects the first metatarsophalangeal joint.", "output": "1.Mild soft tissue swelling and osteoarthritis without acute fracture seen.2.Ossicle lateral to the cuboid bone may not be of current clinical significance, however, if there is clinical concern for tendon rupture MRI can be obtained. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Provided history of recurrent endometrial cancer status post pelvic exenteration. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal suspicious lesion. No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.SPLEEN: The spleen is normal in size and enhancement without focal lesion.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical changes from anterior pelvic exenteration with cystectomy and hysterectomy. BLADDER: Postsurgical changes from anterior pelvic exenteration with cystectomy and hysterectomy. Right lower quadrant ileal conduit.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right sacral insufficiency fracture, not significantly changed. OTHER: Trace free fluid.", "output": "Postsurgical changes from anterior pelvic exenteration without evidence of recurrent or metastatic disease.Stable appearance of right sacral insufficiency fracture. "}
{"instruction": "Generate impression based on findings.", "input": "Left low frequency sensorineural hearing loss and possible cochlear hydrops, but no vertigo . The cochleas bilaterally appear to be intact, without obvious dilation of the scala media. The bilateral vestibules and semicircular canals appear to be intact. However, the bilateral endolymphatic ducts and sacs are not conspicuous. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The bilateral mastoid air cells and middle ears appear unremarkable.", "output": "The cochleas bilaterally appear to be intact, without obvious dilation of the scala media, and the bilateral vestibules and semicircular canals appear to be intact. However, the bilateral endolymphatic ducts and sacs are not conspicuous. "}
{"instruction": "Generate impression based on findings.", "input": "87 years Female (DOB:2/17/1929)Reason: 87F with h/o brain aneurysm and optic neuropathy with sudden loss of color vision left eye History: sudden loss of color vision left eyePROVIDER/ATTENDING NAME: SUSAN M KSIAZEK SUSAN M KSIAZEK MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact There is a punctate focus of enhancement present along the posterior aspect of the pons which corresponds to a microhemorrhage identified on the 9/11/2014 MRI of the brain in can be identified on the echo planar images as a signal void..No foci of diffusion restriction are appreciated within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The ophthalmic arteries are also identifiedThere is a 2.5 mm infundibulum present at the origin of the left posterior communicating artery. The posterior communicating arteries are very small.There appears to be obtaining infundibulum at the origin of the left ophthalmic artery. There is redemonstration of a slight bulge of the left internal carotid artery at the proximal ophthalmic segment and its lateral wall which is likely related to minor atherosclerosis.There is extracranial origin of the right posterior inferior cerebellar artery present.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The vertebral arteries are similar in size.", "output": "1.There is no evidence for an intraorbital mass or other explanation for the patient's visual loss involving the left eye.2.There is a 2.5mm infundibulum present at the origin of the left posterior communicating artery."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question : Status post craniotomy for posterior fossa lesion. Signs and symptoms: As above. Nonenhanced head CT:There is expected postoperative changes of the right paramedian suboccipital craniotomy. Residual vasogenic edema in the right cerebellum is again noted. There is no evidence of parenchymal hemorrhage. Air filled surgical cavity measures approximately 17 times 12-mm in size. Fourth ventricle is in normal position and normal in size. The residual air in the subarachnoid space is also present.Focus of encephalomalacia in the left occipital lobe is likely result of an old stroke and unchanged since prior MRI exam.Prominence of cortical sulci and ventricular system for patient's stated age is similar to the preoperative study.", "output": "1.Expected postoperative changes of right paramedian suboccipital craniectomy.2.Residual vasogenic edema in the right cerebellum similar to prior study.3.Prominence of cortical sulci and ventricular system for patient's stated age of 56 similar to prior exam.4.Focus of encephalomalacia in the left occipital lobe as was seen on prior MRI study."}
{"instruction": "Generate impression based on findings.", "input": "59 year old male with history of thyroid cancer with metastases. Status post resection, brain irradiation, chemotherapy. On clinical trial. CT of the soft tissues of the neck.Images through the skull base including cavernous sinuses are within normal limits.Images through the soft tissues of the neck demonstrate a well demarcated enhancement involving the posterior wall of nasopharynx (axial image 24 through 28). There is no evidence of an increased soft tissue mass with this finding. All of the prior studies where re-examined and demonstrated the same finding with no interval change. The exact etiology of this finding is not clear. Possibility of a tumor would be considered very low considering its stable appearance since 4 -- 28 -- 2008. An MRI may be helpful to precisely determine the etiology of this finding. This finding does not appear as a postsurgical change.An enhancing right posterior triangular lymph nodes on axial image 35 is again identified and no interval change since prior study. This node measures identical to the prior exam and is 10 mm times 11.8-mm in size.A smaller enhancing right posterior triangular lymph nodes is again also identified with no interval change. Enhancement could appearance of a central necrosis immediately medial to the right internal carotid artery is believed to represent a Trumbull was to jugular vein. This finding is also stable since prior exam (axial image 34 through 39).Extensive post therapy changes of the soft tissues of the neck with distortion of anatomy is again identified. No definitive evidence of recurrence of tumor or pathologic adenopathy. Extensive metastatic lesion two bilateral upper lung fields are noted. Please review the dictated report of CT of chest. No osseous metastatic lesion.CT of brain with infusion.Multiple small supra-and infratentorial foci of increased density (cannot be certain whether they represent small calcific post treated metastases or enhancement) are again identified and with no interval change. No evidence of new lesions is identified. No evidence of hemorrhage, edema, midline shift or hydrocephalus.", "output": "1.Stable CT examination of soft tissues of the neck and with no definitive evidence of recurrence of tumor or pathologic adenopathy. Please see above comments.2.Stable findings on CT of brain which may represent post treated metastatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old male is status post 6-foot fall from ladder with L4 compression fracture and retrolisthesis of L4 on L5 on x-ray Advanced degenerative disk disease with significant vacuum phenomenon and sclerotic changes of the adjacent endplates at L5 -- S1 level is noted. There is grade 1 anterolisthesis at this level secondary to bilateral pars defects (spondylolysis).Less than 50% compression fracture of the superior endplate of L4 and a small loose fragment anterior to the vertebral body is noted. The alignment of the spine at this level remains normal. No evidence of any fracture of the posterior elements is noted. The facets remain aligned at this level however demonstrate degenerative changes and minimal widening of the facet space which may be secondary to degenerative changes or possibly soft tissue injury secondary to patient's fall.For better evaluation of the soft tissues and MRI would be helpful. No definitive evidence of any compromise of the spinal canal at this level is detected.", "output": "1.Compression fracture of superior endplate of L4 with no malalignment.2.Grade 1 antral listhesis at L5 -- S1 secondary to bilateral spondylolysis."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male with recurrent Ewing's sarcoma to the right shoulder. Patient is status post radiation. Evaluate response to treatment and for disease progression. The axillary mass seen on the previous study was not imaged in its entirety on the current study. The patient has been contacted and will return for further imaging at no charge at which time an addendum will be logged.There is intermediate signal intensity within the supraspinatus tendon indicating tendinosis. There is mild edema type signal intensity and enhancement of the teres minor muscle which appears more pronounced on the current study which is nonspecific and could represent sequela of radiation therapy, myositis or early denervation atrophy.The acromioclavicular joint appears normal. No frank fluid is is present in the subacromial/subdeltoid bursa.There is linear increased signal intensity separating the anterosuperior labrum from the glenoid likely representing a normal variant sublabral foramen. There is also amorphous low signal intensity between the anterior labrum and subscapularis muscle which appears similar to prior study with no appreciable enhancement or uptake on recent PET scan and may represent scar tissue or thickened ligamentous structures from prior trauma.We see no joint effusion or synovitis.There is curvilinear intermediate signal within the extra-articular tendon of the long head of the biceps that may represent a partial thickness tear but appears similar to prior study and not necessarily of any current clinical significance.As stated previously, the axillary mass seen on the previous study is not visualized in its entirety on the current study and measurements will be provided when the patient returns for further imaging. The mass may represent confluent lymphadenopathy. There are a few additional subcentimeter enhancing lymph nodes again noted more superiorly within the axilla and beneath the clavicle which are unchanged.We see no focal bone marrow lesions.", "output": "1. Incomplete evaluation of the patient's axillary mass. Patient has been contacted and will return at which point measurements and evaluation of the patient's mass will be made. Small enhancing lymph nodes in the axilla and clavicle appear similar.2. Mild edema type signal and enhancement of the teres minor muscle which is nonspecific and could represent sequela of radiation therapy, myositis or early denervation atrophy.3. Mild supraspinatus tendinosis and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female with drainage from groin wound and associated induration. Evaluate for bilateral groin seromas versus abscess. ABDOMEN:LUNG BASES: Bibasilar atelectasis. No acute infiltrates or effusions. Mild cardiomegaly.LIVER, BILIARY TRACT: Cholelithiasis. The multiple ill-defined hepatic hypodensities. The small at the hepatic dome on image 14 of series 3. The largest is adjacent to the hepatic hilum in the medial segment of the left lobe measuring 2 cm in greatest dimension at axial image 37 of series 3. A second lesion in the medial segment of the left hepatic lobe measures 1.6 cm in greatest dimension on axial image 36 of series 3. These hepatic lesions could be better characterized with a multiphase dedicated liver CT or MRI examination.SPLEEN: No significant abnormality noted. Splenule at the hilum. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are multiple bilateral renal cortical cysts. There is a nonobstructing punctate left upper pole renal calculus. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Aortobifemoral bypass graft is in expected position and appears widely patent. Diffuse atherosclerotic changes with vascular calcifications.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple bilateral borderline enlarged inguinal lymph nodes, probably reactive.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Bilateral groin fluid collections, largest on the left. Both fluid collections appear uniloculated with mildly thickened enhancing wall. No gas bubbles. Both of these collections lie superficial to the distal aortobifemoral bypass graft anastomotic sites. Small amount of free fluid in the pelvis. The smaller right-sided fluid collection and has a maximum diameter of approximately 2.5 cm. The left sided collection extends craniocaudally for 13 cm and has a transverse dimension of 5.5 cm.", "output": "Bilateral uniloculated groin fluid collections at the distal anastomoses of aortobifemoral bypass graft. Enhancing rims suggest these are more likely abscess than seroma.. Multiple hepatic hypodensities are better characterized with dedicated liver CT or MR examination, if indicated."}
{"instruction": "Generate impression based on findings.", "input": " Again seen are postsurgical changes of right frontotemporal craniotomy for resection of sphenoid wing meningioma. Again seen is minimal dural based thickening in the right middle cranial fossa measuring up to 7 mm in thickness extending medially into the right paraclinoid region, which is similar to prior from 2/3/2015. There has been evolution of previously seen immediate post surgical changes with resolution of previous seen parenchymal edema and associated mass effect. There has been interval development of encephalomalacia involving the right anterior temporal lobe. No evidence of mass effect on the current study. Remainder of the brain parenchyma appears unremarkable. No hydrocephalus. No extra-axial collections. Aside from aforementioned postsurgical changes, calvarium and extracranial soft tissues are unremarkable.", "output": "Compared to 2/3/2015, there is evolution of postsurgical changes related to prior right sphenoid wing meningioma resection with resolution of previously seen edema and associated mass effect and development of encephalomalacia in the right anterior temporal lobe. There is minimal dural based thickening and enhancement measuring approximately 7 mm in thickness in the right middle cranial fossa extending medially into the right paraclinoid region, which is suspected to represent minimal residual meningioma and remains unchanged since prior. No evidence of mass effect on the current study."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old male with pain. Evaluate for meniscal injury. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Focus of low signal abnormality in the lateral femoral condyle likely represents a benign bone island. Otherwise no bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is thickening and increased signal abnormality within the patellar tendon at its origin suggestive of patellar tendinopathy. ADDITIONAL", "output": "Findings suggestive of patellar tendinopathy \"jumper's knee\" as described above. No evidence of meniscal injury, as clinically questioned. "}
{"instruction": "Generate impression based on findings.", "input": "Assess interval change in hemangioma. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic posterior segment T2 hyperintense lesion measures approximately 3.0 x 2.8 cm (series 6/7), compared to 3.3 x 3.6 cm previously. Left hepatic lobe T2 hyperintense lesion measures 1.2 cm, compared to 1.0 cm previously. The lesions demonstrate peripheral discontinuous nodular enhancement which progressively fills in on delayed phase imaging compatible with hepatic hemangiomata.SPLEEN: Normal splenic size without a focal lesion.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mild interval decrease in size of the posterior segment 3.0 cm hepatic hemangioma. 1.2 cm left hepatic lobe hemangioma also seen as above."}
{"instruction": "Generate impression based on findings.", "input": "Thigh mass, endometrial cancer Within the anteromedial soft tissues of the right thigh is an irregular lesion measuring 4.7 x 2.7 x 2 cm in the greatest transaxial and craniocaudal dimension. This lesion demonstrates predominantly low signal on both T1 and fat-suppressed T2 sequences with some areas appearing slightly more cystic in nature. Following contrast administration, there is no significant enhancement. No additional lesions or abnormal enhancement is identified within the right thigh. The marrow signal of the femur is normal. There is mild atrophy of the posterior compartment musculature.", "output": "Irregular lesion within the anteromedial soft tissues of the right thigh is nonspecific but given the low signal intensity on both T1 and T2 sequences and the lack of discrete enhancement, the findings may reflect fibrosis or scarring in an area of prior hematoma (per clinical history). However given the patient's history, continued follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Dysphagia. Neck lump. PET/CT scan showed soft tissue mass posterior to the trachea, potentially from the known thyroid cancer. The patient has rising globulin. He received RAI 55 years ago. History of papillary thyroid cancer; status post total thyroidectomy and right modified radical neck dissection on December 19, 2014. He had two positive lymph nodes in the central neck and 0/24 nodes in the right lateral neck. He also had invasion of the middle thyroid vein on the right, and minimal extrathyroidal extension into the strap muscles on the right. Subsequently, he underwent radioactive iodide treatments but was told that he had persistence and recent thyroglobulin levels have increased. There are changes of previous thyroidectomy. There is a rightward-eccentric, infiltrative, mildly STIR-hyperintense mass located just inferior to the posterior part of the cricoid cartilage. It demonstrates diffusion restriction diffuse contrast enhancement. The mass posteriorly displaces the uppermost esophagus with no intervening fat plane. It also displaces the trachea anteriorly with high likelihood of invasion into the trachealis muscle and the right posterolateral aspect of the first tracheal ring. It causes mild tracheal narrowing. Craniocaudally, it measures 2.5 cm and abuts the posterior arch of the cricoid cartilage without grossly eroding into it. It wraps around 50% of the circumference of the upper-most trachea and measures axially 4.3 cm x 3.0 cm. Focally decreased T1 signal within the right side of the mass probably reflects susceptibility artifact. Previous PET CT showed a surgical clip in a similar location. The larynx is unremarkable without definite invasion into the cricoid or thyroid cartilages. There is also no definite invasion into the adjacent vertebral bodies of C7 and T1. There is also no vascular encasement and major neck vessels are patent.There is no discrete cervical lymph node enlargement. The major salivary glands are unremarkable.There is complete opacification of the right maxillary sinus with inspissated secretions. There is partial opacification of the ethmoid and left maxillary sinuses and fluid in the right sphenoid sinus. Both orbital lenses have been replaced.Included lung apices are notable for posterior apical pleural thickening was present on the previous PET/CT.", "output": "1.Soft tissue mass involving the upper-most part of the tracheoesophageal groove with signs of invasion into the upper-most trachea, likely representing either a local recurrence given proximity to surgical clips, or regional lymph node metastasis related to the known thyroid cancer.2.There is no separate cervical lymphadenopathy.3.Opacification of the paranasal sinuses including complete opacification of the right maxillary sinus and fluid in the right sphenoid sinus may reflect sinusitis in the proper clinical setting."}
{"instruction": "Generate impression based on findings.", "input": "Female, 67 years old, with low back pain and hyperreflexia in the upper extremities but present sensory and motor exam. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or edema is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No epidural abnormalities are suspected.At C5-6 there is minimal posterior disc-osteophyte complex formation and left facet hypertrophy resulting in a mild left foraminal stenosis. Minimal posterior disc-osteophyte complex formation is seen at C6-7 as well without significant spinal canal or foraminal stenosis. Perineural root sleeve cysts are evident within the C7-T1 neural foramen, but this is a common incidental finding.Lumbar:Grade 1 anterolisthesis of L3 relative to L4 is noted. Elsewhere, sagittal alignment is unremarkable. Vertebral body heights are within normal limits. Extensive degenerative endplate signal abnormality is seen at L3-4 and L4-5 but no worrisome marrow replacement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are seen.L1-2: Facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Facet arthropathy. No significant spinal canal or foraminal stenosis. L3-4: Marked facet arthropathy and ligamentum flavum thickening. Disc bulging and disc uncovering asymmetric to the left. Moderate generalized spinal canal narrowing with some crowding of the nerve roots of the cauda equina. Both lateral recesses are narrowed. The left neural foramen is significantly narrowed with possible nerve root impingement. The right neural foramen remains patent. L4-5: Marked facet arthropathy and ligamentum flavum thickening. Bulging disc asymmetric to the right with a right paracentral protrusion. Moderate generalized narrowing of the spinal canal with right greater than left lateral recess effacement. The right neural foramen is moderately to severely narrowed while the left neural foramen is patent. L5-S1: Facet arthropathy. Minimal bulging disc. No significant spinal canal stenosis. Mild right foraminal narrowing.", "output": "1.No significant abnormalities are detected in the cervical spine to account for the patient's symptoms.2.Spinal canal narrowing with nerve root crowding is seen at L3-4 and L4-5. In addition, the left L3-4 and right L4-5 neural foramina demonstrate significant narrowing."}
{"instruction": "Generate impression based on findings.", "input": "24 year-old female with cystic mass over fifth metatarsal There is a lobulated lesion dorsal to the proximal fifth metatarsal measuring1.4 x 1.6 x 1.6 cm with heterogeneously increased T2 signal, intermediate T1 signal and heterogeneous enhancement. The lesion surrounds and appears inseparable from the extensor tendon sheath. The underlying bone marrow signal and cortex is within normal limits. There is mild edema and enhancement of the surrounding soft tissues.", "output": "Heterogeneously enhancing lesion dorsal to fifth metatarsal as described above for which an underlying infectious or neoplastic process should be considered. This would be atypical for a simple ganglion cyst, although a complicated cyst with hemorrhage or infection remains on the differential. Ultrasound guided biopsy may be considered for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Lower back pain, kyphosis, tight heel cord. Evaluate for syrinx or tethered cord, history of Marfan's syndrome, and kyphosis. There is mild to moderate cervicothoracic scoliosis centered at T4-5, with the apex directed to the left and associated straightening of the cervical and thoracic spine alignment in the sagittal plane. There is mild endplate deformity of multiple lumbar vertebrae. The vertebral body and disc space heights are otherwise preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at L1-2. There is no evidence of fibrofatty filum terminale. The paravertebral soft tissues are unremarkable. The cerebellar tonsils are not low-lying and there is intact CSF flow across the foramen of Monro.", "output": "1. Cervicothoracic scoliosis and mild endplate deformity of multiple lumbar vertebrae are likely stigmata of Marfan's syndrome. 2. No evidence of syringohydromyelia, low lying conus medullaris, or fibrofatty filum terminale."}
{"instruction": "Generate impression based on findings.", "input": " There is redemonstration in the trigone of the left lateral ventricle a cyst that measures 17 x 27 mm, not significantly changed since the previous study. The cyst is displacing the choroid plexus medially and follows spinal fluid signal on all pulse sequences.The brain parenchyma demonstrates no T2/FLAIR abnormalities. There are no diffusion or susceptibility abnormalities. Ventricular size is normal with no midline shift. There is no abnormal enhancement.Vascular flow voids are normal.There are mucous retention cysts in both maxillary sinuses, right more than the left.", "output": "Left lateral intraventricular cyst, unchanged in size since the previous study."}
{"instruction": "Generate impression based on findings.", "input": "Reason: hx seroma post drainage with recurrence. Eval size and location of seroma History: back pain There is a large fluid collection containing fluid levels in the dorsal subcutaneous fat at the L3-L5 level measuring 7.8 x 7.6 x 9.6 cm which extends from the paraspinal muscular fascia to the skin. This most likely represents a postoperative seroma and was not present on the exam from 1/31/2015.Alignment is anatomic. Vertebral body heights are intact. There is disc desiccation at L4-L5 and L5-S1. Marrow signal is normal normal signal and the distal cord and conus which ends at L1-L2. Postsurgical changes of left L4-L5 hemilaminectomy. T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Mild facet arthropathy and ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L3-L4: Right neural foraminal disc protrusion causing moderate to severe neural foraminal narrowing. Mild facet arthropathy and ligamentum flavum thickening. No spinal canal stenosisL4-L5: Large central disc protrusion causing mild to moderate spinal canal narrowing, improved from the prior exam. Mild facet arthropathy and ligamentum flavum thickening. Mild bilateral neural foraminal stenosis.L5-S1: Large central disc protrusion causing moderate spinal canal narrowing, unchanged. Mild facet arthropathy and ligamentum flavum thickening. Mild bilateral neural foraminal stenosis, left greater than right.", "output": "1.Large chronic hematoma/seroma in the dorsal subcutaneous tissues measuring 7.8 x 7.6 x 9.6 cm.2.Right neural foraminal protrusion at L3-L4 causing moderate to severe neural foraminal narrowing.3.Postsurgical changes of left L4-L5 hemilaminectomy with persistent large central protrusion and interval improvement in mild to moderate spinal canal narrowing4.Large central protrusion at L5-S1 with moderate spinal canal narrowing, unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Moya moya, f/u pial synangiosis: surveillance. MRI: There are areas of T2 hyperintensity in the subcortical and deep cerebral white matter bilaterally. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There are postoperative findings related to bilateral pial synangiosis. There is apparent focal loss of flow-related signal in the distal portion of the otherwise patent right superficial temporal artery at the microcraniotomy site, but there is abundant underlying pial vasculature. There is a small caliber left superficial temporal artery diffusely, but there is abundant underlying pial vasculature. There is severe steno-occlusive disease of the supraclinoid right internal carotid artery and proximal right middle and anterior cerebral arteries. There is also severe steno-occlusive disease throughout the length of the left internal carotid artery and proximal right middle and anterior cerebral arteries. There are numerous moyamoya collateral vessels. The posterior cerebral circulation is intact.", "output": "1. MRI: Stigmata of moyamoya disease with what may represent chronic ischemic disease, but no acute infarction. The degree of cerebrovascular steno-occlusive disease is similar to the prior exam. 2. MRA: Findings related to bilateral pial synangiosis with apparent focal loss of flow-related signal in the distal portion of the right superficial temporal artery at the microcraniotomy site, which may be due to stenosis or artifact, but there is abundant underlying pial vasculature. The left superficial temporal artery is of diffusely small caliber, but there is abundant underlying pial vasculature. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: T2DM with osteomyelitis, pain with WB on R ankle History: pain, NWB Patient is status post transmetatarsal amputation. Diffuse soft tissue swelling. Ulceration beneath the remaining base of the fifth metatarsal again noted. Please refer to recent prior MRI for fifth metatarsal base osteomyelitis description. We see no ankle joint effusion or ankle bone osteomyelitis. Mild deformity of the distal fibula likely represents old fracture. No acute fracture is evident.", "output": "Soft tissue swelling and ulceration as above. Please refer to recent prior MRI for fifth metatarsal base osteomyelitis description. No evidence of fracture or ankle osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs. Clinical concern for cholangitis. Patient also has history of cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: There is poorly defined increased T2 signal surrounding the intrahepatic bile ducts, left greater than right. This is a nonspecific finding but can be seen in the setting of inflammation/cholangitis. The left hepatic ducts are moderately dilated which accounting for differences in technique appears similar to most recent CT. The common bile duct has a stent in place, and there is debris proximal to and within the stent. Again seen is poorly defined soft tissue thickening the surrounding the distal common bile duct which measures 2.5 x 1.8 cm in maximum axial dimension compatible with the patient's known tumor.SPLEEN: No significant abnormality noted.PANCREAS: Mild pancreatic atrophy. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged ablation defect in the interpolar region of the right kidney.RETROPERITONEUM, LYMPH NODES: No upper abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right lateral abdominal wall broad-based hernia containing mesenteric fat and nonobstructed ascending colon.OTHER: Basilar subsegmental atelectasis and trace right pleural effusion.", "output": "1.Soft tissue mass surrounding the common bile duct compatible with the patient's known tumor appears similar to prior. There is left greater than right intrahepatic biliary ductal dilatation also not significantly changed. These bile ducts have surrounding increased T2 signal which is nonspecific but may be seen in the setting of inflammation/infection."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other symptoms and signs involving the musculoskeletal systemClinical question: Evaluate for venous sinus thrombosisSigns and Symptoms: Acute onset L sided weakness, headache MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.At the clinoidal segment of the right internal carotid artery there is a medially directed 3 mm broad-based aneurysm.There is no evidence for intracranial cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left transverse sinus and left sigmoid sinus are larger than the right-sided counterparts.", "output": "1.No evidence for cerebrovascular occlusive disease.2.There is a right internal carotid artery clinoid segment 3 mm aneurysm present3.MR venogram of the brain is within normal limits.4.There is no evidence for acute ischemic cerebral infarction.5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "54-year-old woman with history of IPMN, evaluate for stability. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder appear normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen is normal.PANCREAS: An 8 mm cystic focus in the pancreatic body/tail (series 11, image 55) is unchanged and appears to communicate with the pancreatic duct. The pancreas duct is nondilated.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable sidebranch IPMN."}
{"instruction": "Generate impression based on findings.", "input": "Rule-out AVN versus fracture in the lunate. Prior traumaIMAGE ACQUISITIONS: Ultrahigh routine CT of the right wrist was performed with 0.3-mm reconstruction. No enhancement The osseous structures remain in proper alignment with particular attention placed on the lunate relative to the radius, triquetrum and scaphoid. The shape of the lunate is normal without abnormality. Specifically no evidence of fracture or dislocation. No additional CT findings to suggest AVN, however please note MRI would be more sensitive in this early stage.A small benign-appearing cyst noted in the proximal pole of the scaphoid. Small bone island seen in the distal radius. The remainder of the wrist is otherwise unremarkable. Soft tissues normal.", "output": "No additional abnormality, specifically no CT findings to suggest AVN or fracture."}
{"instruction": "Generate impression based on findings.", "input": "Concern for CSF leak, infection. Recent resection of L1-L2 tumor. Five lumbar type vertebral bodies are presumed to be present. There is normal lumbar lordosis. Postsurgical changes of a left L1 hemi-laminectomy for tumor resection and posterior left L1-L2 fixation with pedicle screws and unilateral paraspinous rod are redemonstrated. Additionally, there appears to have been partial resection of the inferior aspect of the L1 vertebral body.There is a fluid collection extending along either side of the spinous processes from T12 to L3. The collection on the left measures 11 mm in thickness and 8 cm in its craniocaudal dimension and appears to communicate with the skin surface. While the fluid collection on the left has a relatively simple fluid appearance, the fluid collection on the right which measures approximately 9 cm in the craniocaudal dimension and 2 cm in thickness demonstrates significant heterogeneous signal, which likely reflects internal debris or blood products. There is peripheral enhancement associated with both collections. Increased enhancement of the paraspinal musculature, left greater than right, may reflect myositis. There is no evidence of epidural abscess or discitis/osteomyelitis. No residual tumor is definitively appreciated The vertebral body and disk heights are well-maintained. Disc desiccation and disc bulge with mild to moderate narrowing of the neuroforamina affects L5-S1. There is no significant spinal canal stenosis. No focal marrow signal abnormality is appreciated. The conus medullaris and cauda equina nerve roots are unremarkable.", "output": "1. Posterior paraspinous fluid collection from T11 to the L3 levels with peripheral enhancement and inflammatory changes in the adjacent musculature. Given recent surgery, differentials include seroma and pseudomeningocele with superimposed infection/abscess not excluded. The fluid collection component on the right demonstrates heterogeneous signal likely reflecting internal debris/blood products while the fluid collection on the left demonstrates signal features more compatible with simple fluid. The collection on the left appears to extend to the skin surface along the surgical tract. Fluid sampling is suggested for further evaluation.2. There is no epidural abscess or spinal canal stenosis at any level."}
{"instruction": "Generate impression based on findings.", "input": "46 year old with biopsy proven grade 3 IDC in the right breast with metastatic right axillary lymph node. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A heterogeneously enhancing mass, measuring 38 x 39 x 37 mm (AP x LR x CC), which is a proven carcinoma, is present at 9:00 position in the right breast. A marker clip is identified at anterior-lateral aspect within the mass. Anterior to this mass, there is a linear non-mass enhancement measuring 28 x 25 x 19 mm, suspicious for extensive disease. Overall, the enhancing lesions measure 66 mm (AP).In the right superior axilla, there is an abnormally enlarged lymph node, a proven metastatic lymph node, measuring 44 mm. Post biopsy changes are seen in the cetral aspect of the lymph node. A marker clip is present at the anterior edge of the lymph node. There are two additional abnormal nodes, both approximately 1 cm in diameter, located posterior to the proven lymph node.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in left axillary region.", "output": "1. Proven right breast cancer with possible anterior non-mass extension 2. Proven right metastatic axillary lymph node, with additional suspicious nodes.3. No MR evidence of malignancy in the left breast or left axilla BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "76 years Male (DOB:8/12/1939)Reason: hx L3-4 bilateral Lami s/p 1 month. eval for stenosis above/below. History: c/o LBP, pain down legs when standingPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation present at this level. There is some mild ligamentum flavum hypertrophy present at this level.At L4-5 there is loss of disc space height, diffuse disc bulge and endplate reactive changes with a Schmorl's node. The endplate reactive changes are mildly elevated in signal on T2 and predominantly high signal on T1. There is some ligamentum flavum hypertrophy present at this level. There is partial effacement of the fat at the right lateral recess at this level. There is some partial effacement of the fat surrounding the right-sided exiting nerve roots at this level.At L3-4 there is loss of disc space height and disc desiccation associated with a large right lateral recess disc extrusion. Disc material extends into the right neural foramen and also effaces the fat at the right lateral recess at this level. There is a superimposed disc bulge at this level. There are endplate reactive changes present at this level which are high signal on T1 and T2 associated with small Schmorl's nodes atThere is a 17 x 14 mm axial dimension T2 hyperintense focus present along the right L3 lamina which represents a laminotomy defect.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.There is a large right lateral recess disc extrusion present at L3-4 which encroaches on the nerve roots at the right lateral recess and in the right neural foramen at this level. It also creates mild degree of spinal stenosis.2.Status post right laminotomy at L3-4.3.There is mild encroachment of the right-sided exiting nerve roots at L4-5 due to a disc disease."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female status post fall with positive forgetfulness and headaches. Concern for subdural hematoma. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of hypoattenuation in the periventricular and subcortical white matter distribution consistent with small vessel ischemic disease common age indeterminate. If there is clinical concern for ischemia, an MRI may be considered.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": "Small vessel disease, age indeterminate. If there is clinical concern for ischemia, MRI may be considered."}
{"instruction": "Generate impression based on findings.", "input": "Female, 52 years old, with headache. A 5 mm lesion is redemonstrated within the right occipital lobe showing internal T2 hyperintensity and a rim of surrounding susceptibility effect. The lesion has not changed in size. The surrounding parenchyma is free of edema. Adjacent curvilinear enhancement most likely represents a developmental venous anomaly.Several scattered small foci of nonspecific FLAIR hyperintensity are redemonstrated within the cerebral hemispheres showing no significant interval change. No edema or mass effect is detected. No abnormal extra-axial fluid collections are seen and there is no evidence to suggest acute intracranial hemorrhage. Ventricular size and morphology are within normal limits. No additional pathologic enhancement is identified intracranially.", "output": "1.Stable presumed right occipital cavernous malformation with an associated developmental venous anomaly.2.Stable scattered foci of nonspecific signal abnormality.3.No new or additional findings are seen to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Right foot/ankle mass; chronic pain Ankle/hindfoot: There is slight prominence of the subcutaneous fatty tissue anterior to the lateral malleolus which could represent a lipoma but this is equivocal. There is otherwise no discrete mass identified. There is minimal edema of the subcutaneous fat about the ankle both medially and laterally. There is slight signal heterogeneity of the deep fibers of the deltoid ligament which may represent prior sprain. The remaining ligaments, tendons, and soft tissues are unremarkable.Midfoot/forefoot: Mild osteoarthritis affects the first MTP joint and there is a mild hallux valgus deformity. There is mild edema of the soft tissues at the bases of the first and second toes. A couple of small (less than 5 mm) foci of high signal intensity are seen lateral to the proximal phalanx of the second toe which are nonspecific in nature and may represent small ganglia or even nerve sheath tumors but are of questionable clinical significance. The location of these foci is slightly distal for the typical presentation of a Morton neuroma. The bone marrow signal intensity of the foot is normal.", "output": "1. Mild nonspecific soft tissue edema of the foot and ankle as described above.2. Prominence of the subcutaneous fat anterior to the lateral malleolus may represent a lipoma but this is equivocal. There is otherwise no discrete mass identified.3. Small foci of increased signal intensity lateral to the proximal phalanx of the second toe which are of uncertain clinical significance and etiology but may represent ganglia or perhaps nerve sheath tumors. Morton neuroma is considered less likely given the relatively distal location."}
{"instruction": "Generate impression based on findings.", "input": "13-year-old male with history of juvenile angiofibroma status post surgery. Evaluate for recurrence. BRAIN: There is no evidence of intracranial hemorrhage, mass or edema. There is no abnormal postcontrast enhancement. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses demonstrate postsurgical changes of the nasopharynx without definitive soft tissue enhancement to suggest tumor recurrence. The left maxillary sinus is near completely opacified which is likely postinflammatory however residual/recurrent tumor cannot be definitively identified and follow a MRI is recommended for further characterization.The surgical cavity and right masticator space gastric postsurgical changes without evidence of abnormal enhancement.The remainder of the soft tissues of the neck are normal in appearance. The oropharynx demonstrates bilaterally enlarged tonsils which are touching however not entirely occluding the airway.", "output": "1. Normal brain CT.2. No postcontrast enhancement to suggest residual or recurrent tumor however left maxillary sinus opacification cannot definitively identify tumor recurrence. A follow-up MRI is recommended for further characterization."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for abnormality/metastatic disease; history ovarian cancer. Brain: There is a peripherally enhancing mass in the medial left occipital lobe that measures up to 24 mm, with extensive surrounding vasogenic edema. There is also a heterogeneously enhancing mass in the right cerebellar hemisphere, which measures up to 15 mm, also with extensive surrounding vasogenic edema. The cerebellar tonsils extend up to 6 mm inferior to the foramen magnum. There is no evidence of intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Complete Spine: There is fatty bone marrow signal in the lumbosacral spine related to radiation effects. There is also irregular linear low T1 signal and enhancement that traverses the right sacral ala. There are prominent sacral perineural cysts with remodelling of the sacrum. Otherwise, there is no evidence of mass lesions in the spine. There are mild degenerative changes in the lower cervical spine and at L5-S1 without significant spinal canal stenosis. The vertebral body heights are preserved. There is no significant spondylolisthesis. The spinal cord signal and morphology is normal. There is a right pleural effusion.", "output": "1. Metastases in the right cerebellar hemisphere and left occipital lobe with associated vasogenic edema.2. Radiation effects in the lumbosacral spine bone marrow with probable right sacral insufficiency fracture versus less likely an infiltrative metastasis.3. Low-lying cerebellar tonsils may represent Chiari 1 malformation.4. Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "59 years Female (DOB:10/19/1956)Reason: 3T scanner, please evaluate for Moyamoya disease, hx of TIA, recent syncopal episode, last imaging in 2014, please compare History: 3T scanner, please evaluate for Moyamoya disease, hx of TIA, recent syncopal episode, last imaging in 2014, please comparePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.There is diffuse marrow replacement present.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses right more than left. There is mild mucosal thickening in the right anterior ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is mild narrowing at the origin of the left middle cerebral artery. There is mild to moderate narrowing of the proximal portion of the inferior division of the left middle cerebral artery with approximately 50% narrowing. This is stable compared to the prior exam. The inferior division of the left middle cerebral artery is the dominant division.There is approximately 25% narrowing at the proximal right middle cerebral artery present. This is stable compared to the prior exam.There is mild narrowing at the left P2 segment of the posterior cerebral artery by approximately 30%. This is stable compared to the prior exam.There is no evidence for intracranial aneurysm.The anterior communicating artery is identified. The posterior communicating arteries are intact. The vertebral arteries are similar in size.There is extracranial origin of the right posterior inferior cerebellar artery present.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. There is 50% narrowing at the origin of the left vertebral artery. This is stable compared to the prior exam.", "output": "1.Two foci of narrowing are present along the left M1 segment. One at its origin is 30% narrowed and one at the proximal portion of the inferior division is 50% narrowed by WASID criteria. This is stable compared to the prior exam.2.There is mild narrowing of the proximal right middle cerebral artery present but also the left P2 segment of the PCA. This is stable compared to the prior exam.3.There is 50% narrowing at the origin of the left vertebral artery. This is stable compared to the prior exam.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. They are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: OA, spinal stenosis Symptoms: back pain Thoracic spine:Thoracic kyphosis and dextroscoliosis of the lower thoracolumbar spine is grossly similar. Otherwise alignment is anatomic. Multilevel heterogeneous marrow signal likely reflects focal fat. Mildly increased endplate degenerative changes at T7-T8 with associated increased STIR signal. Foci of increased T2 signal in T9 may represent hemangiomas. Multilevel disc desiccation. Vertebral body heights are intact. No abnormal signal within the cord. Right neural foraminal disc protrusion at T7-T8 is unchanged. No significant neural foraminal stenosis at this level. No significant spinal or neuroforaminal stenosis at any level.Lumbar spine:Grade 1 anterolisthesis of L3 on L4, slightly worse in the prior exam. Focus of low signal in the L1 and L3 vertebral bodies are unchanged. Otherwise, heterogeneous marrow signal appears similar to the exam. Mild endplate degenerative changes at L5-S1 slightly increased STIR signal. Multilevel disc desiccation with disc space loss, most severe at L4-L5 and L5-S1. Disc space loss at T12-L1 and L3-L4 may be minimally worse since the prior exam. No abnormal signal within the distal cord or conus, which ends at L1.T12-L1: Small left neural foraminal disc protrusion is slightly increased. Mild facet arthropathy. Mild left neural foraminal stenosis, unchanged. No spinal canal stenosis.L1-L2: No disc herniation.. Mild facet arthropathy No spinal canal or neural foraminal stenosis.L2-L3: Diffuse disc bulge with small central protrusion, unchanged. Mild facet arthropathy and ligamentum flavum thickening. Minimal spinal canal narrowing is unchanged. No neural foraminal stenosis.L3-L4: Large right paracentral disc extrusion extending 1.6 cm superiorly is new from the prior exam and narrows the right lateral recess. Mild facet arthropathy. Mild left neural foraminal stenosis is unchanged.L4-L5: No disc herniation. Mild facet arthropathy. Minimal bilateral neural foraminal narrowing is unchanged. No spinal canal stenosis.L5-S1: No disc herniation. No spinal canal or neural foraminal stenosis.Mild fatty atrophy of the paraspinous muscles. Left kidney is atrophic with small cysts. Subtle deformity of the aorta at L3 may represent ectasia is unchanged since the prior exam", "output": "1.New right paracentral disc extrusion at L3-L4.2.Multilevel degenerative changes in the thoracic spine, minimally increased."}
{"instruction": "Generate impression based on findings.", "input": "History of lung cancer, evaluation for metastasis. Generalized weakness. No evidence of acute ischemic or hemorrhagic lesion.Minimal brain atrophy which is age appropriate.Multifocal scattered small high signal intensity lesions on FLAIR imaging indicating nonspecific small vessel ischemic disease. No change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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": "No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "17 years Male (DOB:7/24/1998)Reason: evaluate for residual tumor History: s/p tumor and seizure focus resectionPROVIDER/ATTENDING NAME: PAULA L ZAKRZEWSKI JASON M KANE Since the prior exam patient is undergone right-sided craniotomy and right temporal lobectomy for a right temporal lobe mass. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There are blood products along the path of a previously placed in depth electrode as well as within the temporal lobe resection site. There are some superficial enhancement along the surface of the brain at the surgical site.A small extra-axial hemorrhagic collection is present adjacent to the depth electrode insertion site measuring about 7 mm in thickness and 38 mm in width. Another extra-axial collection of blood is present adjacent to the right frontal and parietal lobes at the surgical site measuring up to 5 mm in width.There is a scalp soft tissue swelling along the right parietal and frontal scalp as well as edema within the right temporalis muscle.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.", "output": "Status post right temporal lobe surgery. There are blood products at the surgical site and along the extra-axial spaces adjacent to the craniotomy and burr hole sites. There is no convincing evidence for residual neoplasm. Please note however, that postoperative changes may mask a tiny nodule on MRI. The follow-up exam would be helpful in further evaluating for residual or recurrent tumor."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with effusion, left ankle neurofibromatosis, unspecified. Evaluate cause of swelling, patient with neurofibromatosis and multiple invasive neurofibromas. There is a joint effusion within the subtalar joint and sinus tarsus which demonstrates low T1 signal, intermediate T2 signal with enhancement compatible with synovitis. There is fluid and thickened synovium within the tendon sheath of the posterior tibialis tendon compatible with tenosynovitis. There is thickening and stranding of the adjacent medial subcutaneous tissues compatible with inflammatory changes. The posterior tibialis muscle appears normal. The remaining tendons and muscles of the ankle appear normal. Within the anterior calcaneus there is an area which demonstrates low T1 signal and intermediate T2 signal with mild enhancement in a tubular configuration compatible with a vascular remnant, which is a normal variant and of no clinical significance. Otherwise the bone marrow signal appears normal.The ligaments of the ankle appear normal.", "output": "1. No findings to suggest neurofibromatosis in the left ankle.2. Synovitis of the subtalar joint and sinus tarsus.3. Tenosynovitis of the posterior tibialis tendon with adjacent inflammatory changes in the medial subcutaneous soft tissues.4. Normal variant vascular remnant within the calcaneus, of no clinical significance."}
{"instruction": "Generate impression based on findings.", "input": "Right wrist/hand pain, decreased range of motion. Bone marrow signal intensity is normal. Note is made of congenital coalition of the lunate and triquetrum, a normal variant. There is perhaps mild synovitis dorsal to the proximal carpal row, but this is equivocal. The metacarpophalangeal joints appear normal. This study was not protocoled for detailed evaluation of the ligaments, but I see no gross abnormalities. Subjectively, there appears to be slight dorsal subluxation of the ulna relative to the sigmoid notch of the radius; however, using the modified radioulnar method of measurement as well as the epicenter method of measurement, distal radioulnar joint alignment is within normal limits. The visualized portions of the tendons of the hand and wrist appear normal. I see no definite abnormalities of the triangular fibrocartilage complex; apparent increase in signal intensity along the volar aspect of the volar radioulnar ligament likely simply represents interface with the ulnolunate and ulnotriquetral ligaments. The remaining soft tissue structures appear normal.", "output": "There is perhaps mild synovitis dorsal to the proximal carpal row, but I otherwise see no definite findings to account for the patient's pain. Although subjectively there appears to be slight dorsal subluxation of the distal ulna relative to the sigmoid notch of the radius, measurements do not support a true subluxation. If there is clinical concern for distal radioulnar joint instability then bilateral wrist CT with neutral, supination, and pronation positioning may be considered."}
{"instruction": "Generate impression based on findings.", "input": "48 years Male (DOB:9/18/1968)Reason: radiculopathy History: pain in back/left legPROVIDER/ATTENDING NAME: WEI WEI LEE WEI WEI LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.The patient is status post posterior fusion with pedicle screws at L5 and S1 associated with interconnecting rods. Patient is status post anterior fusion with disc spacer at L5-S1. The patient is status post laminectomy at L5. There is mild anterior subluxation of L5 on S1.At L5-S1 there is mild anterior subluxation of L5 on S1. There is increase in the AP dimension of the spinal canal at this level. There is narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots related to a diffuse disc bulge. There is someAt L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.Status post lumbar spine surgery at L5-S1. There is encroachment of the exiting nerve roots within the neural foramina at this level due to disc bulge."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old male with history of cystic fibrosis related pancreatic insufficiency. Evaluate for cause of epigastric pain. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Mildly increased signal on opposed phase images in the liver diffusely, suggestive of iron deposition. Trace perihepatic ascites. No biliary ductal dilation. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: Fatty replacement of the pancreas, likely secondary to known cystic fibrosis and similar to prior CT. No pancreatic duct dilation. Poor physiologic response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst and other too small to characterize T2 hyperintense lesions in both kidneys, likely additional 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.Cholelithiasis without evidence of cholecystitis.2.Fatty replacement of the pancreas with poor physiologic response to secretin."}
{"instruction": "Generate impression based on findings.", "input": "36 years old, Female. 19 weeks gestational age. History of fetal ventriculomegaly, abnormal ultrasound. The exam is limited by fetal motion. Lack of sulcation is appropriate for reported gestational age of 19 weeks. The right ventricle measures up to 10 mm at the level of the atrium. The left ventricle measures up to 9 mm at the level of atrium. The fourth ventricle is not enlarged. No large intracranial mass or hemorrhage. No cystic lesion is evident. Although not well visualized, the corpus callosum appears present. Posterior fossa structures are normal for gestational age.", "output": "1. The right lateral ventricle is top normal in size. The left lateral ventricle is within normal limits in size.2. Given the limitations of a motion degraded exam, no significant intracranial abnormality is visualized."}
{"instruction": "Generate impression based on findings.", "input": "Left knee pain MENISCI: There is a complex tear of the lateral meniscus with intercondylar displaced component. Medial meniscus is normal in signal characteristics and morphology.ARTICULAR CARTILAGE AND BONE: The osseous alignment is anatomic. The bone marrow edema in the intercondylar region of the tibia and femur is likely degenerative. There is also a small fluid collection within the tibia at this region, likely subchondral cyst formation. LIGAMENTS: Collateral ligaments and cruciate ligaments are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL", "output": "Complex tear of the lateral meniscus with intercondylar displaced component. There is likely degenerative bone marrow edema of the tibia and femur. Other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "History of right foot sarcoma. Assess for recurrence. Again seen are postoperative findings related to resection of myxoinflammatory fibroblastic sarcoma. Overall, skin thickening and dorsal subcutaneous edema has decreased. A nonenhancing fluid collection previously described as a seroma also has decreased in size.There is a tiny, 4 to 5 mm, lobulated enhancing nodule within the subcutaneous fat dorsal to the second/third cuneiforms. The lesion demonstrates increased T2 signal and is also slightly hyperintense to skeletal muscle on T1 images, perhaps due to volume averaging with surrounding subcutaneous fat. It was not seen on the initial postoperative study from 8/4/2014, and we therefore cannot exclude the possibility of residual or recurrent tumor. However, review of the preoperative MRI from 1/14/2014 also shows no definite tumor in this location, and therefore it is possible this may not represent malignancy (e.g., a small neuroma).Mild poorly defined enhancement of the subcutaneous fat is noted along the dorsomedial aspect of the midfoot, which corresponds to hypointense T1 and T2 signal abnormality, and may represent scarring. A small cystic lesion in the navicular bone with surrounding edema and enhancement appears similar to that seen on the prior study and may be degenerative in etiology. The bones and muscles otherwise appear within normal limits.", "output": "Postoperative changes related to resection of myxoinflammatory fibroblastic sarcoma with overall decrease in dorsal soft tissue edema. New small enhancing nodule in the dorsal soft tissues of the midfoot may represent tumor recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Female, 5 months old, with E. coli meningitis, cerebritis and ventriculitis. Assess size of subdural abscess and for residual ventricular abscess. Since the prior examination, a small left parietal craniotomy has been performed through which the previously seen left-sided extra-axial abscess has been evacuated. The collection is much smaller than that seen on the prior examination with only trace residual diffusion restricting material.There is air within the ventricular system and the right frontal approach EVD has been replaced. The catheter now takes a more medial course into the third ventricle. The ventricles remain markedly dilated, the severity of which is stable to minimally increased when compared to the immediate prior examination. The quantity of diffusion restricting debris within the ventricular system has slightly decreased.On postcontrast images, ependymal enhancement persists in the periatrial and temporal regions, similar to the prior examination. The previous rim-enhancing left parietal collection has collapsed into a small residual cavity with thick enhancement of the surrounding dura. No new enhancing lesions are seen.Marked parenchymal thinning is again seen. T2 hyperintensity within the anterior temporal lobes is unchanged. Mild periventricular T2 hyperintensity elsewhere, and a focus of abnormal signal within the right pons, are also unchanged.", "output": "1.Postoperative findings are seen compatible with evacuation of a left parietal extra-axial abscess. Only a small amount of residual diffusion restricting material is seen.2.Findings are seen compatible with endoscopic intervention and replacement of the right-sided EVD. Ventricular caliber is stable to very slightly increased relative to the prior exam.3.The quantity of diffusion restricting infectious debris within the ventricular system has decreased. Ependymal enhancement is unchanged.4.Generalized parenchymal thinning with areas of parenchymal signal abnormality are also unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Cervicalgia. Pain with movement. Rule out DJD, bulging disc or herniation. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild straightening of the cervical spinal curvature. Alignment is otherwise maintained. Bone marrow signal is benign. Fatty endplate marrow signal changes are evident at the C5-C6 level which are on a degenerative basis. There is moderate disc height loss at the C5-C6 and C6-C7 levels.The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancement.There is mild development of narrowing of the cervical spinal canal with superimposed degenerative changes as described below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a small central/bilateral paracentral disc protrusion. No significant compromise to the spinal canal. There is mild left neural foraminal stenosis related to facet arthropathy. Right neural foramen is patentC4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a disc osteophyte complex with mild to moderate degree of spinal canal stenosis. Bilateral uncovertebral hypertrophy contributes to mild to moderate bilateral, right greater than left, neural foraminal stenosis. These findings are similar to prior.C6-7: There is a disc osteophyte complex with slight interval increase in disc bulge component at this level. There is moderate spinal canal stenosis which is worse since 2/8/2016. There is also uncovertebral hypertrophy with associated moderate bilateral, left worse than right, neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.There is also mild generalized facet arthropathy throughout the cervical spine. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "1. Multilevel degenerative changes in the cervical spine, worst at the C6-C7 and to a slightly lesser degree C5-C6 levels. There is moderate spinal canal stenosis at C6-C7 which is mildly worse since 2/8/2016. There is also moderate degree of bilateral neural foraminal stenosis at C6-C7.2. Additional levels as above."}
{"instruction": "Generate impression based on findings.", "input": "17-year-old male presents with chronic left shoulder pain, evaluate for shoulder pathology. ROTATOR CUFF: There is no complete or partial rotator cuff tear. The subscapularis constituent of the rotator cuff is intact. No bursal effusion or thickening is seen. There is no muscular tear, contusion, or atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Humeral head articulates well with the glenoid. No labral tear is identified. There is no glenohumeral joint effusion. There are no SLAP or soft tissue Bankart lesions. No paralabral cysts are seen.BICEPS TENDON: The biceps tendon is normally situated within the bicipital groove. No complete or partial biceps tendon tear is present. ADDITIONAL", "output": "Normal examination. No complete tear of the rotator cuff. No Hill-Sachs, reverse Hill-Sachs, or bone Bankart lesions are seen."}
{"instruction": "Generate impression based on findings.", "input": "History of lumbar fusion: back and left leg pain. There are postoperative findings related to posterior fusion with pedicle screws and interconnecting rods at the L5-S1 level. Artifact related to the surgical hardware limits the assessment of adjacent structures. There is bilateral spondylolysis at L5 with minimal anterolisthesis of L5 upon S1, as well as mild loss of disc space height at this level. Loosening and fracture of the S1 screws is better delineated on the prior CT. There is no definite evidence of neural foraminal or spinal canal stenosis. The vertebral body heights are preserved. The imaged portions of the spinal cord and cauda equina nerve roots appear unremarkable. The vertebral bone marrow signal appears unremarkable beyond the portions obscured by surgical hardware artifact. Aside from postoperative findings in the lumbosacral region, the paraspinal soft tissues appear to be unremarkable.", "output": "1. Postoperative findings related to posterior fusion with pedicle screws and interconnecting rods at the L5-S1 level. Artifact related to the surgical hardware limits the assessment of adjacent structures and loosening and fracture of the S1 screws is better delineated on the prior CT. 2. Bilateral spondylolysis at L5 with minimal anterolisthesis of L5 upon S13. No definite evidence of neural foraminal or spinal canal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Change in mental status and function. The images are degraded by patient motion. There is no evidence of intracranial hemorrhage or acute infarct. There is scattered periventricular and subcortical white matter T2 signal hyperintensity, compatible with chronic microvascular ischemic disease. More focal areas of signal abnormality in the left occipital lobe and basil ganglia suggest chronic lacunar infarcts. There is moderate global parenchymal volume loss. There is a partially empty sella. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.", "output": "1. Findings compatible with chronic microvascular ischemic disease and chronic lacunar infarcts, without evidence of acute infarct or intracranial hemorrhage.2. Moderate cerebral volume loss.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 2 y/o with hemophilia , new onset seizures, r/o tumor vs structural cause History: new onset seizures Exam slightly limited by patient motion.The brain parenchyma appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The hippocampi are symmetric bilaterally without abnormal signal or atrophy. No heterotopic gray matter or cortical abnormalities. Normal myelination for age. Midline structures are normal. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.", "output": "MRI of the brain appears within normal limits without evidence of structural mass or other abnormality to suggest seizure focus. If there is continued suspicion for a structural abnormality, high-resolution imaging with epilepsy protocol may be considered. "}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male with history of multiple sclerosis experiencing left-sided weakness. Brain MRI:Restricted diffusion with ADC hypointensity within the left cerebellar hemisphere correlates with previously identified increased hypoattenuation within the left cerebellar hemisphere. To a lesser extent, there are a few small foci of restricted diffusion with ADC hypointensity within the right cerebellar hemisphere and vermis. This is associated with some folio effacement on the left, T2 hyperintensity,T1 hypointensity, and a minimal degree of enhancement. This constellation of findings is consistent with subacute infarction. Previously identified supratentorial restricted diffusion in 2012 has resolved.Redemonstrated is T2 hyperintensity within the white matter, confluent in many locations, without associated mass effect correlating with previous hypodense abnormality on CT. There is no associated enhancement. Encephalomalacia in the right parietal lobe and right frontal lobe from prior remote infarct is noted. Prominence of the right sylvian fissure is again noted as identified on the recent head CT, correlating with evolution of the restricted diffusion identified on the 2012 MRI.Mucosal thickening is again noted within the left maxillary sinus. Expected vascular flow-voids are demonstrated, including the distal bilateral vertebral arteries and basilar artery.Cervical spine MRI:Numerous foci of T2 hyperintensity are noted within the cervical cord, most prominently identified at the following levels: C2, C3, C4, C5/6, C7, and T1.There are no fractures. The marrow signal is benign. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Mild posterior osteophyte disc complex, ligamentum flavum thickening, left uncinate hypertrophy, and left facet hypertrophy. There is moderate left neural foraminal stenosis.C3/4: Trace retrolisthesis C3 on C4, posterior osteophyte disc complex, uncinate hypertrophy, ligamentum flavum thickening, and left facet hypertrophy. There is mild central and severe bilateral neural foraminal stenosis.C4/5: Trace retrolisthesis C4 on C5, posterior osteophyte disc complex, uncinate hypertrophy, ligamentum flavum thickening, and minimal left facet hypertrophy. There is minimal central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, left uncinate hypertrophy, and ligamentum flavum thickening. There is moderate left neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex without significant stenosis.", "output": "1.Findings consistent with subacute infarction involving the cerebellar hemispheres (left greater than right) and vermis.2.Redemonstrated is extensive T2 abnormality within the supratentorial white matter, none of which enhances. Some of this correlates with previously identified foci of ischemia. However, the findings most likely represent a confluence of the patient's known multiple sclerosis and superimposed vascular disease.3.Numerous foci of T2 hyperintensity are noted within the cervical cord, most prominently identified at the following levels: C2, C3, C4, C5/6, C7, and T1.4.C2/3: Moderate left neural foraminal stenosis.5.C3/4: Mild central and severe bilateral neural foraminal stenosis.6.C4/5: Minimal central and severe bilateral neural foraminal stenosis.7.C5/6: Severe bilateral neural foraminal stenosis.8.C6/7: Moderate left neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male patient with cholestasis, liver biopsy with biliary perforation with suggestion of extrahepatic biliary obstruction. Patient is status post OLT. Limited study due to the lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense lesions in the right lobe of the liver likely represent cysts. Mild intrahepatic biliary ductal dilatation. At the expected level of the anastomosis, there appears to be a focal stricture (series 5 image 82). There also may be narrowing of the common bile duct at the level of the ampulla.The hepatic vasculature appears patent.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mild intrahepatic biliary ductal dilatation with concern for a stricture at the expected level of the anastomosis with question of narrowing at the ampulla. Recommend an ERCP for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Multiple sclerosis. There are multiple T2 hyperintense lesions in the cerebral white matter bilaterally, which are stable to slightly progressed since 2014, although precise comparison is limited due to differences in technique. Most of the lesions demonstrate T1 hypointensity as well. There may also be a few punctate infratentorial T2 hyperintense lesions. There is no evidence of mass lesions. 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": "The intracranial demyelinating lesions are stable to slightly progressed since 2014, although precise comparison is limited due to differences in technique. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess PVT History: PVT, cirrhosis ABDOMEN:LUNGS: A small right and trace left pleural effusion are new since the prior exam.LIVER, BILIARY TRACT: There is a cirrhotic liver morphology with perisplenic collaterals and perigastric and esophageal varices, similar to the prior exam. Right hepatic hypodensity without arterial enhancement appears similar to the prior exam (9/256). No suspicious hepatic lesions. There is linear hypodensity within the portal vein at the hepatic hilum branching into the right and left portal veins, likely represents a web, similar to the prior exam. The main portal vein is slightly diminutive but patent. The SMV and splenic veins are patent.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged portacaval lymph node appears similar to the prior exam.BOWEL, MESENTERY: Colonic wall thickening likely represents hepatic colopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominal ascites appears to the prior exam.", "output": "1.Hepatic cirrhosis and sequela of portal hypertension without suspicious hepatic lesions.2.Linear filling defect within the main portal vein at the hepatic hilum likely represents a web from recannulization of prior thrombus, appearing similar to the prior exam. The portal vein is otherwise patent.3.Ascites and right pleural effusion suggestive of hepatic hydrothorax."}
{"instruction": "Generate impression based on findings.", "input": "Female, 70 years old, with left lower extremity radicular pain. Prior imaging showed L5-S1 nerve impingement. A trace retrolisthesis of L5 relative to S1 is noted. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. A Schmorl's node is evident at L1-2. Mild endplate degenerative signal is seen at L5-S1. No concerning marrow replacement is detected. Edema is demonstrated within the L5 pedicles.The visualized distal spinal cord and conus are unremarkable. No epidural abnormalities are suspected.Since the prior examination, loss of disc height has progressed at L1-2 and L5-S1. All of the lumbar discs demonstrate loss of T2 signal. Additional level specific findings are as follows:L1-2: Mild facet hypertrophy. Bulging disc asymmetric to the right with a possible right foraminal protrusion. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing, slightly progressed. L2-3: Facet hypertrophy and ligamentum flavum thickening. Minimal bulging disc. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Facet hypertrophy and ligamentum flavum thickening. Minimal bulging disc. Mild spinal canal narrowing. No significant foraminal narrowing. No interval changes. L4-5: Facet hypertrophy and ligamentum flavum thickening, progressed, particularly on the left. Bulging disc, not significantly changed. Generalized spinal canal stenosis with particular effacement of the left lateral recess and likely impingement of the descending left L5 nerve root. The neural foramina are not significantly narrowed. L5-S1: Facet hypertrophy. Mild bulging disc. A previously seen left paracentral and subarticular protrusion has resolved. There is no significant spinal canal stenosis. Severe right and moderate left foraminal narrowing, unchanged.", "output": "1.Progressive facet and ligamentous degeneration on the left at L4-5 which results in a worsened left lateral recess narrowing and possible impingement of the descending left L5 nerve root.2.A previously seen disc protrusion at L5-S1 has resolved with no significant residual canal stenosis or nerve impingement. The right foramen at this level is, however, significantly narrowed.3.No additional areas of high-grade spinal canal or foraminal stenosis are seen."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old female patient with cirrhosis and liver failure. Note that the examination is suboptimal secondary to previous injection of gadolinium contrast.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. There is a segment 4B exophytic lesion measuring 5.3 x 5.1 cm (series 1101 image 151) that does not demonstrate enhancement, but does demonstrate slight washout on portal venous and delayed imaging. This lesion does not have T2 hyperintensity or diffusion restriction. There is no intra or extrahepatic biliary duct dilatation. The portal vein is mildly diminutive. The hepatic vasculature is patent. There is perihepatic ascites and paraumbilical collaterals.Gallbladder wall thickening likely secondary to hypoalbuminemia and there is vicarious excretion of prior contrast into the gallbladder lumen.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The inferior vena cava is mildly enlarged.BOWEL, MESENTERY: There is bowel wall thickening that is most likely secondary to hypertensive colopathy.BONES, SOFT TISSUES: Diffuse anasarca. Right breast implant with intracapsular rupture noted.OTHER: Intra-abdominal ascites.", "output": "1.Suboptimal examination due to the previous administration of intravenous contrast.2.Cirrhotic liver morphology and findings consistent with portal hypertension.3.Segment 4B exophytic lesion with features that not meet strict criteria for hepatocellular carcinoma. Follow up of this lesion is recommended.4.Right breast implant with intracapsular rupture."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male status post OLT for HCC/HCV. Evaluate for lesions and assess hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: No suspicious focal hepatic lesions. Mild wedge-shaped T2 signal abnormality in segment 8 is likely related to perfusional change due to thrombosed portal vein (see below). No intra-or extrahepatic biliary ductal dilatation. Mild pneumobilia, similar to prior CT on 2/10/2015.The proper hepatic artery and its branches are patent. Limited evaluation of the common hepatic artery due to artifact from surgical clips. Main portal vein, left portal vein, and most of the right portal vein are patent. A segment 8 branch of the portal vein is thrombosed, similar to prior CT on 11/18/2014 (series 103/43). Hepatic veins are patent.SPLEEN: Splenomegaly with the spleen measuring 15.2 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple peri-splenic and gastroesophageal varices are again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Complex collection within the anterior abdominal wall seen on prior CT on 2/10/2015 is decreased in size with small residual collection measuring up to 2.6 x 1 cm (series 8/13).OTHER: No significant abnormality noted.", "output": "1. Postsurgical changes from liver transplantation. No suspicious focal hepatic lesions. Stable appearance of the hepatic vasculature as detailed above.2. Complex collection within the anterior abdominal wall seen on prior CT has decreased in size."}
{"instruction": "Generate impression based on findings.", "input": "Lumbar radiculopathy, evaluate for nerve compression at L5-S1. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is moderate levoscoliosis of the lumbar spine with apex at the L2-L3 level. Bone marrow signal is benign. The conus medullaris is normal in position. There are multilevel degenerative changes with disc desiccation throughout the lumbar spine and loss of height which is particularly worse at the L4-L5 and L5-S1 levels. There are fatty associated endplate marrow signal changes.Multilevel degenerative changes are seen, as described below:T12-L1: There is mild spinal canal stenosis related to mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is mild to moderate left greater than right neural foraminal narrowing.L1-L2: Minimal disc bulge and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.L2-L3: Disc height loss particularly on the right. There is mild disc bulge with small central protrusion. There is bilateral facet arthropathy, with likely small subchondral cyst involving the left facet joint. There is also ligamentum flavum thickening. These changes contribute to mild to moderate spinal canal stenosis at this level. There is moderate to severe right neural foraminal stenosis where there may be impingement of the right L2 nerve root. There is moderate left neural foraminal stenosis.L3-L4: Mild disc bulge and moderate bilateral facet arthropathy. There is mild bilateral right worse than left neural foraminal stenosis. There is mild to moderate spinal canal stenosis.L4-L5: There is disc height loss and minimal bulge. There is facet arthropathy, left worse than right. There is mild to moderate left and mild right neural foraminal stenosis. No significant spinal canal stenosis.L5-S1: There is disc height loss and disc bulge. There is bilateral facet arthropathy, left worse than right. There is moderate left neural foraminal stenosis and mild to moderate right neural foraminal stenosis. No significant spinal canal stenosis.Small cysts are noted involving the bilateral kidneys. Paraspinous soft tissues are grossly unremarkable.", "output": "Multilevel degenerative changes throughout the lumbar spine. There is moderate levoscoliosis with apex at the L2-L3 level. There is mild to moderate spinal canal stenosis at L2-L3 and to a slightly lesser degree at the L3-L4 level. There is moderate to severe right L2-L3 neural foraminal stenosis where there may be impingement of the right L2 nerve root. There is also moderate left L5-S1 neural foraminal stenosis. Please see additional levels as above."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old woman with history of left breast MRI guided biopsy with pathology results of focal ALH. Family history of breast cancer in her sister, diagnosed at the age of 37. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are a few areas of benign parenchymal enhancement bilaterally, which are not significantly changed from the most recent prior examination. Notably, background enhancement has significantly decreased when compared to the older comparison examinations. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old man right native kidney nephrectomy for renal cell seen. Assess contralateral native kidneys for cystic changes and 4 right kidney fossa. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Two lesions in the spleen previously identified on the MR reidentified. One near the splenic hilus which is hypodense on image 29/170 measuring 1.9 x 1.7 cm in the peripheral subcapsular area measuring 2.1 x 1.9-cm which is hypervascular. These likely represent hemangiomas and are unchanged in size from the MRI.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postsurgical changes right renal fossa with no evidence of local recurrence.The left kidney is small with numerous cysts consistent with chronic medical renal kidney disease. Most of the cysts are typical. On the lateral cortex two cysts are high density but do not enhance. These is seen pre-contrast coronal image 51/129 and delayed image 73/114. The larger more cephalad lesion measures 1.6 cm in diameter and it abuts a smaller more caudal lesion measuring 1.4 cm in diameter neither of which show significant change in density.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prominent measuring 6.4-cm transverse by 5.2-cm AP is seen on axial image 137/170.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Renal allograft in the right iliac fossa demonstrates normal nephrogram and excretion. Heavy calcifications surrounding the dorsal aspect of the renal allograft is identified. This could represent a calcified old hematoma or foreign body. Correlate clinically.", "output": "No evidence of local recurrence in right renal fossa. None of the lesions in the left kidney is suspicious for neoplasm. Prominent prostate. Calcified structure dorsal to renal allograft correlate with surgical history."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old male with a history of thymic cancer with left femur pain. Evaluate for bony lesion. There is thickening and heterogeneity of the cortex of the left femoral diaphysis which likely reflects periosteal reaction as seen on recent radiographs, which is nonspecific but perhaps due to hypertrophic osteoarthropathy. We suspect a similar process affects the right femur as seen on the large field-of-view coronal images. There is avascular necrosis of the left femoral head appearing similar to the prior pelvic MRI study from February 26 of 2015. There is patchy intermediate signal intensity within the medullary space of the left femur that appears similar to that seen on the right and likely represents residual or reconverted red marrow. There is a 1.5 cm ovoid focus of low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging within the subtrochanteric left femur that we suspect also reflects more concentrated red marrow although we cannot entirely exclude the possibility of a small metastatic focus. A presumed metastatic focus is again noted within the posterior column of the right acetabulum, appearing similar to that seen on the prior pelvis MRI. There is avascular necrosis of the right femoral head also appearing similar to the prior study. There is metallic susceptibility artifact within the distal right femur and proximal tibia presumably related to prior ACL repair. There are small bilateral knee and hip joint effusions.The musculature of the thigh appears atrophic. There is relatively increased signal intensity of the vastus medialis, lateralis and intermedius muscles on fluid sensitive sequences that is nonspecific and could reflect mild edema or subacute atrophy. There are similar findings, suggested on the large field-of-view coronal sequence, affecting the contralateral side, which appear less pronounced. There is also mild edema within the soft tissues along the adductor musculature of the hips bilaterally as well as confluent edema and/or crescentic fluid between the IT band and underlying proximal quadriceps musculature. This is also noted, to a lesser degree, on the contralateral side. We see no masslike collection to suggest abscess formation. There is reticulation of the subcutaneous fat along the lateral aspect of the hips suggestive of mild edema.", "output": "1. Cortical thickening and heterogeneity of the cortex of the femoral diaphysis is nonspecific but may reflect hypertrophic osteoarthropathy and corresponds to the findings seen on prior radiographs.2. Avascular necrosis of the femoral heads, appearing similar to the prior study.3. Heterogeneity of the medullary space of the proximal femora bilaterally is favored to represent residual reconverted red marrow. A slightly more prominent focus in the subtrochanteric left femur may also represent reconverted red marrow although a small metastatic lesion cannot be excluded. Further evaluation with a skeletal scintigraphic examination could be considered if clinically warranted.4. Right acetabular metastatic focus, appearing similar to the prior study.5. Muscular atrophy and nonspecific inflammatory changes of the soft tissues as described above."}
{"instruction": "Generate impression based on findings.", "input": "Female 4 days old Reason: Where are the pulmonary veins draining? History: infant with TAPVR Left VentricleThe left ventricle is normal. There are no regional wall motion abnormalities present. There is no intracardiac thrombus.Left AtriumThe left atrium is normal, however no pulmonary veins are going to it. There is an osteomyelitis second and a as the superiorly to the coronary sinus. Right VentricleThe right ventricle is dilated. Right AtriumThe right atrium is moderately dilated. Hemostasis secundum ASD about the coronary sinus is noted. Open (image 7a series 1101) Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation visualized. Dedicated through plane imaging was not performed.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation visualized. Dedicated through plane imaging was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation visualized. Dedicated through plane imaging was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.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. Pulmonary veins are merging in a common single collecting chamber posterior and inferiorly to the left atrium and drains into the right atrium via the coronary sinus (image 30, series 2401). No other alternative vessel was identified as a possible source of venous return from the lungs.PericardiumThere is a small pericardial effusion.Extracardiac FindingsPossible bibasilar lung consolidation. Partial view of the solid organs of the upper abdomen are normal..", "output": "1. Total anomalous pulmonary venous return to the right atrium as described.2. Osseous secundum ASD.3. Right atrial and ventricular dilatation.4. Small pericardial effusion.5. Bibasilar opacities likely atelectasis.6. Mild to moderate tricuspid regurgitation.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings."}
{"instruction": "Generate impression based on findings.", "input": "Leg mass Note that the exam is limited by motion artifact. The patient was unable to complete several sequences and no contrast was administered. Also note that the right lower extremity was imaged in external rotation.There is severe osteoarthritis of the knee. Evaluation is somewhat limited given the presence of artifact from prior ACL repair. Along the anterior portion of the mid diaphysis of the tibia is a cystic collection which measures approximately 9 x 1.5 cm in the greatest craniocaudal and AP dimensions. This collection appears to connect to an additional lobulated collection within the posterior joint space of the knee (series 12 image 17/70). The underlying marrow signal of the tibia in this area is normal.", "output": "Cystic collection within the medial knee which appears to extend to an additional collection anteriorly. This may represent a complex Baker's cyst with extension although further evaluation is limited given details provided above."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old male with history of lateral knee pain status post ACL repair MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Old mild deformity of an impaction fracture of the lateral femoral condyle is seen overlying the anterior horn of the lateral meniscus. The overlying articular cartilage appears intact. The remainder of the articular cartilage is within normal limits. There is mild edema type signal within the intracondylar eminence of the tibia, particularly within the medial tibial spine just posterior to the graft, which may be reactive in etiology.LIGAMENTS: The patient is status post ACL reconstruction with the graft appearing slightly thickened and mildly heterogeneous in signal intensity, but otherwise intact. There is focal increased signal intensity within the anterior fibers of the graft, which can be seen in graft impingement. A small focus of intermediate signal intensity immediately anterior to the graft may represent scar tissue, also seen on the prior exam. The PCL is intact. The medial and lateral collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps tendon is intact. The patella tendon is bisected and thickened, representing changes from prior graft harvesting, appearing similar to the prior exam.ADDITIONAL", "output": "Postoperative changes of ACL graft reconstruction appearing similar to the prior exam, with slight heterogeneity of the graft that could represent impingement in the appropriate clinical setting. We see no articular cartilage injury, meniscal tear or loose body."}
{"instruction": "Generate impression based on findings.", "input": " BRAIN MRI:There is bilateral predominantly parietal subdural hemorrhages with mixed hyper and isointense signal on T1-weighted images and associated septations and strong susceptibility artifact. These collections produce mass effect with effacement of the sulci. There is no evidence of brain herniation. The widest thickness of the collection measures 15 mm on the right and 13 mm on the left. The dura overlying the collections is thickened and enhancing, which extends to involve almost the entire cerebral dura on the left and somewhat less so on the right. On postcontrast images, there is a suggestion of contrast permeation into the collections.Since the prior examination, substantial periventricular white matter volume loss has occurred giving the false impression of improvement in the degree of both periventricular T2 signal abnormality and the previously seen, biopsy proven benign periventricular enhancement. A 4 mm focus of enhancement is seen within the right insula, which is new compared to the previous study.High signal seen in the peripheral right frontal bone due to biopsy related burr hole.Normal flow voids of the visualized internal carotid arteries and of the cerebral arteries.PITUITARY MRI:The pituitary gland is normal in enhancement and in size. No evidence of pituitary adenoma or distinct mass.", "output": "1. Bilateral subdural hematomas with mixed intensities, suggestive of a combination of older and newer blood product.2. Diffuse dural enhancement, likely reactive to the the subdural hematomas. 3. Substantial periventricular white matter volume loss giving the false impression of improving T2 signal and enhancement in the periventricular regions. 4. A new 4 mm focus of enhancement in the right insula is nonspecific. Follow-up is suggested.5. Normal pituitary evaluation."}
{"instruction": "Generate impression based on findings.", "input": "63 year-old female history of HCV and cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Segment 7/8 mildly T2 hyperintense focus with persistent and delayed enhancement is stable from prior. No lesions fitting the criteria for HCC.Hepatic vessels are patent.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence of HCC."}
{"instruction": "Generate impression based on findings.", "input": "37 year-old female with persistent pain and effusion of the left knee. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: A small contusion is present at the medial femoral condyles, which may relate to recent trauma. Suboptimal images secondary to habitus limits evaluation of the patellar cartilage. Otherwise, the articular cartilage appears within normal limits.LIGAMENTS: No significant abnormality noted. Specifically, the medial collateral ligament is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1.Bony contusion of the medial femoral condyle.2.Baker's cyst in the posteromedial aspect of the knee.3.The medial collateral alignment is intact, as clinically queried."}
{"instruction": "Generate impression based on findings.", "input": " Images are motion degraded secondary to claustrophobia. Given this caveat:Cervical spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Left facet hypertrophy causes mild left neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, uncinate hypertrophy (left greater than right), and bilateral facet hypertrophy (left greater than right). There is mild flattening of the anterior cord surface without intrinsic cord signal abnormality. There is severe left neural foraminal and mild right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, uncinate hypertrophy (right greater than left), and minimal left facet hypertrophy. There is mild flattening of the anterior cord surface without intrinsic cord signal abnormality. There is moderate left and severe right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild flattening of the anterior and posterior cord surfaces, without intrinsic cord signal abnormality. There is mild central and moderate to severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy (left greater than right). There is minimal central, moderate to severe left neural foraminal, and mild to moderate right neural foraminal stenosis.C7/T1: Mild disc bulge and left facet hypertrophy. There is mild left neural foraminal stenosis.T1/2: Left-sided facet hypertrophy causes mild left neural foraminal stenosis.Lumbar spine:Dextrorotoscoliosis is present centered at approximately L3. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: UnremarkableL2/3: Diffuse annular disc bulge, slight ligamentum flavum thickening, and mild left facet hypertrophy. There is mild bilateral neural foraminal stenosis.L3/4: Asymmetric bulge to the left, ligamentum flavum flavum thickening, and moderate bilateral facet hypertrophy. There is a tiny left facet fusion, and reactive marrow changes are noted within bilateral L3 and L4 pedicle secondary to the facet arthropathy. There is mild central, moderate to severe left neural foraminal, and mild right neural foraminal stenosis.L4/5: Asymmetric bulge to the right, ligamentum flavum thickening, and mild to moderate bilateral facet hypertrophy. There is a small left facet effusion. There is mild central, mild left neural foraminal, and moderate right neural foraminal stenosis.L5/S1:Mild disc bulge and mild bilateral facet hypertrophy without significant stenosis.", "output": "1.Images are motion degraded secondary to claustrophobia.2.C2/3: Mild left neural foraminal stenosis.3.C3/4: Severe left neural foraminal and mild right neural foraminal stenosis.4.C4/5: Moderate left and severe right neural foraminal stenosis.5.C5/6: Mild central and moderate to severe bilateral neural foraminal stenosis.6.C6/7: Minimal central, moderate to severe left neural foraminal, and mild to moderate right neural foraminal stenosis.7.C7/T1: Mild left neural foraminal stenosis.8.T1/2: Mild left neural foraminal stenosis.9.L2/3: Mild bilateral neural foraminal stenosis.10.L3/4: Mild central, moderate to severe left neural foraminal, and mild right neural foraminal stenosis.11.L4/5: Mild central, mild left neural foraminal, and moderate right neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with past medical history of COPD, DM, HTN presents to the Emergency Department with left-sided weakness and right eye deviation since 3am today. There is focal diffusion restriction involving the posterior limb of the right internal capsule with superior extension along caudothalamic groove. This is a recent acute/subacute ischemic infarct. In addition, there is extensive confluent periventricular cerebral hemispheric T2/FLAIR hyperintensity without diffusion restriction which represents chronic microvascular ischemia. Patchy similar findings are present the right cerebral peduncle and along the right cortical spinal tract.There is a small focus of susceptibility effect involving the left middle cerebellar peduncle which may represent tiny focus of hemorrhage. Accounting for basal ganglia calcification, there is no supratentorial intraparenchymal hemorrhage.The right eye globe is elongated (versus staphyloma) while the left eye lens is absent.Dynamic contrast imaging was performed. However, the quality of the examination is not optimal, as judged by the arterial input function curve. However, there is no significant asymmetry on the color coded rCBV, rCBF and MTT maps between the 2 cerebral hemispheres.", "output": "1.Diffusion restriction in the posterior limb of the right internal capsule is compatible with an acute/subacute infarct in the right anterior choroidal artery territory.2.There is no significant asymmetry between the two cerebral hemispheres on the perfusion maps but the study is technically limited as described above.3.There is no other acute infarct in the brain. Extensive cerebral white changes are most compatible with chronic microvascular ischemia."}
{"instruction": "Generate impression based on findings.", "input": " Counting of the vertebral bodies is limited due to motion between upper and lower spine sequences. L5 is probably sacralized. The last fully formed disc is at L4-L5 and the L5-S1 disc appears rudimentary. The last visualized rib is at T11.The conus medullaris is seen at the level of mid L1 with non-thickened fatty filum. The fatty filum extends from L1 to the distal end of the thecal sac. There is appropriate the ventral motion of the cord on prone imaging. There is prominence of the central canal at the distal cord and the conus. The central canal measures 2 x 2 mm at the mid T11 level although there is further more ill-defined prominence of the central spinal canal from T6 to T12.There is prominence of the CSF space along the posterior and inferior aspect of the cerebellum which favors mega cisterna magna. The fourth ventricle does not appear enlarged. There may be minimal inferior vermian hypoplasia although this is difficult to completely assess on this dedicated spine exam.The bladder is severely distended.", "output": "1. Normal conus termination with non-thickened fatty filum. Appropriate ventral motion of the cord on prone imaging. No MR imaging findings to support tethered cord.2. Trace prominence of the central canal from T6 to T12, most conspicuous at the mid T11 level where it measures up to 2 mm. The more caudal findings may relate to a ventricularis terminalis, although the greater extent of subtle abnormal signal may relate to underlying trace syringohydromyelia. Follow-up imaging and clinical correlation may be helpful.3. Significant focal prominence of the CSF space along the posterior and inferior aspect of the cerebellum which favors mega cisterna magna along the Dandy-Walker spectrum with questioned mild inferior vermian hypoplasia. If there is clinical concern, MRI of the brain may be obtained for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Male, 83 years old. Right shoulder pain. ROTATOR CUFF: The rotator cuff tendons are intact, without evidence of tear. There is no significant atrophy of the rotator cuff muscles. There are multiple subcortical cysts along the rotator cuff insertions on the humeral head, likely degenerative in etiology.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There degenerative changes of the glenohumeral joint with subchondral cysts in the glenoid. Anterior and posterior horns of the labrum are irregular compatible with degeneration. There is a small amount of fluid within the joint.BICEPS TENDON: The tendon of the long head of the biceps is normal in course and morphology. ADDITIONAL", "output": "1.No evidence of rotator cuff tear.2.Osteoarthritis of the shoulder with associated labral degeneration as above."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Left leg weakness x 3 weeks. Moderate low back pain. History of malignancies. Signs and symptoms: As above. Pre-and post-enhanced lumbar MRI:The signal intensity of vertebral column demonstrate changes related degenerative disk disease. There is also uniformly T1 hyperintensity of L5 and visualized S1 and S2 levels of cervical spine consistent with radiation changes.The signal intensity and caliber over the lower most visualized thoracic cord, conus and cauda equina is also within normal.Post enhanced images demonstrate no detectable abnormal enhancement the vertebral column, cord, leptomeninges or the cauda equina to suggest metastatic disease.T12 -- L1 is unremarkable.L1 -- L2 demonstrate mild degenerative changes are unremarkable otherwise. Incidental note at this level is made of severely atrophic right kidney. Multiple cystic like lesions within the large left kidney is noted.L2 -- L3 demonstrate mild disk disease and moderate bilateral ligamentum flavum hypertrophy and mild facet degenerative changes. Constellation of above changes results in mild to moderate central spinal stenosis and moderate bilateral neural foraminal compromise.L3 -- L4 demonstrate advanced degenerative disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy and resultant significant central spinal stenosis with severe right and mild left neural foraminal compromise. Degenerative changes at this level also results in mild grade 1 anterolisthesis.L4 -- L5 demonstrate moderate disk disease and loss of disk height, moderate to severe right and moderate left facet and ligamentum flavum hypertrophy. Constellation of changes results in moderate central spinal stenosis and moderate left neural foramina compromise.L5 -- S1 demonstrate moderate disk disease and loss of disk height and asymmetric moderate left facet and ligamentum flavum hypertrophy. There is no central spinal stenosis. Mild to moderate left neural foraminal compromise is however noted.Pre-and post enhanced brain MRI:Negative diffusion weighted images.Flair and T2 weighted images demonstrate minimal small foci of periventricular and subcortical flair hyperintensity which are nonspecific however considering patient's stated age of 75 the often represent microvascular ischemic changes.Signal intensity and overall anatomical morphology of brain parenchymal otherwise remains within normal on all MRI sequences. The signal void of major intracranial arterial branches are identified.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable calvarium and orbits and without evidence of abnormal enhancement.There is normal pneumatization signal pattern of all paranasal sinuses and bilateral mastoid air cells and the middle ear cavities.", "output": "1.Pre-and post enhanced MRI of the lumber spine demonstrate no evidence of study disease. Marrow signal changes suggestive of prior radiation is noted at L5, S1 and S2. Extensive degenerative changes of the lumbar spine results in central spinal stenosis at L2 -- L3, L3 -- L4 and L4 -- L5 levels as detailed. Degenerative changes also results in neural foraminal compromise as detailed per level.2.Pre-and post enhanced brain MRI demonstrates findings suggestive of minimal chronic non-hemorrhagic small vessel ischemic strokes and unremarkable otherwise."}
{"instruction": "Generate impression based on findings.", "input": " The study is motion degraded, given this caveat:Brain MRI:T2 hyperintensities are present within periventricular and subcortical white matter without restricted diffusion, susceptibility abnormality, or enhancement. Additionally, there is a small focus of T2 hyperintensity involving the cortices and underlying subcortical white matter of the anteromedial left occipital lobe without restricted diffusion.There is diffuse volume loss without a specific lobar predominant atrophy pattern.The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Note is made of an empty sella. 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. Cervical spine MRI:Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no abnormal enhancement.C2/3: UnremarkableC3/4: UnremarkableC4/5: Posterior osteophyte disc complex, bilateral facet hypertrophy, and ligament flavum thickening. There is mild central, moderate left neural foraminal, and mild right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral facet hypertrophy, and ligament flavum thickening. There is mild central and mild to moderate bilateral neural foraminal stenosis.C6/7: Minimal posterior osteophyte disc complex as well as bilateral uncinate hypertrophy. There is mild bilateral neural foraminal stenosis.C7/T1: Unremarkable", "output": "1.Chronic small vessel ischemic disease.2.Small right anteromedial occipital lobe chronic infarct.3.Diffuse volume loss without a specific lobar predominant atrophy pattern.4.C4/5: Mild central, moderate left neural foraminal, and mild right neural foraminal stenosis.5.C5/6: Mild central and mild to moderate bilateral neural foraminal stenosis.6.C6/7: Mild bilateral neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": " Contrast opacified the radiocarpal articulation in the expected fashion. Contrast extended into the midcarpal joint initially via a defect in the lunotriquetral ligament. With gentle manipulation of the wrist, communication of contrast between the radiocarpal and midcarpal joints was also noted via the scapholunate interval; however, I suspect that this communication is of limited significance, as the dorsal component of the scapholunate ligament appears intact on preliminary review of the MR images. No contrast extended into the distal radioulnar joint indicate a triangular fibrocartilage tear. Please refer to the subsequent MRI report for further information.Exposure time: Three minutes and 14 seconds", "output": "Tears of the lunotriquetral and scapholunate ligaments as described above, of questionable clinical significance."}
{"instruction": "Generate impression based on findings.", "input": "Ankle swelling TENDONS: There is a small amount of fluid within the tendon sheaths of the posterior tibialis and flexor digitorum longus as they cross posterior to the medial malleolus. The amount of fluid is slightly more than typically expected and is suggestive of mild tenosynovitis. There is also a mild amount of edema in the overlying subcutaneous fat. The remaining tendons appear normal.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibiofibular ligament complex is intact. The visualized components of the deltoid ligament complex appear intact. A mild amount of edema is noted within the sinus tarsus which is of uncertain clinical significance.ARTICULAR SURFACES AND BONE: The marrow signal of the ankle is normal and there are no osteochondral defects identified. ADDITIONAL", "output": "Mild tenosynovitis of the posterior tibialis and flexor digitorum longus tendons with additional findings described above. "}
{"instruction": "Generate impression based on findings.", "input": "Female 28 years old Reason: assess for invasive endometrial cancer. If needs contrast, please do. History: vaginal bleeding, grade 1 endometrial cancer PELVIS:UTERUS, ADNEXA: Uterus measures 8.0 x 4.8 x 5.1 cm. The anterior junctional zone is thickened. Endometrial stripe is normal in thickness. Bilateral ovaries contain follicles. There are scattered cervical nabothian cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Cystic area adjacent to the right ovary likely represents portion of the cecum. No bowel obstruction is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic ascites.", "output": "1.Mild thickening of the anterior junctional zone may be due to adenomyosis. No discrete endometrial mass."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Memory loss. Evaluate for chronic vascular changes. Non-infused head CT:Images through posterior fossa again identify a right-sided cerebellopontine angle extra axial primarily fatty density mass measuring 14.7 x 11.6-mm in size. There is no appreciable interval change in the size or morphology of this lesion. Finding likely present a lipoma however an MRI examination is recommended for more precise evaluation. Images through posterior fossa are otherwise unremarkable.Anatomical variation of partially empty sella is also again identified with no change.Images supratentorial space demonstrate diffuse patchy areas of low attenuation in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Although nonspecific these findings however are often result of small vessel ischemic strokes. These findings were present on prior exam and precise comparison is not possible.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Calvarium is intact. Visualized orbits, mastoid air cells and middle ear cavities are unremarkable.Limited images of the paranasal sinuses again demonstrate complete opacification of right chamber of the sphenoid sinus with no change since prior examination from 2008.", "output": "1.Small vessel disease of indeterminate age.2.Revisualization of complete opacification of right chamber of sphenoid sinus."}
{"instruction": "Generate impression based on findings.", "input": "Female 25 years old with history of left shoulder pain, eval shoulder labrum ROTATOR CUFF: No evidence of rotator cuff tear. The infraspinatus, supraspinatus, subscapularis, and teres minor muscles and tendons appear normal.SUPRASPINATUS OUTLET: The acromial clavicular joint is normal for age.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a superior labral tear with contrast extension underneath the anterior and posterior labrum consistent with a SLAP (superior labrum anterior posterior) tear. The glenohumeral joint alignment is within normal limits without evidence of joint effusion.BICEPS TENDON: The tendon of the long head of the biceps is unremarkable. ADDITIONAL", "output": "Superior labral anterior posterior tear of the left shoulder."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old male with history of meniscal injury, partial ACL tear now with recent injury and pain along the medial jointline. Inability to bear weight and decreased range of motion with flexion. MENISCI: The medial meniscus appears intact. There is increased signal abnormality within the posterior horn of the lateral meniscus. Some of this extends to the tibial articular surface suggestive of superficial tearing/fraying (image 21; series 10). No fluid-filled tear is identified.ARTICULAR CARTILAGE AND BONE: There is increased signal abnormality within the lateral femoral condyle on fluid sensitive sequences which may represent a bone contusion. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: Increased signal abnormality about the ACL on fluid sensitive sequences suggesting a sprain or partial tearing of the proximal fibers. The PCL appears intact. The LCL appears intact. There is increased signal abnormality on fluid sensitive sequences within the proximal fibers of the superficial band of the MCL, anteriorly, indicating partial tearing. There is fluid within the MCL bursa indicating a bursitis. There is nonspecific subcutaneous edema in the surrounding area.EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small amount of increased signal abnormality within the proximal fibers of the patellar tendon which may represent a very mild patellar tendinosis.ADDITIONAL", "output": "1. Partial tear of the MCL. 2. Partial tearing/sprain of the ACL. 3. Superficial fraying/tearing of the posterior horn of the lateral meniscus. No fluid-filled tear is evident.4. Bone contusion within the lateral femoral condyle.5. Moderate sized joint effusion."}
{"instruction": "Generate impression based on findings.", "input": " There is no acute cord compression.Degenerative changes in the cervical spine resulting several levels of central canal stenosis with cord abutment and flattening. Susceptibility artifact is present from aortic stent grafting. Degenerative changes of the lower lumbar spine resulting in central and neural foraminal stenoses. There is no abutment of the conus.", "output": "No acute cord compression. Dedicated segment-specific MRI is recommended if symptomology localizes."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old female with left shoulder pain. Reevaluation to determine with there is now a full-thickness rotator cuff tear. ROTATOR CUFF: Again seen is increased signal intensity within the distal supraspinatus tendon near its insertion at the greater tuberosity with associated foci of increased signal within the articular and bursal surfaces compatible with partial tear of the supraspinatus tendon. Similar findings are present within the infraspinatus with no evidence of full-thickness tear. There is increased fatty atrophy of the supraspinatus muscle from prior study as well as mild fatty atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear normal. Again seen are foci of increased signal intensity within the distal fibers of the subscapularis tendon likely a combination of tendinosis and interstitial tearing. There is mild fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Mild arthritic changes of the acromioclavicular joint. Again seen is small amount of fluid within the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. Alignment is normal. There is a small joint effusion, however this is improved from prior study. No definite findings to suggest a labral tear on this non-arthrogram study.BICEPS TENDON: Again seen is a atleast a partial-thickness tear of the tendon of the long head of the biceps at its transition from the intertubercular groove to the rotator interval. There is a small amount of fluid communicating with the long head biceps tendon distally.ADDITIONAL", "output": "1. Tear of the long head of the biceps tendon similar to prior study.2. Tendinosis and partial-thickness rotator cuff tear with no discrete full-thickness tear as described above."}
{"instruction": "Generate impression based on findings.", "input": " There is no acute infarct, mass effect or midline shift. There is no suspicious intracranial enhancement. There is no hippocampal signal abnormality or volume loss. There are moderate nonspecific periventricular and subcortical white matter T2 signal abnormalities again seen, grossly stable from the prior exam, although evaluation is somewhat limited due to motion artifact present on the prior exam. The ventricles are unchanged. There is no hydrocephalus.", "output": "1.No evidence of intracranial metastases.2.Moderate nonspecific white matter signal abnormalities grossly unchanged.3.No findings to explain patient's new onset seizure."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate one year status post sarcoma resection, index finger, and middle finger removed. There has been surgical resection of the second and third rays at the carpometacarpal articulation. No abnormal enhancement is identified. There is no specific evidence of tumor recurrence.", "output": "No specific evidence of tumor recurrence. "}
{"instruction": "Generate impression based on findings.", "input": "68 year old man with remote history of colon cancer, and more recent diagnosis of carcinoid of the liver with tricuspid valve involvement and severe tricuspid regurgitation, referred for cardiac MRI as part of a pre-surgical evaluation for possible valve replacement. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVEDV is 167 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 109 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Native T1 relaxation time is 990-1020ms, which is normal. There is no evidence of myocardial iron overload. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. The interatrial septum bulges to the left, consistent with elevated right atrial pressures. Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 190 ml/m2 (normal range 82+/-16), the RVEDV is 372 ml (normal range 142+/-31), the RV end systolic volume index is 102 ml/m2 (normal range 31+/-9), and the RVESV is 190 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 with trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve leaflets are thickened, calcified, with severely restricted motion, consistent with the diagnosis of carcinoid tricuspid valve disease. The tricuspid annulus is severely dilated with severe malcoaptation. There is severe tricuspid regurgitation with evidence of diastolic tricuspid regurgitation and also forward flow acceleration due to the substantial volume of TR.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 mildly dilated (34mm). Venous AnatomyThe SVC drains normally into the right atrium. The IVC is dilated.PericardiumThere is a small pericardial effusion. Extracardiac FindingsThere is hepatic vein dilation. There is a pre-tracheal calcified lymph node. 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. Normal size left ventricle with normal systolic function (EF 55%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. Severely dilated right ventricle with mildly reduced systolic function (EF 49%). 3. The tricuspid valve leaflets are thickened, calcified, with severely restricted motion, consistent with the diagnosis of carcinoid tricuspid valve disease. The tricuspid annulus is severely dilated with severe mal-coaptation. There is severe tricuspid regurgitation with evidence of diastolic tricuspid regurgitation and also forward flow acceleration due to the substantial volume of TR.4. Mild dilation of the main pulmonary artery. 5. Severe right atrial dilation with evidence of increased RA pressures.6. Small pericardial effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female, 71 years old, with history of left frontal meningioma status post stereotactic radiosurgery. Follow-up examination. Redemonstrated is evidence of prior right-sided craniotomy for tumor resection. Small areas of encephalomalacia in the right inferior frontal gyrus are unchanged.An extra-axial mass along the left superior frontal gyrus does not appear to have changed significantly from the prior examination. Within the limitations of this noncontrast examination, no definite additional intracranial tumors are seen.No restricted diffusion is evident. Scattered nonspecific foci of white matter T2 hyperintensity are unchanged. No evidence of parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is suspected. The ventricles are stable and normal in size.", "output": "Redemonstrated are postoperative findings related to right-sided tumor resection. Within the limitations of this noncontrast examination, no definite evidence of recurrent tumor is seen. A small presumed meningioma along the left superior frontal gyrus also shows no significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "Forthcoming odontoid procedure, apnea, possible venous sinus thrombosis There is localized restricted diffusion on the right front lobe alongside with interhemispheric fissure without evidence of hemorrhagic transformation. This lesion may represent acute ischemic infarction likely embolic in nature.No evidence of hemorrhagic lesion on the scan.There is a 27 mm x 11 mm sized fluid collection on the right high frontoparietal area scalp, no change of its size since prior CT scan.There is no evidence of venous congestive encephalopathy.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Left PCAs fetal origin.2D brain noncontrast enhanced MRV with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal craniofugal flow related enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. These findings indicate venous blood flow within the major dural sinuses has been maintained. Multifocal signal drops on the distal superior sagittal sinus and proximal left transverse sinus as well as bilateral proximal internal jugular vein are likely to be artifactual considering no evidence of associated venous congestive encephalopathy. However, the diameter of distal superior sagittal sinus as well as bilateral transverse sigmoid sinuses appear to be a bit larger and than normal, these findings could represent mild to dural sinus malformation with maintaining cranial fugal flow. Therefore, follow-up imaging including brain MRI about 3-6 months is later can be considered.", "output": "1. Restricted diffusion on the right frontal lobe as described above indicating possible acute ischemic stroke. No evidence of hemorrhagic lesion.2. Normal brain MRA3. Ectatic venous sinuses with demonstration of craniofugal venous flow without evidence of congestive venous encephalopathy. No evidence of venous sinus thrombosis.4. Follow up brain MRI can be considered since the diameter of dural sinuses appears to be a bit larger than normal, thus possibility of mild dural sinus malformation may need to be excluded. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: pain History: pain ROTATOR CUFF: There is minimal heterogeneity of the supraspinatus tendon suggesting mild tendinosis, but we see no discrete tear. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. There is increased signal intensity along the deep fibers of the subscapularis tendon likely representing a combination of tendinosis and undersurface tearing, but we see no full-thickness subscapularis tear. There is perhaps mild fatty atrophy of the superior fibers of the subscapularis muscle. There are foci of signal abnormality within the lesser tuberosity which are likely degenerative in etiology.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There is no fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Mild osteoarthritis affects the glenohumeral joint. There is a small amount of fluid within the glenohumeral joint extending into the subscapular recess. There is poorly defined intermediate signal intensity within the joint, anteriorly, which may represent a synovitis. There is mild degeneration of the anterior superior labrum, but otherwise the labrum appears normal for age.BICEPS TENDON: The tendon of long head of the biceps appears perched on the lesser tuberosity, suggesting pulley dysfunction and its margins are irregular within the proximal bicipital groove indicating partial thickness tearing.ADDITIONAL", "output": "1. Undersurface degeneration and tearing of the subscapularis tendon. There is also partial thickness tearing of the long head of the biceps tendon which appears perched on the lesser tuberosity, suggesting pulley dysfunction.2. Osteoarthritis of the acromioclavicular and glenohumeral joints. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Shoulder pain. ROTATOR CUFF: Moderate supraspinatus tendinopathy. No discrete tears. The infraspinatus, subscapularis and teres minor tendons are intact. No significant muscle atrophy.SUPRASPINATUS OUTLET: Mild AC joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic. No definite labral tear. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL", "output": "Moderate supraspinatus tendinopathy with no discrete rotator cuff tears. "}
{"instruction": "Generate impression based on findings.", "input": "Posterior knee pain MENISCI: There is increased globular signal within the posterior horn of the medial meniscus. There may be a small focus of extension to the tibial articular surface (series 4 image 13/32) but otherwise there is no discrete extension to either articular surface. Additionally, the root of the medial meniscus appears intact and these findings directly representing intrasubstance degeneration. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a small full-thickness cartilage defect within the lateral femoral condyle anteriorly measuring approximately 5 mm. There is associated underlying degenerative marrow signal abnormality. This is superimposed upon mild thinning of the articular cartilage. The articular cartilage of the medial femoral condyle also demonstrates diffuse thinning with a small partial-thickness defect of the femoral condyle anteriorly as well. There is diffuse thinning of the articular cartilage of the patellofemoral compartment without full-thickness defect.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Abnormal signal within the posterior horn of the medial meniscus thought to represent intrasubstance degeneration although there may be a small focus of extension to the tibial articular surface. The root of the meniscus is intact.2. Small areas of full-thickness cartilage loss within both the medial and lateral femoral condyle anteriorly."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with new brain tumor, questionable metastases versus primary brain tumor with increased FDG uptake in the right shoulder on recent PET examination. ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear normal for age. The subscapularis and teres minor muscles and tendons appear intact. There is a fusiform, near fluid signal intensity, small mass within the teres minor muscle, measuring approximately 1.5 cm in the long axis and 7 mm in the short axis. There is no enhancement of this mass on post gadolinium images and we suspect that this represents an intramuscular ganglion or less likely a benign nerve sheath tumor. It does not correspond to the morphology of the increased uptake seen on the patient's recent PET/CT examination.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial bursa which may not be of any clinical significance. The acromioclavicular joint appears normal for age.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild enhancement of the glenohumeral joint indicating a mild synovitis that corresponds to the increased uptake seen on recent PET/CT examination. The glenohumeral joint alignment is within normal limits. There is intermediate signal intensity within the posterior superior labrum suggesting degeneration, but we see no fluid-filled tear.BICEPS TENDON: There is mild circumferential enhancement of the tendon sheath of the long head of the biceps tendon representing a tenosynovitis, perhaps an extension of synovitis from the glenohumeral joint. ADDITIONAL", "output": "1. Mild synovitis of the glenohumeral joint with extension of the synovitis along the tendon of the long head of the biceps which corresponds in morphology to the increased uptake seen on recent PET/CT examination.2. Small nonenhancing mass in the teres minor muscle likely represents a ganglion or less likely a benign nerve sheath tumor.3. No findings to suggest metastatic disease or a primary tumor of bone."}
{"instruction": "Generate impression based on findings.", "input": "Numbness, headaches. There is no significant interval change in the numerous high T2 signal lesions in the cerebral white matter bilaterally. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.", "output": "No significant interval change in the numerous intracranial presumed demyelinating lesions. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 37 years old, with a submucosal mass, approximately 1 cm in size, at the right tonsillar pillar/soft palate. The right palatine tonsil is mildly enlarged relative to the left, measuring up to 16 x 12 mm in the axial plane compared to 15 x 9 mm on the left. At the junction of the right palatine tonsil and soft palate, a 3 mm cystic focus is also identified (see image 35 series 901). The signal intensity of the right palatine tonsil on T1, T2 and diffusion-weighted images is identical to that seen on the left with the exception of the small cystic focus. The pattern of enhancement is also similar to that seen on the left.The aerodigestive mucosa is otherwise unremarkable. No evidence of pathologic adenopathy is detected in the neck. The salivary glands and the thyroid are free of focal lesions. The bone marrow signal characteristics are within normal limits.", "output": "Mild asymmetric enlargement of the right palatine tonsil is seen along with a 3 mm cystic focus at the junction of the tonsil with the soft palate. Otherwise, signal characteristics and pattern of enhancement of the right palatine tonsil are identical to those of the left.The differential diagnosis for these findings would include an asymmetrically reactive or inflamed tonsil. A neoplastic process is not excluded, though the lack of a discrete lesion, and lack of any differential enhancement or signal compared to the normal left tonsil, would argue against this possibility."}
{"instruction": "Generate impression based on findings.", "input": "Biopsy-proven idiopathic hypertrophic pachymeningitis Again seen is a retroclival mass extends inferiorly through the craniocervical junction to the C1 level. There is no significant change in size compared to 5/30/2015. Mass measures approximately 13 mm in thickness at the level of the medulla similar to prior with near complete effacement of the premedullary cistern. The craniocaudal extent measures approximately 5.4 cm and extends from the dorsum sella to the upper C2 level. No significant change allowing for differences in scanning technique and head position. Also noted is dural based thickening T1-T3 levels which is partially imaged and was present previously.The cervical vertebral bodies are appropriate in height. Alignment is unchanged including mildly exaggerated cervical lordosis, mild retrolisthesis of C4 on C5, and mild anterolisthesis of T2 on T3. Postsurgical changes of posterior spinal fusion are again seen with hardware including lateral mass screws at C3, C4, and C5 and paraspinous rods which extend inferiorly into the upper thoracic spine outside the field-of-view. Hardware may be better assessed by radiographs or CT. Bone marrow signal is within normal limits. The cervical spinal cord has grossly normal signal characteristics and overall morphology with artifact related to susceptibility slightly limiting evaluation. There is mild spinal canal stenosis at the C4-C5 level similar to prior. There is otherwise no significant spinal canal or neural foraminal stenosis in the remainder of the cervical spine. Paraspinous soft tissues aside from postsurgical changes are unremarkable.", "output": "Compared to 5/30/2015, there is no significant change in enhancing dural-based retroclival mass which extends from the dorsum sella to the craniocervical junction and effaces the premedullary cistern. Dorsal dural based enhancement involving the upper thoracic spine is again seen and partially imaged."}
{"instruction": "Generate impression based on findings.", "input": "Syncope and collapse. Suspicion of seizure-like activity. There are a few punctate T2 FLAIR hyperintense lesions, and scattered in the subcortical white-matter. There is no associated abnormal contrast enhancement or diffusion restriction. There is no acute infarct or mass. There is no mass-effect, midline shift or brain herniation. The ventricles and the other CSF-containing spaces are normal in size. Major intracranial vascular flow voids are preserved. The skull, scalp, and orbits are grossly unremarkable. Partially empty sella has not changed since the previous examination.", "output": "Scattered subcortical punctate T2/FLAIR-hyperintense lesions. Similar lesions have been described in patients with migraine. The lesion are otherwise are nonspecific. There is no other intracranial abnormality."}
{"instruction": "Generate impression based on findings.", "input": "68Yrs old female history of IgG Lambda SII multiple myeloma; evaluate for lytic lesions and prep for clinical trial. SKULL: Two views of the skull show numerous lucent lesions, compatible with multiple myeloma, stable from prior exam accounting for positional differences.CERVICAL SPINE: Two views of the cervical spine are provided. Evaluation of the lower cervical spine is limited due to overlying anatomy. The bones appear demineralized, which may reflect diffuse myelomatous involvement. The C2 vertebra appears deformed, which may in part be artifactual related to positioning, however we cannot exclude the possibility of myelomatous involvement or prior trauma. This can be further evaluated with CT or MRI if clinically warranted.THORACIC SPINE: Single view of the thoracic spine is provided. Multiple compression fractures are redemonstrated, most severely affecting the T9 vertebral body. Loss of height of T7 appears to have progressed slightly when compared to the prior study. Severe compression deformities of T4 and T5 are additionally noted. LUMBAR SPINE: Two views of the lumbar spine are provided. The bones appear diffusely demineralized. Multiple compression deformities appear similar to the prior exam, with cement in the L4 vertebral body. Degenerative arthritic changes appear similar to the prior study.RIBS: Rib radiographs demonstrate multiple bilateral rib fractures, most of which appear to be healing or healed, though some are new when compared the prior study and are presumably related to underlying myelomatous deposits. Bone formation along the inferior margin of the scapula bilaterally may represent healing pathologic fractures. Right chest wall port catheter terminates in the right atrium. The lungs are underinflated. Streaky atelectasis is noted in the right mid lung zone.PELVIS: Single view of the pelvis is provided. The bones appear demineralized, perhaps representing widespread myelomatous deposition. Moderate osteoarthritis affects the right hip. Left hip hemiarthroplasty device appears similar to the prior exam. New heterotopic ossification about the lesser and greater trochanters is noted.UPPER EXTREMITY: Right humerus: Two views of the right humerus show small, poorly defined lucencies and endosteal scalloping appearing similar to the prior study, compatible with myelomatous deposits.Left humerus: Two views of the left humerus show small, poorly defined lucencies and endosteal scalloping appearing similar to the prior study, compatible with myelomatous deposits. Lucent lesion of the distal left clavicle also appears similar to the prior study.Right forearm: Single view of the right forearm demonstrates poorly defined lucencies in the radius which may represent myelomatous deposits, appearing similar to the prior exam.Left forearm: Single view of the left forearm demonstrates poorly defined lucencies in the radius which may represent myelomatous deposits, appearing similar to the prior exam.LOWER EXTREMITY: Right femur: Two views of the right femur demonstrate lucent lesions of the femoral diaphysis compatible with myeloma, appearing similar to the prior study. Moderate osteoarthritis affects the right knee.Left femur: Two views of the left femur demonstrate a bipolar hemiarthroplasty device situated in near anatomic alignment without evidence of hardware complication. Small lucent lesions in the distal left femoral diaphysis are consistent with myeloma, appearing similar to the prior study. Moderate osteoarthritis affects the left knee.Right tibia/fibula: Single view of the right tibia/fibula shows tiny poorly defined lucencies which may represent myelomatous deposits, appearing similar to the prior study.Left tibia/fibula: Single view of the left tibia/fibula shows tiny poorly defined lucencies which may represent myelomatous deposits, appearing similar to the prior study.", "output": "Findings compatible with widespread myeloma appearing similar to the prior study, with possible progression of thoracic vertebral compression fractures and rib fractures and possible healing scapular tip fractures."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old male with known prostate cancer and history of head and neck cancer presents with altered mental status and negative head CT. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Periventricular white matter T2/FLAIR hyperintense foci are seen, likely representing mild small vessel ischemic disease. Nonspecific T2/FLAIR hyperintense lesion is also seen within the right cerebellum measuring up to 1.0 cm (image 11, series 401). There is no associated enhancement or diffusion restriction. 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": "1.No evidence of acute infarct, intracranial mass or mass effect. No evidence of intracranial metastatic disease. 2.Mild chronic small vessel ischemic disease. Rounded T2/FLAIR hyperintense lesion in the right cerebellar hemisphere is nonspecific and may also represent sequela of prior ischemia or possibly treatment-related injury."}
{"instruction": "Generate impression based on findings.", "input": "4-year-old male with recent seizure-like activity, ex-28 week premature gestation Several sequences are degraded secondary to artifact induced by the patient's ventricular shunt reservoir. Given this caveat:Redemonstrated is a right parietal approach ventriculostomy catheter which crosses the midline with its tip terminating at the lateral aspect of the left lateral ventricle, unchanged in position. There has been interval increase in size of the dysmorphic lateral ventricles. The third and the fourth ventricles are unchanged in size. Left hemispheric dysmorphism is unchanged.A previously demonstrated prominent left extra-axial fluid space which has been becoming more hypodense on CT demonstrates mid intensity on T1, hyperintensity on T2, with diffuse enhancement. This extends to also involve the tentorium and falx, as well as to a lesser extent the right hemispheric dura. Overlying this is a second area of crescentic abnormality measuring up to 6 mm in maximal depth over the parietal-occipital region which is nonenhancing, lower intensity on T1and T2 when compared to the overlying process, yet appearing hyperintense on T1 and T2 compared to CSF.Hemosiderin staining along the epididymal surface of the lateral ventricles is not as well demonstrated as previously. Redemonstrated is residual from germinal matrix hemorrhage. Previously demonstrated hemorrhagic debris in the right occipital horn as well as hemorrhagic foci within the posterior fossa are not visualized secondary to the aforementioned artifact.There is no midline shift or basal cistern effacement. Myelination within the uninvolved brain appears mature. Redemonstrated is thinning of the corpus callosum and volume loss in the white matter.Major intracranial flow voids appear present. Paranasal sinuses are completely opacified. Mastoid air cells and middle ear cavities are clear. Orbital contents are unremarkable.", "output": "1.Redemonstrated is a right parietal approach ventriculostomy catheter which crosses the midline with its tip terminating at the lateral aspect of the left lateral ventricle, unchanged in position. 2.There has been interval increase in size of the dysmorphic lateral ventricles. 3.Diffuse dural enhancement is present, especially notable along the left hemisphere, however also involving the falx, tentorium, and to a lesser extent the right hemisphere. There is a superimposed crescentic abnormality measuring up to 6 mm in maximal depth over the parietal-occipital region which is nonenhancing as described in detail above. The enhancing aspect is most likely secondary to dural reaction from changes of ventricular sizes and intracranial pressures. The nonenhancing crescentic portion most likely represents an evolving hemorrhage within the dura."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for interval changes in HCC ABDOMEN:LIVER, BILIARY TRACT: Centrally located (just above right/main portal vein junction) 2.2 x 1.5 cm right hepatic lesion measuring on image 31 series 100 demonstrates heterogeneous arterial enhancement with subsequent washout. Lesion shows restricted diffusion and increased T2 signal. Additional tiny arterially enhancing focus seen more anteriorly in hepatic segment 8 on image 28 series 10, no corresponding restricted diffusion or washout seen, nonspecific but may be a perfusional anomaly. Hepatic steatosis. 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.BONES, SOFT TISSUES: Spinal degenerative disease.OTHER: No significant abnormality noted.", "output": "Centrally located right hepatic segment 8/7 lesion measuring 2.2 x 1.5 cm, fulfills imaging criteria for hepatocellular carcinoma."}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval for scapholunate disassociation History: left wrist pain after trauma LIGAMENTS: There is linear fluid signal intensity within the membranous portion of the scapholunate ligament which may represent a partial thickness tear, but we see no gadolinium traversing the ligament to indicate a full-thickness tear. Similar findings affect the membranous portion of the lunotriquetral ligament, but again we see no gadolinium traversing the ligament indicate a full-thickness tear.TRIANGULAR FIBROCARTILAGE COMPLEX: Gadolinium extends from the radiocarpal joint through a full-thickness perforation of the articular disc of the triangular fibrocartilage near its radial attachment extending into the distal radial ulnar joint.TENDONS: The flexor and extensor tendons appear intact. Gadolinium is identified within the extensor carpi ulnar tendon sheath which is likely iatrogenic.BONES: There is branching signal abnormality and edema within the triquetrum indicating a mildly displaced comminuted fracture. The main fracture plane appears oriented in the coronal plane through the volar aspect of the body of the triquetrum. There is also a mild amount of poorly defined edema type signal within the capitate that may represent a bone contusion.", "output": "1. Triquetral fracture as described above.2. Tear of the articular disc of the triangular fibrocartilage as described above.3. Linear signal abnormality within the scapholunate and lunotriquetral ligaments may represent partial-thickness tears, but we see no gadolinium traversing either ligament to confirm a full-thickness tear.These findings were relayed to Dr. Meislin and by phone at 10:00 AM on 2/3/2016."}
{"instruction": "Generate impression based on findings.", "input": "Resected pituitary adenoma in 2007: surveillance. There are postoperative findings related to transsphenoidal surgery. There is a pituitary mass that measures up to 12 mm craniocaudally, previously 15 mm. There is mild mass effect upon the bilateral medial cavernous sinuses. There is no mass effect upon the optic apparatus. The pituitary stalk remains deviated to the right. There is diffuse cerebral volume loss and scattered foci of cerebral white matter T2 hyperintensity.", "output": "Interval decrease in size of the pituitary macroadenoma."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic head and neck cancer with new brain lesion. There is a presumably ring-enhancing mass that measures up to 12 mm in the left superior frontal gyrus with associated vasogenic edema. There is a defect in the left caudate head, which may represent a chronic lacunar infarct. There are also a few punctate foci of nonspecific T2 hyperintensity in the cerebral white matter. There is no midline shift or herniation. There is no evidence of hydrocephalus. The skull, orbits, and scalp soft tissues are unremarkable.", "output": "Limited treatment planning MRI demonstrates a mass that measures up to 12 mm with associated vasogenic edema in the left superior frontal gyrus, which is compatible with metastatic disease. "}
{"instruction": "Generate impression based on findings.", "input": "Female 15 years old Reason: evaluate for cruciate ligament tear History: right knee injury and pain MENISCI: The posterior and anterior horns of both the medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a focal depression of the lateral femoral condyle near the junction of the weightbearing and nonweightbearing portions with underlying high T2 signal compatible with impaction. There is thinning of the articular cartilage at the area of impaction. Additionally, there is associated high T2 signal in the posterior lateral tibial plateau.LIGAMENTS: High T2 and low T1 signal is evident within the anterior cruciate ligament consistent with an ACL tear. The posterior cruciate ligament is intact. The lateral collateral and medial collateral ligament complexes are normal in signal and morphology.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1.High T2 and low T1 signal within the anterior crucial ligament consistent with an ACL tear.2.Contusion and impaction of the lateral femoral condyle with associated high signal in the posterolateral tibial plateau.3.No evidence of meniscal injury."}
{"instruction": "Generate impression based on findings.", "input": "Prostate cancer. Staging exam.Additional history per EMR: PSA 2010 2.46 ng/mL, biopsy, Gleason 3+3=6 in four cores with maximum involvement 60%. Active surveillance. March 2011, PSA 3.27, prostate biopsy Gleason 3+3=6 in one core 10%. March 2013, PSA 5.52, prostate biopsy Gleason 3+3=6 in three cores, maximum involvement 20%. October 2014, PSA 8.57 prostate biopsy Gleason 3+4=7 in two cores with maximum involvement 35%. PSA 6/19/2015 was 8.27. PELVIS:PROSTATE:Exam is limited by artifact from right hip prosthesis, markedly degrading diffusion-weighted images.Prostate Size: 5.6 x 4.6 cm.Peripheral Zone: Area of T2 hypointense signal in the left medial mid gland with suggestion of enhancement. This is incompletely evaluated without interpretable diffusion weighted images, though suspicious for patient's known prostatic adenocarcinoma.Central Gland: Marked nodularity and hypertrophy of the central zone without suspicious focal lesion.Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: There is no evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Left inguinal, left pelvic sidewall, and left external iliac prominent lymph nodes are noted. Left external iliac node measures 1.9 x 1.3 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Limited exam due to degradation of diffusion weighted images by artifact related to right hip prosthesis.2.Abnormality in the medial left mid gland is suspicious for patient's known prostatic adenocarcinoma. No evidence of extracapsular extension or seminal vesicle invasion.3.Prominent left inguinal, pelvic sidewall, and external iliac lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "Reason: s/p OLT History: s/p OLT ABDOMEN:LIVER, BILIARY TRACT: Status post hepatic transplant. Patent hepatic vasculature. Of note, there is mild stenosis of the anastomosis of the hepatic artery (1201:191) with minimal poststenotic dilatation - the lumen measures approximately 3 mm. No suspicious hepatic lesion.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: Large amount of blooming artifact inferior to the right kidney of uncertain significance. On prior radiograph a small metallic density was seen in the vicinity.BOWEL, MESENTERY: Large amount of blooming artifact within the stomach may be from Dobbhoff tube tip.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Poststernotomy wires.", "output": "1.Status post hepatic transplant. No suspicious hepatic lesions. Patent hepatic vasculature. Mild hepatic artery stenosis at the anastomotic site as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Chronic myelomonocytic leukemia not having achieved remission [C93.10] / Nontraumatic subarachnoid hemorrhage, unspecified [I60.9] / Transplanted organ and tissue status, unspecified [Z94.9] / Toxoplasmosis, unspecified [B58.9], Reason for Study There is evidence of encephalomalacia on the right parietal lobe superior parietal lobule and right superior and middle frontal gyri indicating chronic ischemic infarct. These lesions are new comparing to prior scan.There is no abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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 are clear.Fluid collections on the right mastoid air cells.", "output": "1. Interval development of right superior and middle frontal gyri as well as right parietal lobe superior lobe middle indicating chronic ischemic infarct.2. No abnormal enhancement. "}
{"instruction": "Generate impression based on findings.", "input": " There has been interval decrease in size and number of enhancing metastatic lesions throughout the brain. For example, a right cingulate gyrus lesion measures 7 mm in diameter, previously 14 mm, and an inferior vermis lesion measures up to 6 mm, previously 12 mm. The degree of associated vasogenic edema has also diminished. Otherwise, a small left parafalcine dural based extra-axial calcified lesion is unchanged. The ventricles and sulci are within normal limits. There is no midline shift. There is no evidence of acute infarction or hemorrhage. There is nonspecific fluid signal in the left mastoid air cells. There is also mild scattered paranasal sinus mucosal thickening. The orbits are unremarkable.", "output": "1. Interval decrease in size and number of the numerous intracranial metastases.2. An unchanged small left parafalcine mass may represent a meningioma."}
{"instruction": "Generate impression based on findings.", "input": "48 year old female with BRCA mutation and family history of pancreatic cancer, presents with abdominal fullness. LIVER, BILIARY TRACT: No suspicious hepatic lesions or biliary ductal dilatation. No filling defects seen within the biliary tree. Patent hepatic vasculature.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology without suspicious lesions. Nondilated pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral breast implants, unchanged.", "output": "Unremarkable MRI/MRCP of the abdomen, without any specific findings to suggest pancreatic neoplasm."}
{"instruction": "Generate impression based on findings.", "input": "Syncope and collapse, T6 sensory level abnormality. There are partially imaged findings related to posterior fossa decompression and low-lying cerebellum with brainstem compression. The imaged portions of the spinal cord grossly display normal signal and morphology, although motion artifacts limit assessment. 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 paravertebral soft tissues are unremarkable.", "output": "1. The imaged portions of the spinal cord appears to be grossly unremarkable, although motion artifacts limit assessment. No evidence of spinal canal stenosis.2. Partially imaged findings related to posterior fossa decompression and low-lying cerebellum with brainstem compression. Please refer to the recent brain MRI report for additional details."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status [780.97], Reason for Study: ^Reason: CVA? History: altered mental status Due to patient incorporation, the exam was prematurely ended. As a consequence, there is no acquisition of gradient echo sequences.There is a focal high signal intensity on diffusion weighted image (series #406, image 200/32), with restricted diffusion on the right precentral gyrus.There is a focal encephalomalacia seen on the left side of upper pons most likely representing previous stroke.Underlying brain shows patch confluent high signal intensity on periventricular white matter on FLAIR images indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Bilateral mastoid air cell show fluid collection.Nonvisualization of right eyeball lens.", "output": "1.Focal acute ischemic infarction, right precentral gyrus as described above.2. Chronic infarction with encephalomalacia seen on the right upper pons with nonspecific small vessel ischemic disease.3. Hemorrhagic lesions cannot be precisely evaluated due to Mr. Gradient-echo sequences, however, there is no other evidence suggesting intracranial acute hemorrhagic lesion on the scan."}
{"instruction": "Generate impression based on findings.", "input": "34 years Male (DOB:12/16/1981)Reason: 3T scanner, CCM Protocol, QSM/permeability; s/p cavernoma resection on 4/8/16. History of prior resections and radiation. History: Bilateral weakness, rt. side numbness, gait problems, double vision, s/p craniotomyPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is redemonstration of a hemorrhagic lesion centered in the left pons but also involving the left middle cerebellar peduncle which currently measures 32 x 41 mm . On the 4/10/2016 exam it measured 38 x 41 mm. When compared to the 4/10/2016 exam a previously noted cystic component along the medial aspect of the lesion has regressed.. A hemorrhagic lesion within the right cerebral peduncle is redemonstrated. There is more susceptibility effect the associated with the current exam versus the prior exam.Another hemorrhagic lesion in the left upper posterior midbrain has also changed character but appears to have less T2 signal hyperintensity centrally slightly less cystic.A high signal intensity lesion on T2 imaging in the left medulla remains stable. T2 signal hyperintensity along the posterior aspect of the left cerebellar hemisphere also remains stableThere is a developmental venous anomaly redemonstrated in the left cerebellar hemisphere inferiorly.The patient is status post suboccipital craniotomy.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus as well as minor opacities in the left ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There is redemonstration of multiple cerebral cavernous malformations in the brainstem and cerebellum associated with a left cerebellar developmental venous anomaly. These have mildly changed character and size when compared to the prior exam from 4/10/16.2.Status post posterior fossa surgery."}
{"instruction": "Generate impression based on findings.", "input": "Headache after trauma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of cerebral white matter T2 hyperintensity. 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. There is fluid within the right mastoid air cells.", "output": "Scattered foci of cerebral white matter T2 hyperintensity are nonspecific, but may represent chronic small vessel ischemic disease. No evidence of acute intracranial hemorrhage, mass, or acute infarct. Fluid in the right mastoid air cells may indicate mastoiditis."}
{"instruction": "Generate impression based on findings.", "input": "Female 43 years old Reason: s/p pelvic tumor resection History: s/p pelvic tumor resection. Additional history from EPIC notes; status post retroperitoneal approach resection of sacral mass 03/13/15. PELVIS:UTERUS, ADNEXA: There has been interval hysterectomy. Unremarkable appearance of the bilateral ovaries. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the right anterolateral pelvic wall.OTHER: Postsurgical changes status post resection of presacral mass. There is a 7.1 x 3.7 cm nonenhancing, mixed solid and fluid collection in the presacral space extending along the right internal iliac vessels. The appearance is suggestive of postsurgical hematoma. There is additional perirectal hematoma.There is a 1.7 x 1.6 cm ( series 1405, image 400) T2 isointense/progressively enhancing focus along the right S2/S3 neural foramen nerve root which is consistent with residual tumor.", "output": "1.Postsurgical changes in the presacral space with moderate postoperative hematoma. 2.1.7-cm enhancing focus along the right S2/S3 neural foramen consistent with residual tumor."}
{"instruction": "Generate impression based on findings.", "input": "68 years Female (DOB: 12/22/1947)Reason: Pt with 4-6 week hx of dizziness/lightheadedness, L leg weakness, numbness, spasticity, ? of urinary retention; rule out vessel occlusion, stroke History: Pt with 4-6 week hx of dizziness/lightheadedness, L leg weakness, numbness, spasticity, ? of urinary retention; rule out vessel occlusion, strokePROVIDER NAME: TAO XIE TAO XIE MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are 7 mm enhancing lesions present in each internal auditory canal. These were not present on the exam from 10/20/2014. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.Incidental note is made of partial empty sella.The visualized portions of the paranasal sinuses demonstrate some minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.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.Thoracic spine:There is diffuse leptomeningeal nodular enhancement throughout the thoracic spinal cordThe thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine. There is a mild dextrocurvature to the thoracic spine.There is a 13 mm x 16 mm axial dimension well-circumscribed lesion along the posterior surface of the right lobe of the liver which does not enhance following contrast administration. It is bright on T2 and dark on T1 suggesting it is cystic.Lumbar spine:There is nodular enhancement present within the thecal sac along the conus medullaris, cauda equina and within the full-thickness of the thecal sac at the S2 level. There is enhancement following the sacral exiting nerve roots. There is nerve root enhancement along many of the nerve roots in the cauda equina.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.Findings suggest a lesions in the internal auditory canals bilaterally and symmetrically. Given the leptomeningeal enhancement within the spine this is most likely represents leptomeningeal enhancement. These were not present on the exam from 10/20/2014. Please correlate with clinical history. Given the fact that these lesions in the internal auditory canals did not exist in the 2014 exam schwannoma is unlikely.2.There is leptomeningeal disease predominantly involving the thoracic spinal cord, cauda equina and sacral exiting nerve roots. One possibility is that this represents leptomeningeal carcinomatosis. Other differential considerations include granulomatous disorder including sarcoid and tuberculosis. "}
{"instruction": "Generate impression based on findings.", "input": "2 years, Male, strep pneumonia meningitis. Previous seen areas of nonsuppression of CSF in the cerebral hemispheres on the FLAIR sequences have resolved. Subtle foci of T2/FLAIR hyperintensity are again seen within the bilateral cerebellar hemispheres, which are slightly decreased in prominence on the right and slightly increased on the left. There is subtle associated diffusion hyperintensity. No abnormal parenchymal or meningeal enhancement is appreciated. No intracranial mass or mass effect. No findings to suggest cerebral abscess or evidence of empyema. Ventricles are normal in size without evidence of hydrocephalus. No evidence of acute ischemia or hemorrhage.There is symmetric enhancement of the bilateral cavernous sinuses without evidence of cavernous sinus thrombosis. Pituitary gland appears unremarkable for patient's age. Bilateral orbits appear grossly unremarkable. Interval marked improvement in previously seen opacification of the bilateral maxillary sinuses and ethmoid sinuses is noted. Previously seen opacification of the left mastoid air cells is much improved with mild residual opacification.", "output": "1. No evidence of cavernous sinus thrombosis. No evidence of intraparenchymal abscess or empyema. 2. Previously seen nonsuppression of CSF on the FLAIR sequence related to meningitis is no longer appreciated and is suggestive of overall improvement of meningitis. There are however subtle foci of FLAIR hyperintensity in the bilateral cerebellar hemispheres, which are slightly decreased on the right and slightly increased on the left since 1/1/2016; these findings are likely related to parenchymal involvement of infection.3. Interval improvement in previously seen paranasal sinus opacification as well as improved aeration of the left mastoid air cells."}
{"instruction": "Generate impression based on findings.", "input": "62 year old female with strong family history of breast cancer in mother diagnosed at age 60 and ovarian cancer at 86, breast cancer in maternal grandmother, and breast cancer in paternal aunt diagnosed at age 60. Personal history of skin cancer diagnosed at age of 52. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Multiple subcentimeter nonenhancing cysts are seen bilaterally. There is no new abnormal enhancement seen in either breast.No abnormal axillary 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": "Asymptomatic female presents for routine screening mammography. Family history of breast cancer in her mother diagnosed at age 37, and a maternal aunt. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C), unchanged in pattern and distribution. Stable scattered benign calcifications. Stable circumscribed masses are again present bilaterally, compatible with cyst seen on MRI.No suspicious masses, microcalcifications or areas of architectural distortion are present.", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of right upper quadrant pain, possible cirrhosis?, rule out cbd stone, cholecystitis, pancreatic mass, hepatic mass History: right upper quadrant pain. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Geographic areas of T2 hyperintense signal and arterial hyperenhancement involving segments 4, 5, 8, and some of 2, with associated retraction compatible with advanced focal confluent fibrosis. Two foci within segment 5 and 8 within these areas of fibrosis demonstrate delayed washout (1604 images 60 and 71). For future reference, the largest focus measures 3.1 x 3.7 cm (series 1601 and 1604 image 60). Small subcentimeter cyst in the left lobe. The gallbladder is mildly distended. No gallstone, pericholecystic fluid or gallbladder wall thickening. Extrahepatic biliary ductal dilatation. The common bile duct measures up to 1.1 centimeters (series 10 image 98) with gradual tapering to the ampulla. No filling defect identified. Small amount of perihepatic ascites.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is dilated measuring 0.7 cm (series 10 image 51) with gradual tapering to the ampulla. No pancreatic mass identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Cirrhotic morphology with advanced confluent fibrosis. Within this fibrosis in segments 5 and 8, there are two foci of delayed wash out. While, this is unusual for HCC, recommend short term follow up in 3-4 months to confirm stability. 2.Dilated common bile and pancreatic ducts, which gradually taper to the ampulla without filling defects or obstructing mass. 3.Mildly dilated gallbladder again noted without other evidence of acute cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Status post left knee injury. Pain medial side swelling, instability. Evaluate for ligamentous tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage within all three compartments is intact. LIGAMENTS: The collateral ligaments, cruciate ligaments, and popliteus muscle/tendon are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "No evidence of ligamentous or meniscal injury. "}
{"instruction": "Generate impression based on findings.", "input": "Evaluate pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: Multiple liver hyperintensities likely represent cysts but are incompletely characterized.Mild central biliary ductal dilatation without a discrete lesion, within the limitations of a nonenhanced study.Suggestion of diffuse iron deposition of the liver.Probable focal adenomyomatosis of the normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum. 1.9 x 1.3 cm pancreatic body cystic appearing lesion likely communicates with the main pancreatic duct which is minimally prominent measuring 4 mm. The lesion demonstrates no mural nodularity. Side branch ectasia and additional probable small side branch type IPMNs are noted.ADRENAL GLANDS: Mild adrenal gland thickening.KIDNEYS, URETERS: Multiple bilateral renal hyperintensities are not completely characterized without intravenous contrast. Some of them demonstrate internal complexity/septations.Left renal inferior pole T2 hypointense lesion measures 1.8 x 1.7 cm with proteinaceous/hemorrhagic components, incompletely characterized. No hydronephrosis.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.Cystic-appearing pancreatic body 1.9 cm lesion likely communicated with the main pancreatic duct and is likely a side-branch IPMN without mural nodularity. Limited evaluation without contrast.2. Multiple bilateral renal cystic lesions are incompletely characterized. 3. Indeterminate left renal inferior pole 1.8 cm T2 hypointense complex lesion.4. Probable multiple hepatic cysts."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with chronic pancreatitis and pancreatic exocrine insufficiency. Status post ERCP on 1/29, which showed pancreatic duct obstruction, unable to be passed endoscopically, assess stricture. ABDOMEN:LIVER, BILIARY TRACT: No intra- or extra-hepatic biliary ductal dilation. No focal mass lesion identified.SPLEEN: No evidence of splenomegaly.PANCREAS: There is atrophy of the pancreas as well as loss of the expected intrinsic T1 signal intensity, consistent with the stated history of chronic pancreatitis. Note is made of irregular contour and non-distensibility of the main pancreatic duct. There is a focal area of narrowing of the main pancreatic duct, approximately 1.7 cm proximal to the level of the ampulla, consistent with the stated history of main pancreatic duct stricture. Additionally, proximal to this area of focal narrowing, is a long segment of relative narrowing of the main pancreatic duct, at the level of the pancreatic body, measuring approximately 2.3 cm in length (as seen on series 1401). There is slight distention of the main pancreatic duct proximal to this region. There is a blunted response to secretin augmentation consistent with the stated history of pancreatic exocrine insufficiency.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cysts are identified within the kidneys bilaterally.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "1.Findings consistent with the stated history of chronic pancreatitis. There are multiple foci of narrowing affecting the main pancreatic duct, consistent with the stated history of main pancreatic duct stricture, likely related to sequelae of chronic pancreatitis. No obstructing focal mass lesion identified. 2.Blunted response to secretin augmentation, consistent with the stated history of pancreatic exocrine insufficiency which may also be related to the patient's history of chronic pancreatitis. "}
{"instruction": "Generate impression based on findings.", "input": "66 years, Male, Reason: met urothelial cancer History: met urothelial cancer; staging. Study limited due to lack of intravenous contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple scattered subcentimeter T2 hyperintensities. No cysts were seen on prior CTs. Common bile ducts is a prominent without an obstructing lesion present.SPLEEN: No significant abnormality noted.PANCREAS: Prominent pancreatic duct.ADRENAL GLANDS: Right adrenal nodule measuring 1.2 cm (601/27) which does not definitively lose signal on out of phase imaging. Left adrenal nodule measures 0.8 cm (601/23) which does not definitively lose signal on out of phase imaging. Both of these lesions are considered indeterminate and unchanged from prior exams.KIDNEYS, URETERS: Bilateral subcentimeter hemorrhagic cysts. Additional T2 hyperintensities are not well characterized without intravenous contrast. Diffusely increased signal within the kidneys on T2 images likely indicates chronic renal disease.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.PELVIS: PROSTATE, SEMINAL VESICLES: There is a mass within the perineum at the base of the penis which has increased in size measuring 7.1 x 4.7 x 6.4 cm (1501/7 and 1401/18), previously 3.2 x 4.0 x 2.4 cm. There is invasion superiorly to the right apex of the prostate. The mass abuts the anterior aspect of the rectum. There is increased T2 signal within the central portion of the mass, indicating necrosis.BLADDER: Foley catheter within the bladder.LYMPH NODES: Small pelvic lymph nodes, including a right obturator node measuring 2.2 x 0.6 cm (1501/27) unchanged. Small inguinal lymph nodes are also noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered T2 hyperintensities within the pelvis and spine, incompletely characterized.OTHER: No significant abnormality noted.", "output": "1.Necrotic mass at the base of the penis is increased in size.2.Multiple subcentimeter T2 hyperintensities within the liver. A benign etiology is favored, such as biliary hamartomas, however these were not seen on prior CTs and are incompletely characterized without intravenous contrast.3.Indeterminate bilateral adrenal nodules are stable.4.Findings of chronic renal disease with bilateral hemorrhagic cysts and indeterminate cysts"}
{"instruction": "Generate impression based on findings.", "input": "Male, 38 years old, with multiple sclerosis presenting with numbness and weakness. C-spine:Mild prominence of the central canal of the spinal cord is seen from the level of the obex to C2. The caliber of the canal never measures more than 1 mm which is within the limits of normal variation.Since the prior examination, extensive central cord T2 hyperintensity spanning from C2 through C7 has significantly improved. All that remains of this prior abnormality are two longitudinal tracts of T2 hyperintensity within the central gray of the cord bilaterally spanning the C5 and C6 levels. Elsewhere no new areas of pathologic cord signal are seen. No pathologic cord or leptomeningeal enhancement is seen.Straightening of the cervical lordosis is likely positional. Vertebral body height and morphology are normal. No pathologic marrow signal abnormality is seen.No significant spinal canal or neuroforaminal stenosis is evident at any level. Mild posterior disc-osteophyte complex formation is seen at C5-6.Brain:Several punctate foci of T2 hyperintensity are seen within the right frontal subcortical white matter. Accounting for differences in technique, these seem to have been present on the prior examination and have not significantly changed.A small focus of T2 hyperintensity is evident along the left frontal horn, and another along the body of the right lateral ventricle, both of which also seem to have been present previously.No evidence of parenchymal edema, mass effect or midline shift is seen. No restricted diffusion is demonstrated. No pathologic enhancement is seen. A small right frontal developmental venous anomaly is seen.Incidental note is made of ectopia of the right cerebellar tonsil, a stable finding.Extensive ethmoid and maxillary sinus mucosal inflammation is demonstrated, a new finding from the prior exam.", "output": "1.Several scattered punctate lesions are demonstrated in the cerebral hemispheres without significant or convincing interval change. Although two of these are along the ventricular margin, they are ultimately nonspecific in morphology.2.Longitudinally extensive signal abnormality seen previously within the cervical spinal cord has significantly improved. Only two small tracts of T2 hyperintensity persist at the C5-6 level.3.The above described brain and cord findings are not entirely typical for multiple sclerosis. Particularly, the previously seen longitudinally extensive central cord signal abnormality would be an unusual finding in multiple sclerosis. Neuromyelitis optica does remain within the differential based on imaging findings. Likewise, other inflammatory, postinfectious and autoimmune etiologies may also be considered.4.Stable ectopia of the right cerebellar tonsil.5.New paranasal sinus inflammatory disease."}
{"instruction": "Generate impression based on findings.", "input": "14-year-old female with left knee pain with a history of patellar instability. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is lateral translation of the patella relative to the femoral trochlea. The femoral trochlea is abnormally shallow, indicating dysplasia. There is a full-thickness articular cartilage defect of the patella along the inferior aspect of the median eminence with edema type signal within the underlying bone marrow. There is also near full-thickness to full-thickness cartilage loss along the medial facet of the patella. There is edema within the lateral aspect of the lateral femoral condyle likely representing a contusion from transient patellar dislocation. The articular cartilage along the anterior lateral aspect of the lateral femoral condyle is slightly increased in signal intensity likely reflecting posttraumatic degeneration. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. The tibial tuberosity trochlear groove distance is approximately 15 mm.ADDITIONAL", "output": "Findings compatible with the stated history of patellar instability with femoral trochlear dysplasia, lateral displacement of the patella, and articular cartilage defects/degeneration as well as other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "History of multifocal prostate cancer. Patient presents for focal laser ablation of the cancer in the left side of the prostate Patient used prophylactic antibiotics before and after the procedure asprescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500 mg bidstarting the night before the procedure. He took 2 tablets of Ciprofloxacin 500 mg beforethe procedure and will take two tablets after the procedure. Following the discussion ofthe risks, benefits, and alternatives of the procedure, informed consent was obtained forthe research study. The procedure was performed under moderate conscious sedation.MRI focus in the left base, mid-gland and apical peripheral zone suspicious for patient's known cancer waslocalized with T2 weighted MR images. Following sterile preparation, Medtronic's laserablation template was placed in the perineum on the patient and localized on MR images andregistered to the MR images where prostate lesion could be visualized.Following local anesthesia with lidocaine, 14-gauge MR- compatible needles were insertedinto the left side of the prostate to stabilize the prostate. Upon confirmation of thetip of the needle on the left side close to the known lesion, a total of 5 laser ablationswith 30-W, 90 % power was performed within the left mid-gland and apical peripheral zone of theprostate zone. The patient tolerated the procedure well without any immediate complications.Pre-and postcontrast axial MR images are obtained before and after administration of 10 ccMultiHance, upon completion of the procedure. On MR images of ablation defect was notedwithin and around the ablated region. COMPLICATIONS: No immediate complications.BLOOD LOSS: < 10 ml", "output": "MR guided laser ablation of the left base mid-gland and base peripheral zone of theprostate.PLAN: Patient was sent to the post-procedural area for observation to ensure voiding. Will follow-up with urology."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified tinnitus [388.30], Reason for Study: ^Reason: any structural problems History: tinnitus The brainstem, cerebellum, vermis and tonsils are normal. The inner ear structures, cochlea, vestibule, semicircular labyrinth are normal. The internal auditory canals are normal with delineation of the facial, cochlear and vestibular nerves. No evidence of signal abnormality, mass or abnormal enhancement is noted. The ventricles, cerebral sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or 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. No evidence of acute ischemic or hemorrhagic lesion on the scan.There is Thornwald cyst sized about 12.5mm x 9.6mm.", "output": "Normal brain and internal auditory canal MRI scans."}
{"instruction": "Generate impression based on findings.", "input": "Male, 36 years old. Right hip pain. Several images are limited by patient motion artifact.ACETABULAR LABRUM: There is a large gadolinium/fluid-filled labral tear extending from the 12 o'clock to the 4 o'clock position anteriorly. ARTICULAR CARTILAGE AND BONE: There is a small cyst in the acetabular dome underlying the above-mentioned labral tear anteriorly, with adjacent mild marrow edema. There is prominence of the anterior aspect of the femoral head/neck junction indicating a CAM deformity with an alpha angle of approximately 70 degrees. There are underlying cystic changes anteriorly within the femoral head neck junction.SOFT TISSUES: The soft tissues of the right hip are within normal limits. ADDITIONAL", "output": "1.Cam deformity of the right femoral head/neck junction with a large labral tear as described above.2.Degenerative disc disease of the lower lumbar spine and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Compression of brain. Spinal stenosis in cervical regionClinical question: hx 4th ventriclar flow obstruction with Stenting tube placed eval CINE flow- eval patency of stent and CSF flowSigns and Symptoms: headaches to the base of the skull The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post posterior fossa decompression for Chiari I malformation. There is a ventricular stent present in the fourth ventricle which courses through the foramen of Magendie and behind the upper cervical cord. The appearance of the adjacent cerebellum is stable.The ventricles are non-dilated.CSF flow at the foramen Magnum is biphasic and within normal limits.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Status post Chiari I decompression and 4th ventricular stent without current evidence for ventriculomegaly. The findings are stable compared to the prior exam.2.CSF flow at the foramen Magnum is intact."}
{"instruction": "Generate impression based on findings.", "input": "63 year old woman with GBM. Rule out bleed. There is no evidence of acute intracranial hemorrhage.Patient is status post left temporal craniotomy and left temporoparietal tumor resection. A resection cavity is present in the left temporoparietal region. The temporal horn of the left lateral ventricle is dilated, reflecting volume loss. Left-sided periventricular hypoattenuation and mild dilation of the body of the left lateral ventricle are present -- these findings likely reflect treatment-related gliosis/edema and volume loss. Meningeal thickening is present along the left greater wing of the sphenoid and the left temporal bone -- this is likely postoperative in nature. The study is inadequate to assess for the presence of residual or recurrent tumor -- recommend contrast enhanced MRI for this purpose.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. No CT evidence of acute intracranial hemorrhage.2. Postoperative findings of left temporoparietal tumor resection as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 10 years old, with history of medulloblastoma, surveillance MRI. Brain:Postoperative findings are redemonstrated in the posterior fossa without significant interval change. The right cerebellar resection cavity is stable in size and morphology. No evidence of pathologic enhancement is seen within or adjacent to the cavity. Scattered foci of susceptibility along the medial margin of the resection cavity are unchanged.No pathologic enhancement is detected intracranially. Nonspecific foci of FLAIR hyperintensity in the right inferior frontal white matter, and the left cerebellum, are unchanged. Likewise, foci of susceptibility within the bilateral temporal lobes are unchanged. No evidence of edema or mass effect is seen. The supratentorial ventricles are normal in size and morphology. Mucosal thickening and secretions are evident in the right maxillary sinus.Spine:A 3 mm focus of susceptibility within the left aspect of the spinal cord at C7-T1 is unchanged. The spinal cord, conus and cauda equina otherwise demonstrate normal signal intensity. No pathologic intrathecal enhancement is seen.Spinal alignment is anatomic. Vertebral body heights are preserved. Fatty marrow replacement throughout the spine is probably related to prior radiotherapy. Otherwise, no pathologic marrow signal abnormality is seen. The intervertebral discs are preserved with no evidence of significant spinal canal or foraminal stenosis.", "output": "1.Stable postoperative findings in the posterior fossa with no evidence of tumor recurrence.2.Stable examination of the spine."}
{"instruction": "Generate impression based on findings.", "input": "Reason: is there a medial meniscus tear? History: medial knee pain after twist MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the knee appears normal. No bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are normal in appearance.ADDITIONAL", "output": "No meniscal tear or other specific findings to account for the patient\u2019s pain."}
{"instruction": "Generate impression based on findings.", "input": "53 years Male (DOB:11/12/1962)Reason: lumbar radiculopathy History: painPROVIDER/ATTENDING NAME: RODERICK H. BIRNIE RODERICK H. BIRNIE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is a large left lateral recess disk extrusion which compresses the nerve roots at the left lateral recess and compresses the thecal sac, effacing CSF surrounding the nerve roots. Disk material extends behind the adjacent endplates. There is associated loss of disk space height and subacute end plate reactive changes (bright on T2 low signal on T1) which is superimpose on a larger area of chronic endplate reactive change (T1 hyperintense and T2 hypointense). The endplates are irregular. There is disk dessication. Overall there is moderate spinal stenosis.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.There is a large L4-5 disk left lateral recess disc extrusion creating moderate spinal stenosis and compression of the nerve roots predominantly at the left lateral recess. It is associated with subacute on chronic endplate reactive change. "}
{"instruction": "Generate impression based on findings.", "input": "36 years Male (DOB:9/21/1979)Reason: eval for lumbar disk disease History: left hip pain w/ neuropathyPROVIDER/ATTENDING NAME: SACHIN DILIP SHAH SACHIN DILIP SHAH Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "No compromise to lumbar spinal canal or neural foramina."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified esotropia [H50.00], Reason for Study: ^Reason: L ptosis, L esotropia History: above Brain MRINo evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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. The mastoid air cells are clear. Mucosal thickening of bilateral ethmoid sinuses.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal brain MRA "}
{"instruction": "Generate impression based on findings.", "input": "History of right lumpectomy in 1999 with radiation therapy for right breast cancer. Also history of benign left breast biopsy in the 1980s. Family history of breast cancer in her mother at 42, and sister at age 60. Patient is enrolled in a screening program for high-risk individuals. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.There are stable postsurgical changes and volume loss from right lumpectomy. 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: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "38 year old female status post left lumpectomy for invasive ductal carcinoma in 2012. Patient received chemotherapy, radiation and Herceptin. History of right reduction mammoplasty with keloid formation. History of benign right breast biopsy showing fat necrosis. No current breast complaints. Family history of breast carcinoma in her maternal aunt in her 40s. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. Stable small high T2 signal lesion in the left lobe of liver most likely a cyst or a hemangioma.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "History of medulloblastoma resected in 1994, with recent seizures, for which workup detected a right parietal meningioma. There is an avidly enhancing right superior parietal convexity extra-axial mass that measures up to 22 mm, which is unchanged. There is associated mass effect upon the underlying brain parenchyma, but no evidence of regional vasogenic edema. There are postoperative findings related to left suboccipital craniotomy with encephalomalacia in the left cerebellar hemisphere, but no evidence of a mass in the posterior fossa. There is diffuse dural thickening related to calcifications. There is encephalomalacia in the right lateral temporal lobe. There are scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres. There is no evidence of acute intracranial hemorrhage or acute infarct. There is a left transparietal ventricular catheter in unchanged position. 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. There is an enhancing mass in the right frontal scalp that measures up to 16 mm. There are bilateral posterior maxillary cystic lesions.", "output": "1. Unchanged right parietal convexity meningioma with associated mass effect upon the underlying brain parenchyma, but no evidence of regional vasogenic edema.2. Postoperative findings related to left suboccipital craniotomy related to medulloblastoma resection with encephalomalacia in the left cerebellar hemisphere, but no evidence recurrent tumor in the posterior fossa. 3. Diffuse dural calcification may be a manifestation of Gorlin syndrome.4. Bilateral posterior maxillary cystic lesions may represent keratocystic odontogenic tumors, which may also be a manifestation of Gorlin syndrome. Dedicated maxillofacial imaging may provide further insights, nevertheless.5. A persistent right frontal scalp lesion may represent a basal cell nevus or carcinoma or other neoplasm.6. Scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres may represent cavernous malformations or chronic microhemorrhage related to prior radiation. 7. Unchanged appearance of the shunted ventricular system."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old man with elevated alkaline phosphatase and total bilirubin. Evaluate for suspicious lesion or biliary issues. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 20.6 cm in length. No enhancing liver lesion.The gallbladder is normally distended with no cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: The splenic vein is not well seen however small collateral vessels are present consistent with the previously documented splenic vein thrombosis. The spleen measures 14.0 cm in length.PANCREAS: The pancreatic head and uncinate process are normal in appearance and without focal lesion. The body and tail of the pancreas are not well seen secondary to previous necrotizing pancreatitis. The pancreatic duct is not dilated. Inflammatory changes surrounding the pancreas have resolved.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No suspicious renal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small peripancreatic and porta hepatis lymph nodes are nonspecific.BOWEL, MESENTERY: Tubular enhancing structures in the gastric fundus may represent varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small amount of pelvic ascites.", "output": "1.No suspicious liver lesion or biliary ductal dilatation.2.Hepatosplenomegaly.3.Chronic splenic vein occlusion with formation of splenic collaterals and possible gastric fundal varices."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status and history of alcoholic cirrhosis of liver with ascites. Many of the images are degraded by patient motion. There is mild cerebral white matter T2 hyperintensity, primarily in a periventricular distribution. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild T1 hyperintensity in the bilateral basal ganglia and pituitary gland. There is also diffuse nonspecific susceptibility effect within the bilateral basal ganglia and midbrain. There is diffuse cerebral and cerebellar 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 secretions that encompass the entire left maxillary sinus.", "output": "1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Diffuse cerebral and cerebellar volume loss is likely related to alcohol use.3. Findings suggestive of chronic hepatic encephalopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o hemorrhage History: Headache persistent 8/10 from fell on 04/07/15 The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minimal opacities. The visualized portions of the orbits are intact. There is bony thickening at the level of the lambdoid sutures. This is better evaluated than on the CT of the head and is a little clinical relevance.", "output": "MRI of the brain is within normal limits"}
{"instruction": "Generate impression based on findings.", "input": " Exam is limited by patient motion. There are areas of cortical diffusion restriction along the right superior temporal and right lateral frontal parietal region. Areas of sulcal susceptibility and FLAIR hyperintensity are also identified in these areas, consistent with the subarachnoid blood products seen on recent CT. Other scattered foci of susceptibility are similar to that of the prior exam, including within both thalami. There is a new left superior frontal gyrus oval area of susceptibility consistent with the previously seen small parenchymal hemorrhage, grossly unchanged. There is also slight increased conspicuity of very faint susceptibility in the left frontal deep white matter as compared to the prior MRI, corresponding to an area of subtle hyperdensity on CT. This may represent developing mineralization. There is a punctate focus of diffusion restriction in the right frontal deep white matter as seen on 501/215.Post-contrast images do demonstrate left carotid canal on the fat saturated postcontrast images which may relate to slow flow of contrast within the vessel.Compared to the recent CT, there are stable bilateral well hemispheric subdural effusions, slightly greater on the left side. On the left, the collection measures up to 11 mm in thickness, with long the right measures 8 mm. These are approaching CSF signal intensity on all sequences. There is no pathological enhancement. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or significant mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild-moderate chronic small vessel ischemic changes including numerous scattered lacunar infarcts.The midline structures and craniocervical junction are within normal limits. MRA HEAD", "output": "1. Abnormal cortical diffusion restriction along the right superior temporal lobe and just cranially along the right lateral frontal parietal region, with associated areas of subarachnoid as well as parenchymal hemorrhage. Given background of numerous foci of susceptibility, this is felt to be most likely related to amyloid angiopathy, perhaps the rare inflammatory type, which can results in hemorrhagic infarcts.2. Redemonstration of left superior frontal gyrus parenchymal hemorrhage.3. Stable appearance of the thin left greater than right near CSF signal intensity subdural effusions, new since prior MRI.4. Complete occlusion or near occlusion of visualized portion of left internal carotid artery with likely minimal slow flow along the carotid canal on post contrast images, that is most likely chronic. CTA of the head and neck may be obtained for further evaluation.5. Mild stenosis and irregularity of the mid to distal basilar artery and the right P2 segment. Moderate focal narrowing at the left A1 segment origin. Decreased flow related enhancement in the left middle cerebral artery branches. Moderate irregular in narrowing of the cavernous right internal carotid artery.6. Unremarkable MRV head."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic renal cell carcinoma Evaluation of the postcontrast images limited by motion artifact.There are multiple foci of signal abnormality scattered throughout the pelvis consistent with osseous metastatic disease. The largest lesion is noted within the posterior ilium and demonstrates soft tissue extension into the overlying musculature. The mass demonstrates enhancement following gadolinium administration and measures approximately 7 x 3.9 x 6.4 cm in the greatest transaxial and craniocaudal dimensions. Just inferior to this dominant mass is an additional focus in the left ilium measuring approximately 3.4 x 1.3 x 1.8 cm which may represent a satellite lesion or extension from the more superior mass.Scattered additional foci of enhancement are noted throughout the pelvis and delineated on PACS including within the left iliac wing, the right acetabulum, the sacrum bilaterally, and the right femoral head. Additionally, there is abnormal enhancement and irregularity of the superior endplate of L4 concerning for an additional metastatic lesion with possible pathologic fracture.", "output": "Multifocal osseous metastatic disease throughout the pelvis with additional foci noted in the proximal femora and lower lumbar spine. The largest lesion involves the left posterior ilium and measures 7 x 3.5 x 6.4 cm."}
{"instruction": "Generate impression based on findings.", "input": " Compared to examination from 5 days prior, there are interval postsurgical changes of decompression of the thoracic spinal canal from T5 to T8 and tumor debulking. Previously seen cord deformity is improved. There remains epidural tumor involving the left ventrolateral aspect of the spinal canal including with minimal cord deformity at the T7 level involving its left lateral aspect. Dorsal thecal sac effacement is much improved. There is subtle T2 hyperintensity within the thoracic cord from T5 to T7 which is suspected and probably present on prior although difficult to appreciate on prior due to the compressed cord.Multifocal osseous metastatic disease is again seen including the T1, T6-T8, and L1 vertebrae. Again noted is extensive involvement of the posterior elements on the left from T6 to T8 and narrowing of the left T6-T7, T7-T8, and T8-T9 neural foramina due to tumor. Enhancing tumor involving the neural foramina at the right C7-T1, right T1-T2, right T2-T3, right T12-L1, and right L1-L2 neural foramina also again seen. Tumor involving the left chest wall from approximately T7-T9, moderate left-sided pleural effusion, and para-aortic lymphadenopathy also again seen.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. Vertebral body heights are maintained. Mild degenerative changes are seen including small central disc protrusion at T6-T7 and T7-T8.There is a fluid collection in the surgical bed which is mostly in the posterior midline paraspinous soft tissues and may represent a seroma or pseudomeningocele. Small amount of the fluid extends into the left lateral epidural space extending from T6 to the T7-T8 levels.", "output": "Compared to MRI examination from 5 days prior, interval posterior decompression of the spinal canal from T5 to T8 is seen with laminectomies and tumor debulking. Previously seen cord deformity is improved. Dorsal thecal sac effacement is significantly improved. There however remains rightward displacement of the cord and mild cord deformity at the T7 level related to epidural tumor involving the left ventrolateral aspect of the spinal canal. Paraspinous fluid collection which has mild extension into the left lateral epidural space from the T6 to the T7-T8 levels also mildly contributes to the mass effect. There is subtle T2 hyperintensity within the thoracic cord from T5 to T7 which may have been present on prior study although difficult to appreciate due to the compressed cord.Please see above and recent report from 12/5/2015 regarding additional foci of metastatic disease including involvement of multiple neural foramina."}
{"instruction": "Generate impression based on findings.", "input": "Headache There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Left globe is atrophic and calcified with prosthesis. Single image of the sella turcica demonstrates calcification. There is no CSF density seen in the sella. Correlation with clinical history is recommended. Further evaluation with MRI can be performed. The optic chiasm is normal.", "output": "1. No acute abnormality seen to account for the patient's symptoms of headaches. 2. Calcification noted in the sella turcica. Correlation with clinical history is recommended and further evaluation with MRI can be performed if indicated. "}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for osteomyelitisIMAGE ACQUISITIONS: CT- right hip, bilateral foot and ankle. Please note that the patient presented with a history of possible osteomyelitis with draining ulcers. An MRI with contrast was suggested to evaluate the right hip and bilateral foot and ankles. However, after conference with the primary service, our request for an MRI was modified and a CT with no enhancement was performed at the service's request.CT of the right hip shows a deep ulcer overlying the greater trochanter extending to the level of the bone with minimal cortical destruction and associated soft tissue gas. These findings are suspicious for osteomyelitis.CT of the right foot and ankle shows what appears to be a shallow soft tissue defect consistent with an ulcer overlying the medial and lateral malleoli. The underlying bony cortex appears intact. Vascular calcifications are noted. Degenerative changes affect the foot and ankle.CT of the left foot shows no ulceration, discrete abscesses or other radiographic findings to suggest osteomyelitis. Slight fat stranding about the foot is consistent with soft tissue edema. The patient is status post mid first metatarsal amputation with the osteotomy edge remaining intact.", "output": "1) Deep ulcer overlying the greater trochanter extending to the level of bone with minimal cortical destruction and associated soft tissue gas suspicious for osteomyelitis. 2) Shallow ulcers overlying the medial and lateral malleoli of the right foot with no evidence of cortical disruption."}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of brain, unspecified site [191.9], Reason for Study: ^Reason: Eval GBM. History: GBM. Redemonstration of the post resection cavity of the right frontal GBM which does not show any interval change in terms of maximum diameter (54mm x 42mm x 63mm) and MR characteristics.There is no evidence of abnormal enhancement except overlying dural enhancement which does not show any interval change since prior exam.Patchy high signal intensity on the peripheral side of the resection cavity on FLAIR/T2 images do not show any interval change since prior scan.No change of retention cyst in the sphenoid sinus.Extra axial fluid collections on craniotomy site has been smaller since prior scan (maximum thickness 4mm from 9mm).The ventricles, sulci and cisterns are symmetric and unremarkable. 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 change of post resection cavity since prior scan in terms of size and MR characteristics.2. No evidence of new or residual tumor."}
{"instruction": "Generate impression based on findings.", "input": " There are no subependymal nodules or foci of susceptibility effect to suggest parenchymal/subependymal calcifications. There is no hydrocephalus. There is no suspicious enhancement, acute infarct, mass, or cerebral edema. Myelination pattern is normal for patient age. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.", "output": "Unremarkable exam. Specifically, there are no MRI findings of tuberous sclerosis at this time."}
{"instruction": "Generate impression based on findings.", "input": "Female, 47 years old, with back pain and numbness in the right leg. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits allowing for a mild concavity of the superior T11 endplate. No evidence of marrow edema or concerning marrow replacement is seen. The visualized distal spinal cord, conus and cauda equina are unremarkable except as discussed below.T10-11: Small left paracentral/foraminal disc extrusion which mildly narrows the left neural foramen. No significant interval changes.T11-12: Mild facet hypertrophy. Mild loss of disc height with slight disc bulging. No significant spinal canal or foraminal stenosis. No significant interval changes.T12-L1: Unremarkable.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Progressive moderate facet hypertrophy, particularly on the right with there is a large facet joint effusion and subchondral cystic degeneration. Ligamentum flavum thickening. Mild disc bulging. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L4-5: Progressive advanced facet hypertrophy with large facet joint effusions bilaterally. Significant ligamentum flavum thickening. A new cyst is evident arising from the right ligamentum flavum projecting into and effacing the right dorsal aspect of the spinal canal. A sliver-like area of cystic degeneration also seems to be new within the left ligamentum flavum. Mild disc bulging is seen. These findings contribute to produce a moderately severe generalized spinal canal stenosis, new from prior, with slight crowding of the nerve roots of the cauda equina. The neural foramina are not significantly narrowed. L5-S1: Facet hypertrophy. Mild bulging disc. No significant spinal canal stenosis. Minimal right foraminal narrowing, slightly progressed.", "output": "Progressive degenerative findings are seen, primarily affecting the posterior elements at L3-4 and L4-5. For example, there is significant facet degeneration at L3-4 with facet effusion on the right. At L4-5, there is marked bilateral facet degeneration with effusions, and a large new cyst arising from the right ligamentum flavum which projects into the spinal canal and contributes to a moderately severe canal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question answered: 10 month old male with fever x 2 days with swelling behind right ear. Access versus tendinitis. Look for retropharyngeal extension. Signs and symptoms: Fever swelling behind right ear. Examination demonstrates extensive area of soft tissue swelling with stranding of subcutaneous fat and effacement of fascial planes on the right side of neck extending from the right occipital region inferiorly into the right parapharyngeal space and retropharyngeal space with extension into the right submandibular region and inferiorly into the right submental region. At the level of right submandibular region there are multiple loculated necrotic cavities which are believed to represent necrotic lymph nodes. There is significant mass-effect and anterior and medial displacement of right carotid artery. There is complete occlusion of right internal jugular at the level of skull base. There is fixation of edema and swelling into the retropharyngeal space allover no evidence of cavity formation is detected. No evidence of any significant airway compromise is detected. The mastoid air cells and middle ear cavity as well as the external auditory canals remain within normal limits. There is normal enhancement of the right lateral (transverse) sinus and sigmoid sinus as well as the right jugular bulb however as mentioned above the internal jugular vein is occluded exactly at the level of the skull base. Soft tissue swelling with subtle enhancement overlapping the right occipital bone demonstrates suspected minimal lytic changes of the bone. This finding is best appreciated on axial images 62 through 65. This finding is not associated with any abnormality of the lateral or the sigmoid sinus on the right and the inner table of the skull remains intact at this level. This finding may be normal anatomical variation of irregularity of the bone and I believe possibly two of an overlapping infectious process (osteomyelitis) is considered less likely. Entirely exclude possibility of osteomyelitis an MRI examination might be helpful.", "output": "1.Extensive soft tissue thickening extending from the right occipital region into the right parapharyngeal space, right retropharyngeal space, right submandibular region and right submental region as detailed.2.Enhancement of abnormal soft tissue thickening contains areas of internal necrosis in the right submandibular region which are believed to represent the chronic lymph nodes.3.Edema of retropharyngeal space with no evidence of abscess formation or any significant airway compromise.4.Mass effect and anterior displacement of right internal carotid artery by the above findings.5.Complete occlusion of right internal jugular at the level of skull base and inferior.6.Normal enhancement of right lateral and sigmoid sinuses and jugular bulb.7.Minimal irregularity of outer table of the skull in the right occipital region may be anatomical variation and unlikely osteomyelitis. Please see above comments.8.No evidence of spread of infection into the intracranial space or spinal canal.9.Normal pneumatization of right external auditory canal, right middle ear cavity and mastoid air cells."}
{"instruction": "Generate impression based on findings.", "input": " Previously demonstrated multiple foci of diffusion signal abnormality have resolved. There are no new foci of restricted diffusion. There is a chronic appearing infarct is present in the subcortical white matter of the inferior frontal gyrus (series 303, image 172). Hemorrhagic products are now evident at a few of these foci of prior restricted diffusion consistent with hemosiderin deposition.There has been interval decrease in size of a right posterior parietal lesion, now measuring 16 x 23 mm in transaxial dimensions (previously 25 x 21 mm. This contains intrinsic T1 hyperintense material without significant associated residual enhancement. Postoperative changes are again noted secondary to a biopsy of this lesion.There is a new small focus of enhancement involving a posterior left insular cortex, in an area of prior stroke, and now associated with susceptibility abnormality.Confluent T2 hyperintense white matter abnormality has increased bilaterally, without associated mass effect, suggestive of treatment change.There is no significant mass effect or midline shift. The cerebellar tonsils are in normal position. The ventricles and sulci are unchanged in size. Flow voids are present within the major vessels indicating patency. Redemonstrated is diffuse sinus disease, with worsening of the frontal sinuses and left sphenoid sinus.", "output": "1.Previously demonstrated multiple foci of diffusion signal abnormality have resolved. There are no new foci of restricted diffusion.2.There has been interval decrease in size of a right posterior parietal lesion, now measuring 16 x 23 mm in transaxial dimensions (previously 25 x 21 mm. This contains intrinsic T1 hyperintense material without significant associated residual enhancement. 3.There is a new small focus of enhancement involving a posterior left insular cortex, in an area of prior stroke, and now associated with susceptibility abnormality. This is of uncertain clinical significance.4.Confluent T2 hyperintense white matter abnormality has increased bilaterally, without associated mass effect, suggestive of treatment change.5.Redemonstrated is diffuse sinus disease, with worsening of the frontal sinuses and left sphenoid sinus."}
{"instruction": "Generate impression based on findings.", "input": " Cervical spine:The right cerebellar tonsil lies 7 mm below the level of the foramen magnum and demonstrates a pointed morphology, unchanged. CSF flow analysis demonstrates a flash of biphasic flow at the level of the cerebellar tonsils, unchanged in extent.Straightening of the cervical spine is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The visualized paraspinal contents are unremarkable.C2/3: Unremarkable and unchangedC3/4: Small midline protrusion slightly indents the anterior cord surface without intrinsic or signal abnormality and no resulting stenosis, unchanged.C4/5: Unremarkable and unchangedC5/6: Unremarkable and unchangedC6/7: Unremarkable and unchangedC7/T1: Unremarkable and unchangedThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.T1/2 demonstrates no significant disc bulge or cord encroachment, unchanged.T2/3 demonstrates no significant disc bulge or cord encroachment, unchanged. T3/4 demonstrates no significant disc bulge or cord encroachment, unchanged. T4/5 demonstrates no significant disc bulge or cord encroachment, unchanged. T5/6 demonstrates no significant disc bulge or cord encroachment, unchanged.T6/7 demonstrates no significant disc bulge or cord encroachment, unchanged. T7/8 demonstrates no significant disc bulge or cord encroachment, unchanged. T8/9 demonstrates no significant disc bulge or cord encroachment, unchanged. T9/10 demonstrates no significant disc bulge or cord encroachment. There is right ligamentum flavum and facet hypertrophy without significant resulting stenosis, unchanged. T10/11 demonstrates no significant disc bulge or cord encroachment. Bilateral ligamentum flavum and facet hypertrophy without significant resulting stenosis, unchanged.T11/12 demonstrates no significant disc bulge or cord encroachment. Slight ligamentum flavum thickening and facet hypertrophy without significant resulting stenosis, unchanged.T12/L1 demonstrates no significant disc bulge or cord encroachment, unchanged.", "output": "1.The right cerebellar tonsil lies 7 mm below the level of the foramen magnum and demonstrates a pointed morphology providing MRI evidence of Chiari I formation. CSF flow analysis demonstrates a flash of biphasic flow at the level of the cerebellar tonsils. These findings are stable in appearance.2.There are no MRI findings of syrinx.3.C3/4: Small midline protrusion slightly indents the anterior cord surface without intrinsic or signal abnormality and no resulting stenosis, unchanged.4.Mild degenerative changes of the lower thoracic spine without significant resulting stenosis are stable in appearance."}
{"instruction": "Generate impression based on findings.", "input": "Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: pre op navigation tumor History: rue weakness, transient dysarthria Multiple fiducial markers attached on scalp.Re demonstration of the left parietal operculum irregularly enhancing mass lesion with surrounding edema.The size (38.1mm x 31.3mm), MR characteristics and the extent of surrounding edema appear to be unchanged since prior scan.The left lateral ventricle appears to be slightly deformed.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": "No interval change of the size, MR characteristics and surrounding edema of the left parietal opercular intra axial mass since prior scan."}
{"instruction": "Generate impression based on findings.", "input": " There is evidence of interval development of the left fronto-parietal craniotomy for the biopsy of the left parietal intra axial lesion. There is extra dural fluid collections with blood products just underneath of the craniotomy site which is measured about 11.2mm.There is fluid fluid level within the lesion indicating local blood products within the resection cavity.There are irregular enhancement on the site of the lesion especially inferior and peripheral aspect of the original lesion which could represent residual tumor or could represent reactive changes after the surgery.There is no evidence of acute ischemic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "Postoperative status of the left parietal intra-axial mass lesion as described above.In particular, intra lesional blood products, extra dural blood products and subtle enhancement especially on peripheral aspect of the lesion were demonstrated."}
{"instruction": "Generate impression based on findings.", "input": "Male 44 years old Reason: 44M with h/o fistulizing Crohn's disease, c/b EC fistula from terminal ileum to buttock involving sacrum; please eval for residual fluid collection/pelvic fistula tract History: EC fistula PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: The distal right ureter is dilated and demonstrates mural thickening and hyperenhancement suggestive of inflammation. A right ureteric stent is incompletely imaged and terminates in the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is a presacral fluid collection which is stable in size and measures 2.6 x 1.5 cm (series 501, image 60), previously 2.6 x 1.3. There are surrounding inflammatory changes. Diffuse inflammatory changes also surround a fluid tract which extends from the collection inferolaterally across the left hemisacrum, through a left lower sacral foramen, and through the gluteus maximus into the subcutaneous tissues of the left posterolateral pelvic wall. There are inflammatory changes posteromedial to the left sciatic nerve. The fluid collection abuts the posteromedial aspect of the right sciatic nerve.BONES, SOFT TISSUES: The aforementioned collection abuts the sacrum and although this study is not optimized for evaluation of the bone there appears to be some abnormal T2 hyperintense and possibly some subtle T1 hyperintense signal within the sacrum. OTHER: No significant abnormality noted.", "output": "1.Presacral space fluid collection consistent with abscess which is unchanged in size compared to prior study.2.Persistent inflammatory changes surrounding the fluid collection with a persistent fistula exiting at the left posterolateral pelvic wall.3.Right hydroureter is incompletely imaged however there is mural thickening and edema suggestive of inflammation. This is nonspecific but may relate to the in situ ureteric stent.4.Signal abnormality within the sacrum immediately subjacent to the aforementioned fluid collection suggestive of chronic osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "History of liver transplant. Evaluate for biliary stricture. ABDOMEN:LIVER, BILIARY TRACT: Again seen are several hepatic cysts.Mild irregularity of the common hepatic duct with moderate stenosis at the level of Klatskin, stable to slightly increased from the prior study.There is mild irregularity and narrowing at the hepatic duct anastomosis, similar to the prior study.No intrahepatic biliary ductal dilatation.The hepatic artery anastomosis is not visualized but the hepatic artery enhances and appears patent. The portal vein and hepatic veins are patent.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.At least moderate stenosis at the level of Klatskin is stable to slightly increased compared to the prior study.2.Mild irregularity and narrowing at the hepatic duct anastomosis appears similar to the prior.3.Patent vasculature."}
{"instruction": "Generate impression based on findings.", "input": "79 years Female (DOB:5/4/1937)Reason: metastatic FT cancer with new prolonged headaches History: headachePROVIDER/ATTENDING NAME: NITA KARNIK LEE NITA KARNIK LEE The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is a developmental venous anomaly in the left cerebellar hemisphere.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for brain metastases.3.Examination is limited as a fusion exam."}
{"instruction": "Generate impression based on findings.", "input": "27 year-old female. History of small bowel and ?duodenal stricture. Evaluate for active disease and stricturing. EPIC history: had ileocecectomy 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: Gastric distention suggestive of partial gastric outlet obstruction due to a stricture at the first and second portions of the duodenum, unchanged. The stricture is approximately 1.5 cm in length and with a 0.7-cm luminal diameter. No associated diffusion restriction or hyperenhancement of the duodenal stricture to suggest active disease.Postsurgical findings of ileocecectomy. No evidence of inflammatory bowel disease in the small bowel or colon. No fistulae or abscesses. Moderate stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Physiologic follicles in the ovaries with a dominant follicle in the left ovary.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free pelvic fluid, likely physiologic.", "output": "Short segment likely fibrostenotic disease of the duodenum causing a partial gastric outlet obstruction, unchanged. No new findings."}
{"instruction": "Generate impression based on findings.", "input": "Multiple hepatic lesions. History of hepatic steatosis. ABDOMEN:LIVER, BILIARY TRACT: Diffuse decrease in signal intensity on the out of phase images is consistent with hepatic steatosis/fatty infiltration. The liver is enlarged measuring 23 cm in craniocaudal dimension.Demonstrated again are multiple hepatic lesions which are not significantly changed in size or number. The reference largest lesion measures 4.7 x 3.5 cm (series 11 image 15), compared to 4.5 x 3.7 cm previously.The lesions are relatively hyperintense on the T1-weighted fat-suppressed precontrast imaging sequences likely secondary to the background fatty liver and relatively homogeneously hypointense on the nonfat suppressed T2 weighted images. Again, the larger lesions demonstrate some heterogeneity on the fat-suppressed T2-weighted images and peripheral restricted diffusion. On the multi hour delayed images the lesions are iso to slightly hyperintense to the background liver parenchyma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal inferior pole simple cyst.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.Stable size and number of the multiple hepatic lesions. Although a few of the lesions demonstrate somewhat atypical characteristics these likely represent multiple focal nodular hyperplasias.2.Hepatomegaly and steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Seizure-like activity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is mild prominence of the temporal horn of the right lateral ventricle, but the ventricles and hippocampi are otherwise normal in size and configuration. There is an incidental focus of subcentimeter dural ossification along the posterior falx cerebri. 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 potential seizure foci."}
{"instruction": "Generate impression based on findings.", "input": "3-month-old female with a history of VACTERL syndrome (cloaca, multicystic dysplastic right kidney, low lying left kidney, and tethered spinal cord on MRI, left thumb hypoplasia, esophageal atresia s/p TEF repair, PFO/PDA) including an imperforate anus with cloaca.EXAMINATION: MR pelvis without and with IV contrast 6/29/2016 The slice thickness and gaps were too large to clearly delineate the anatomy. The lower pole of the solitary left kidney appears to function normally. The T1 fat saturation sequence was not saturated. These technical problems render the exam nondiagnostic.", "output": "Nondiagnostic examination. The patient will be recalled for a repeat examination. "}
{"instruction": "Generate impression based on findings.", "input": "55-year-old man with history of elevated PSA status post prostatectomy. PELVIS:PROSTATE:The patient is status post prostatectomy. There is a 19 x 8 mm soft tissue nodule in the left prostatectomy bed (series 801, image 26) which has low T2 signal, diffusion restriction, and mild enhancement. This nodule appears to extend to the level of the left anterior rectal wall.BLADDER: There is concentric thickening of the bladder wall.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Enhancing soft tissue focus in the left prostatectomy bed suspicious for local recurrence, less likely residual seminal vesicle. Please correlate with patient's operative history."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old male with bilateral posterior joint line pain and IT band pain and sports/running on and off for 2 years MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. The patellofemoral compartment cartilage appears relatively spared.LIGAMENTS: The cruciate and collateral ligaments appear intact. Specifically, there is no increased signal abnormality within the lateral synovial recess to suggest IT band syndrome as clinically questioned. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "Marked fatty atrophy of the semimembranosus muscle is nonspecific but may be secondary to denervation, although atrophy due to an old proximal hamstring tear could also be considered. No findings to suggest iliotibial band friction syndrome."}
{"instruction": "Generate impression based on findings.", "input": "47 years, Female, Reason: 47 yr/old female with h/o UC s/p proctocolectomy with IPAA, pouchitis, fissure and now 2 possible fistulae openings on the distal gluteal fold in the tailbone area History: 2 openings with some serosanguiness drainage, small amount in distal gluteal fold area. PELVIS: UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a small suprasphinteric sinus tract extending from the left lateral aspect of the rectum (3 o'clock position) approximately 1 cm.BONES, SOFT TISSUES: The tip of the coccyx has high signal intensity on T2 and low signal intensity in T1, suggesting osteomyelitis. There is a sinus tract extending from the coccyx to the left gluteal fluid which may represent a draining sinus.There is heterogeneous increased T2 signal within the prevertebral space which may represent phlegmon.Increased T2 signal adjacent to the right sacroiliac joints is likely degenerative.OTHER: Small Tarlov cysts.", "output": "1.Findings compatible with osteomyelitis of the coccyx with a sinus tract draining to the left gluteal fold2.Suprasphincteric sinus tract extending from the left lateral aspect of the rectum.3.Phlegmonous inflammatory changes in the prevertebral space"}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval for septic joint History: overlying wrist cellulitis, diminished ROM Limited study due to suboptimal coil.There is thickening of the skin of the wrist with subcutaneous edema both volarly and dorsally. There is also edema of the interosseous musculature and scanned portions of the hypothenar musculature with sparing of the thenar musculature. Mild edema of the pronator quadratus and distal flexor musculature. Additionally, there is fatty atrophy of the intraosseous muscles.There is small amount of fluid surrounding the extensor digitorum and extensor carpi ulnaris tendons as they cross the carpus. We see no soft tissue fluid collection to suggest abscess. There is trace fluid in the joints of the wrist, within normal limits. We see no specific features of septic arthritis. There is mild increased signal intensity in the distal ulna, medial margin of the triquetrum, and medial margin of the hamate on fat-suppressed T2-weighted images with relative preservation of signal on T1 images. This finding may represent reactive osteitis, but we see no frank cortical destruction to confirm osteomyelitis. Otherwise bone marrow signal is normal. Please note, this study was not protocoled for or of sufficient quality to assess intrinsic ligaments of the wrist or TFCC; however, no gross abnormalities noted.", "output": "Limited evaluation of the wrist due to suboptimal coil as patient's wrist was in a cast (per verbal communication with technologist).Nonspecific soft tissue inflammation as above compatible with cellulitis without evidence of abscess formation. We see no specific findings of septic arthritis. Other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: MS; f/u progression. Signs and Symptoms: Paresthesias. Nonenhanced thoracic MRI:Stable chronic demyelinating plaque in the right posterior aspect of thoracic cord at T3 demonstrate no change since prior study.Demyelinating plaque of thoracic cord at T6 level demonstrate no interval change since prior exam.Demyelinating plaque in the left lateral aspect of the cord at T7 demonstrate no change.Ill-defined demyelinating plaque at T9 level on the right is again identified without change since prior study.Small demyelinating plaque on the right lateral aspect of the cord at T11 is again identified and without change.There is no convincing evidence of any new lesions since prior MRI exam from December 2014.There is normal signal intensity and anatomical alignment of vertebra, without spinal stenosis or neural foraminal compromise.Nonenhanced lumbar MRI:Normal signal intensity and caliber of the lower most visualized thoracic cord and the conus.Normal signal intensity and morphology of cauda equina.Normal signal intensity and alignment of vertebral,. No spinal stenosis or neural foraminal compromise at any level. Examination at L3-L4, L4-L5 and L5-S1 levels demonstrate mild to moderate facet and ligamentum flavum hypertrophy without resultant spinal canal or neural foraminal compromise.", "output": "1.Stable scattered foci of T2/T2 STIR hyperintensity of the thoracic cord consistent with patient's known multiple sclerosis and without convincing evidence of a new finding.2.Unremarkable MRI examination of lumbar spine with the exception of mild to moderate hypertrophic/degenerative changes of posterior elements in the lower lumbar spine as detailed. No spinal stenosis or neural foraminal compromise."}
{"instruction": "Generate impression based on findings.", "input": ", trouble speaking. Unspecified chest pain. Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal. Considering provided clinical data follow-up with an MRI is recommended.Calvarium, visualized orbits, paranasal sinuses and mastoid air cells are unremarkable.", "output": "Unremarkable nonenhanced CT brain and calvarium."}
{"instruction": "Generate impression based on findings.", "input": "Facial paresthesias, bilateral arm paresthesias There are small posterior disc-osteophyte complexes at C5-6 and C6-7 that mildly indent the spinal cord. There is no convincing signal abnormality within the spinal cord, however. There is a minimal disc-osteophyte complex at C4-5 without associated spinal canal or neural foramen stenosis. There vertebral bone marrow signal characteristics appear unremarkable. There is straightening of the vertebral column alignment in the sagittal plane. The vertebral body and disc space heights are preserved. The paravertebral soft tissues are unremarkable.", "output": "Degenerative spondylosis of the cervical spine with small posterior disc-osteophyte complexes at C5-6 and C6-7 that mildly indent the spinal cord. 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 64 years old Reason: Evaluate for HCC History: Cirrhosis with an elevated AFP The arterial phase images are suboptimal, limiting evaluation for hepatocellular carcinoma.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. The gallbladder is distended, but not significantly changed compared to prior study. Heterogeneous hepatic parenchyma with prominence of the fissures consistent with cirrhosis. Diffuse signal drop out on in phase images is suggestive of iron deposition. Additional punctate foci of signal drop out are suggestive of siderotic nodules. Arterial phase images are limited due to suboptimal timing. Within this limitation no suspicious lesion is identified.Patent hepatic vasculature.SPLEEN: Mild splenomegaly at 13.6 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Asymmetric renal enhancement in the earlier phases of imaging with normalization on the 3-minute delayed phase of imaging. This is likely perfusional.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites. Multiple upper abdomen collateral vessels.", "output": "1.Cirrhotic liver morphology without suspicious focal hepatic lesion. Sequela of portal hypertension with splenomegaly and multiple upper abdominal collateral vessels.2.Cholelithiasis with gallbladder distention, unchanged compared to prior study."}
{"instruction": "Generate impression based on findings.", "input": " There is no significant change in size of of the predominantly cystic craniopharyngioma measuring up to 45 mm in the maximal AP dimension and 42 mm in the transverse dimension, similar to prior. There continues to be involvement of the suprasellar, prepontine, cerebellopontine angle, right ambient and right quadrigeminal cisterns, as well as the right middle cranial fossa, with associated mass effect upon the brainstem, right medial temporal lobe, and hypothalamus-optic apparatus complex. Areas of enhancement in the suprasellar cistern are not significantly changed. T1 shortening which may reflect proteinaceous material or blood products in the right ambient cistern also not significantly changed. No enlarging components. Leftward displacement of the pons and contour deformity involving the right lateral aspect of the midbrain is not significantly changed. There is no new mass effect. Again seen are foci of susceptibility effect within the right temporal lobe resection cavity, consistent with hemosiderin deposition, and within portions of the tumor particularly in the suprasellar cistern, which likely represent calcifications.Parenchymal defect/encephalomalacia in the right lateral temporal lobe is unchanged. There is unchanged volume loss of the left cerebellar hemisphere associated with increased T2 signal, which may be attributable to crossed cerebellar diaschisis versus chronic injury. T2/FLAIR signal abnormality in the left medial temporal lobe which may reflect posttreatment change is also unchanged. The basilar artery is tortuous and encased by the tumor. There is stable position of right transfrontal catheter with the tip in the right prepontine cyst. The ventricular system also appears unchanged without hydrocephalus.", "output": "Compared to 8/18/2016, there is no significant interval change in size of the treated craniopharyngioma."}
{"instruction": "Generate impression based on findings.", "input": "No significant PMH with 2 days of dizziness associated with nausea and leftward horizontal gaze-evoked nystagmus and leftward drifting of fixed gaze. Orbits: The globes and ocular adnexa are intact. Likewise, the optic nerves are unremarkable. There is no evidence of intraorbital mass lesions or abnormal enhancement. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small retention cysts in the maxillary sinuses.", "output": "1. The orbits are unremarkable.2. No evidence of acute intracranial hemorrhage, mass, or acute infarction."}
{"instruction": "Generate impression based on findings.", "input": "Post-op ACDF There is postsurgical fusion of C4, C5, C6, and C7 with anterior plate and screw device and interposed bone graft. No radiographic evidence of hardware complication is evident. The alignment is anatomic. There is no evidence of superimposed instability.There is fusion of C2 and C3, likely congenital.", "output": "Post-operative changes, without evidence of hardware complication or instability."}
{"instruction": "Generate impression based on findings.", "input": "Somnolence [R40.0], Reason for Study: ^Reason: anatomic abnormalities? Chiari? History: LOC concerning for seizure No evidence of acute ischemic or hemorrhagic lesion.There is about 22.6mm cerebellar tonsilar herniation through foramen magnum indicating Chiari I malformation.Associated cervical spinal cord syringomyelia from the level of C2 is also seen.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells show fluid signal intensity and mucosal thickenings on bilateral maxillary sinuses, ethmoid sinuses, frontal sinus and sphenoid sinus.", "output": "1. Chiari I malformation with cervical spinal cord syringomyelia.2. No evidence of acute ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": " There is normal alignment of the cervical spine with no prevertebral, paravertebral, ligamentous or osseous marrow T2 signal abnormality. The vertebral body and disk heights are preserved. The cord signal is within normal limits. The visualized soft tissues are unremarkable. The flow-voids in the neck are patent. There is no spinal stenosis or disk herniation at any level in the cervical spine. Mild sphenoid sinus disease is partially visualized.", "output": "No evidence of acute traumatic injury to the cervical spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Patient with non-small cell lung cancer history of epilepsy. Status post craniotomy for brain metastases. No needs disease evaluation prior to therapy In comparison with the prior examination residual blood from the left posterior temporal has been absorbed. Area of edema of right frontal lobe has significantly increased since prior study and is concerning for neoplasm and should be further evaluated with a dedicated MRI examination with infusion. Postsurgical changes of left parietal craniotomy is again identified. No evidence of hemorrhage, midline shift or hydrocephalus.", "output": "Significant increase in the amount of vasogenic edema in the right frontal lobe concerning for recurrence of disease and should be further evaluated with an MRI examination."}
{"instruction": "Generate impression based on findings.", "input": "44 year old present for pre-surgical evaluation after receiving neoadjuvant chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Numerous high T2 signal cysts are seen.Mild parenchymal enhancement is noted bilaterally.The index mass is in one dimension increased in size compared to the most recent prior measurements, today measuring 3.1 x 2.7 x 2.9 cm, previously 3.1 x 2.7 x 2.7 cm. Internal artifact from the biopsy clip is noted. Artifact from the benign biopsy Hydromark clip is also again seen anterior to the known cancer and has no suspicious adjacent enhancement. A few scattered peripherally enhancing cysts are noted on contrast enhanced images of the left breast.No significant change in left axillary lymph nodes, with a reference node again measuring 1.3 x 0.9 cm. No suspicious enhancement is seen in the right breast. There are a few peripherally enhancing cysts in the right breast. No abnormal lymph nodes are identified in the right axillary region.Right chest wall Port-A-Cath is present. Hepatic mass also again noted.", "output": "Slight interval increase in measurement of the left breast cancer. No change in reference axillary node.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Ring finger mass There is a lobulated mass within the radial and volar soft tissues of the ring finger. It measures approximately 2 x 1 cm in the craniocaudal and transverse dimensions and extends from the mid diaphysis of the middle phalanx to the base of the distal phalanx with a possible additional small component more distally at the level of the mid shaft of the distal phalanx. The mass abuts the lateral aspect of the flexor digitorum profundus tendon however the underlying tendon is normal. Additionally, the underlying bone is normal in signal without erosion. The mass is isointense to skeletal muscle on T1 sequences and contains tiny foci of increased signal best appreciated on the coronal T1 sequence. The mass is hyperintense to skeletal muscle on fat saturated T2 sequences with small round and curvilinear foci of low signal intensity. Following administration of gadolinium, there is heterogeneous enhancement. No additional masses are identified. The remaining visualized bone marrow signal is normal. A tiny cyst is seen within the head of the third metacarpal.", "output": "Subcutaneous mass of the ring finger as detailed above. The enhancement pattern is not consistent with that of a ganglion and the lobulated margin and signal characteristics may be reflective of a vascular anomaly such as a venous malformation. A tenosynovial giant cell tumor is also considered as a less likely option."}
{"instruction": "Generate impression based on findings.", "input": "Female 12 years old; Reason: Left hip pain x 6months, CAM and pincer lesion on previous MRI, need arthrogram to diagnose labral tear, no improvement with PT. Evaluation is slightly limited by the presence of an air bubble within the joint. BONES / CARTILAGE: The bone marrow signal is normal. The cartilage appears normal. There are prominent supra-acetabular fossae bilaterally at the 12:00 position on both sagittal and coronal planes, a normal variant. HIP JOINT / LABRUM: There is a very small tear of the anterior superior labrum, best seen on the radial images (series 1201, image 5). SOFT TISSUES: No significant abnormality noted. OTHER", "output": "1. Small anterior superior labral tear.2. Prominent supra-acetabular fossae bilaterally, a normal variant."}
{"instruction": "Generate impression based on findings.", "input": "Lesion in pituitary and possible Chiari malformation: yearly follow up. Pituitary: There is an unchanged hypoenhancing lesion in the left lobe of the pituitary gland, measuring up to approximately 4 mm. The posterior pituitary bright spot and infundibulum are intact. The optic apparatus and cavernous sinuses are unremarkable. Brain: The cerebellar tonsils are minimally low-lying, but conserve rounded morphologies. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. No appreciable change in the left pituitary lesion, which likely represents a microadenoma.2. The cerebellar tonsils are minimally low-lying, but conserve rounded morphologies."}
{"instruction": "Generate impression based on findings.", "input": "Right sided weakness and sensory change. There are punctate foci of restricted diffusion and high T2 signal in the upper left precentral gyrus and paracentral lobule. There is a background of diffuse patchy cerebral, brainstem, and cerebellar white matter T2 hyperintensity. There are punctate foci of encephalomalacia in the bilateral basal ganglia and corona radiata. There is also encephalomalacia and susceptibility effect in the right posterosuperior temporal lobe and inferior parietal lobule. There is a pineal cyst that measures 9 mm in diameter. There is diffuse mild cerebral volume loss. There is no midline shift or herniation. There is a 9 mm diameter basilar tip aneurysm. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. Punctate recent infarcts in the left upper left precentral gyrus and paracentral lobule.2. Chronic lacunar infarcts in the bilateral basal ganglia and corona radiata. 3. Area of chronic hemorrhagic infarction in the right posterosuperior temporal lobe and inferior parietal lobule. 4. A background of diffuse patchy cerebral, brainstem, and cerebellar white matter T2 hyperintensity may represent chronic small vessel disease. 5. A 9 mm diameter basilar tip aneurysm appears to have gradually increased in size. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: last MRI abnormal with finding of possible gliosis, previous hematoma, or a developmental anomaly: 6 month follow up There is a persistent somewhat ill-defined T2 hyperintense intra-axial mass involving the right mesial temporal lobe, which appears to be unchanged. There is thin smooth, sheet-like enhancement overlying the anteromedial aspect of the tumor, which is also unchanged. The right temporal horn is posteriorly displaced due to mass effect. There is no evidence of acute intracranial hemorrhage or acute infarct. There is nonspecific thickening of scattered ethmoid air cells and right sphenoid sinus. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "Persistent right mesial temporal lobe mass, which may represent a low-grade neoplasm. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female 62 years old Reason: 62F with colon CA. Suspicious lesions in liver on CT History: see above ABDOMEN:LIVER, BILIARY TRACT: There are 2 hypoenhancing lesions within the liver, one within segment 4A and the second within segment 8. These are difficult to identify on the axial T2 and diffusion-weighted images however on postcontrast images these demonstrate rim enhancement (series 1003, image 35). The largest lesion measures 0.6 x 0.5 cm (series 1003, image 35). The lesions do not meet criteria for hepatic cyst/hemangioma and are suspicious for hepatic metastases.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: Multiple enhancing, diffusion restricting retroperitoneal lymph nodes are suspicious for malignant involvement.BOWEL, MESENTERY: Circumferential thickening of an approximately 6.8 cm segment of distal transverse and proximal descending colon about the splenic flexure. There is abnormality of the adjacent mesentery likely due to a combination of direct extension from the colonic mass into the mesentery and an aggregate of matted regional lymph nodes. This confluent abnormality measures approximately 4.3 x 5.8 cm (series 1004, image 76). There is delayed enhancement of a peripheral thick rind of tissue surrounding the aforementioned colonic mass and mesenteric abnormality suggestive of a fibrous component of tumor which extends into the retroperitoneum to the left psoas muscle posteriorly (series 1004, image 74) and extends to proximal jejunal loops anteromedially (series 1004, image 71).BONES, SOFT TISSUES: No significant abnormality noted.", "output": "Circumferential colonic tumor at the splenic flexure with direct extension into the adjacent mesentery, mesenteric and retroperitoneal lymphadenopathy, and suspicion for hepatic metastases."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with rising PSA after prostatectomy. PSA 0.21 PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Surgically absent.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted. Asymmetric soft tissue along the left aspect of the cystourethral anastomosis with corresponding mild early asymmetric enhancement (series 1501, image 42). LYMPH NODES: Prominent bilateral inguinal lymph nodes are nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Asymmetric soft tissue demonstrating early enhancement along the left aspect of the cystourethral anastomosis is equivocal for a focus of residual/recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": " Redemonstrated are enhancing lesions in the left medial temporal lobe and superior right cerebellar vermis. The enhancing lesion involving the left medial temporal lobe abutting the left cerebral peduncle and left optic tract is smaller measuring 5 x 10 mm (series 12, image 54) compared to 9 x 10 mm previously on the OSH MRI from 6/8/2016 and 10 x 13 on the brain MRI from 12/8/2015. The second enhancing lesion involving the right superior cerebellar vermis measures 10 x 11 mm, previously 10 x 12 mm on the OSH MRI from 6/8/2016 and 8 x 6 on the brain MRI from 12/8/2015 (when utilizing axial T1 postcontrast images, as this allows for more comparable measurements). The corresponding FLAIR signal abnormality in these regions is unchanged.There are several scattered foci of susceptibility compatible with hemosiderin staining and are unchanged. There are scattered periventricular and subcortical cerebral white matter T2/FLAIR hyperintensities which are nonspecific and stable. There is no diffusion abnormality. There is diffuse volume loss. The cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. There are changes related to right-sided parotidectomy which is only partially visualized. There is persistent asymmetric thickening of the post-geniculate segment of the right facial nerve on the delayed postcontrast images which is somewhat more continuous compared to the previous exam. There is fatty marrow replacement in the visualized marrow of the clivus and upper cervical spine, which is likely related to posttreatment changes.", "output": "1.Stable to decreased size of the left medial temporal lobe metastatic lesion.2.Right cerebellar vermian lesion stable since outside prior exam, but is remains slightly larger than more remote 12/2015 exam.3.Post surgical changes of parotidectomy which is incompletely evaluated with persistent more continuous enhancement of the post-geniculate portion of the right 7th nerve.4.Mild degree of unchanged chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "Right tonsil p16+squamous cell carcinoma T4N? treated with CRT 2011 at OSH with multiple recurrences, status post salvage oropharyngectomy with flap and right neck dissection 2/2014 at OSH no PNI or LVSI, followed by second local recurrence to right neck and salvage surgery right oral cavity with negative margins but dysplasia 12/10/14 at OSH, referred here with right nasopharynx recurrence, which was treated with induction chemotherapy, followed by chemo/re-irradiation to a total dose of 75Gy completed on 0/30/15. There are postoperative findings related to resection of the posterior right hemimandible with hardware fixation and flap reconstruction of the right-sided pharyngeal soft tissues. There are also postoperative findings related to right neck dissection. There is no measurable residual tumor within the right nasopharynx. There are denervation changes in the right tongue. There is no evidence of significant cervical lymphadenopathy. The thyroid and remaining salivary glands appear unchanged. There is newly apparent patchy T2 hyperintensity and enhancement in the left C1 and C2 vertebrae. There is scattered fluid within the right mastoid air cells. The right internal jugular vein is absent. The imaged intracranial structures are unremarkable.", "output": "1. Post-treatment findings in the right nasopharyngeal region without measurable residual tumor.2. Newly apparent patchy T2 hyperintensity and enhancement in the left C1 and C2 vertebrae is of uncertain significance and may be treatment related or inflammatory versus less likely neoplastic. Perhaps follow up via PET may be useful. "}
{"instruction": "Generate impression based on findings.", "input": "Left shoulder pain. Rotator cuff tear? ROTATOR CUFF: There is a full-thickness, near-complete tear of the supraspinatus tendon from its insertion on the greater tuberosity; I suspect that a small portion of degenerated tendon anteriorly extends to the tuberosity. There is up to 1 cm of retraction of the torn tendon. The tear measures approximately 2 cm in AP dimension, involving the infraspinatus tendon anteriorly; the infraspinatus tendon posteriorly can be followed to its insertion on the greater tuberosity. Thickening and increased signal intensity of the supraspinatus and infraspinatus tendons indicates tendinosis. There is mild to moderate fatty atrophy of the infraspinatus along its myotendinous junction. The supraspinatus muscle appears relatively normal. Although the teres minor tendon can be followed to its insertion on the greater tuberosity, there is moderate fatty atrophy of the teres minor muscle. There is thickening and increased signal intensity of the subscapularis tendon distally indicating moderate tendinosis and perhaps undersurface fraying. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. A small amount of fluid is present within the subacromial/subdeltoid bursa, with strands of intermediate signal intensity in the bursa likely reflecting synovitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid in the glenohumeral joint. Tiny osteophytes suggest minimal osteoarthritis. Intermediate signal intensity within the superior labrum likely reflects degeneration and degenerative tearing.BICEPS TENDON: There is mild increased signal intensity within the tendon of the long head of the biceps reflecting mild tendinosis. ADDITIONAL", "output": "Full-thickness rotator cuff tear involving the supraspinatus and infraspinatus, and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question to be answered: Two months old baby boy with sudden cardiac arrest. Recent stroke on MRI, recent seizure activity, check for progression of stroke. Signs and symptoms: Seizures. A well demarcated area of low attenuation in the right posterior temporal region is again identified and with no definitive interval change.A very subtle low-density involving the cortex and subcortical white matter of left posterior temporal and occipital region is suspected. This finding is very subtle and it may also represent an artifactual beam hardening finding. Follow-up with a repeat CT or an MRI is recommended. There is no definitive evidence of any mass effect with this finding. No evidence of any intracranial hemorrhage. Ventricular system and subarachnoid space remains identical to prior study. All CSF cisterns remain widely patent.New since prior examination is thickening of the soft tissues of the scalp on the left side in the posterior parietal region.", "output": "1.Stable area of low attenuation in the right posterior temporal lobe since prior study.2.Artifact or a new area of low-attenuation in the left posterior temporal occipital region as detailed. Follow-up with a CT or an MRI is recommended.3.Stable ventricular system and CSF cisterns.4.No evidence of intracranial hemorrhage.5.Edema of left posterior parietal scalp."}
{"instruction": "Generate impression based on findings.", "input": "67 years Female (DOB:1/19/1949)Reason: dysarthria History: dysarthriaPROVIDER/ATTENDING NAME: ANTON M CHIVU MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is small. The posterior communicating arteries are very small. The vertebral arteries are similar in size. There is extracranial origin of the left posterior inferior cerebellar artery present.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.", "output": "1.No evidence for intracranial or extracranial cerebrovascular occlusive disease.2.No evidence for acute ischemic cerebral infarction.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Low back pain for months with extension and gymnastics. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is mild disc bulge and superimposed tiny central disc protrusion at L5-S1. 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": "Mild disc bulge and superimposed tiny central disc protrusion at L5-S1. No spinal canal or neuroforaminal stenosis at any level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "patient with posterior epidural and paraspinous fluid collection. Please aspirate for sampling. 42 yo female Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the fluid collection. Following needle removal images obtained demonstrate no complications . A small amount of air was present in the remaining cavity.", "output": "Paraspinous fluid collection aspiration under CT guidance."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with pain in the left knee The images are suboptimal secondary to patient body habitus.MENISCI: There is blunting of the posterior horn of the medial meniscus consistent with a tear. The posterior horn of the medial meniscus is also abnormally small and approximately the size of the anterior horn. There is perhaps mild extrusion of disc material medially but there is no fluid between the meniscus and the medial lateral ligament.ARTICULAR CARTILAGE AND BONE: There is marked thinning of the hyalin cartilage involving the medial femoral condyle and this is likely the cause of the adjacent abnormal bone marrow signal in the distal posterior medial femur and proximal posterior medial tibial plateau. Within the posterior medial tibial plateau is a little focus of decreased T1 and increased T2 signal abnormality with a raspberry configuration and which most likely represents a benign endochondroma. There is also uniform narrowing of the patellar cartilage but no focal defects.LIGAMENTS: There is mild increased signal involving the medial collateral ligament which may indicate a mild strain. The remaining cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact. A Baker's cyst is incidentally noted. There is mild increased T2 signal abnormality in stranding involving the soft tissues adjacent to the medial compartment.ADDITIONAL", "output": "1.Tear of the posterior horn of the medial meniscus.2.Marked thinning of the posterior medial tibial and femoral surface articular cartilage with adjacent bone marrow signal changes.3.Mild increased signal involving the medial collateral ligament indicating possible mild medial collateral ligament strain.4.Uniform narrowing of the patellofemoral cartilage but no focal defects."}
{"instruction": "Generate impression based on findings.", "input": "Male, 40 years old, with left facial palsy and cranial nerve VI palsy, status post AVM resection in 9/25. Postoperative findings are redemonstrated compatible with prior left suboccipital craniectomy and lesion resection from the left pontomedullary junction. A pseudomeningocele is partially visualized within the left posterior neck soft tissues, having become somewhat larger and better organized than on the prior examination. This collection does not appear to exert mass effect upon the brainstem in any way.At the level of the pontomedullary junction on the left, a hemosiderin stained region of tissue is again seen measuring approximately 14 x 12 mm on T2-weighted images (image 10 series 1001). This lesion is similar in size to that noted on the prior examination, but demonstrates less internal bubbly T2 hyperintensity. A curvilinear enhancing structure is seen coursing along the right margin of the lesion, similar to that noted on a prior exam, likely representing a small venous structure or DVA. No significant edema is evident surrounding the lesion.A 2 mm focus of susceptibility is evident along the right lateral ventricular margin which appears to be new when compared to prior examinations. No other new findings are seen. No additional areas of significant parenchymal signal abnormality are detected. Diffusion-weighted images are within normal limits. The pattern of contrast enhancement is otherwise unremarkable. Ventricular size and morphology are stable and normal.", "output": "1.Expected findings status post left suboccipital approach for resection of a lesion from the left pontomedullary junction. A pseudomeningocele within the posterior soft tissue operative bed has become somewhat larger and better organized than on the prior examination, but no significant mass effect is exerted upon the brainstem.2.Hemosiderin staining of the left pontomedullary junction appears similar in overall size to the prior examination which may reflect a combination of postoperative change and/or residual lesion. Bubbly internal T2 hyperintensity has decreased in prominence. No significant parenchymal edema is identified. A small likely venous structure or DVA is again seen traversing the right margin of the lesion similar to prior.3.A punctate focus of susceptibility appears to be new along the lateral margin of the right lateral ventricle. This is nonspecific. No other new or concerning intracranial lesions are seen."}
{"instruction": "Generate impression based on findings.", "input": "Left hip pain There is abnormal signal intensity within the left inferior pubic ramus with early adjacent periosteal new bone formation compatible with stress fracture. There is mild edema within the adjacent musculature but the remaining adductor muscles are otherwise normal as is the prepubic aponeurotic complex. No additional fractures are identified.There is mild signal intensity seen within the hamstring origins bilaterally, left greater than right, perhaps reflecting mild degenerative tendinopathy although this is not necessarily of any clinical significance.Seen on a single sagittal image (1 of 76) is linear signal intensity partially separating the anterior superior labrum from the underlying acetabulum which may represent a labral tear. This is incompletely evaluated on this study and is also not necessarily of any clinical significance. The hip joints otherwise appear normal as do the sacroiliac joints.The remaining soft tissue structures are within normal limits.", "output": "Stress fracture of the left inferior pubic ramus with other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Right renal lesion noted on CT 7/31/2015. ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilation status post cholecystectomy.SPLEEN: T2 hyperintense focus in the inferior spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Previously described indeterminant right inferior pole cyst on CT demonstrates intermediate signal without enhancement compatible with a hemorrhagic or proteinaceous cyst. There are additional bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach and colon are distended with food and stool respectively.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "Findings compatible with a right inferior pole hemorrhagic / proteinaceous renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with a possible brain biopsy and limited for presence of intracerebral hemorrhage Status post open brain biopsy changes with foci of pneumocephalus and left parietal burr hole. There is a high density focus in the superior medial aspect of the left postcentral gyrus compatible with intraparenchymal hemorrhage. Extensive hypo-attenuation involving predominantly the left parietal lobe with extension into the posterior left frontal lobe, anterior aspect of the left occipital lobe and splenium of the corpus callosum associated with ill defined lesions and mass effect on the occipital horn of the lateral ventricle that were better visualized on prior MRI. The extension of the ill defined hypoattenuation to the corpus callosum is highly suggestive of a glioblastoma multiforme, versus less likely CNS lymphoma. The basal cisterns are normal in size and configuration.The orbits are unremarkable. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1.Postsurgical changes with small expected high density left postcentral gyrus intraparenchymal hemorrhage. 2.Ill-defined hypoattenuation ill defined lesions predominantly involving the left parietal lobe were better visualized on recent MRI. The extension into the splenium of the corpus callosum is highly suggestive of GBM versus CNS lymphoma."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old male with pain. Clinical ACL tear. MENISCI: There is linear branching signal abnormality within a diminutive posterior horn of the lateral meniscus which extends to the tibial and femoral articular surfaces consistent with a complex tear. The anterior horn appears intact. There is linear signal abnormality within the posterior horn of the medial meniscus which extends to the tibial articular surface near its root consistent with a complex tear with both horizontal and longitudinal components. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is increased bone marrow signal abnormality within the medial femoral condyle, the posterior aspect of the medial tibial plateau, and the posterior aspect of the lateral tibial plateau consistent with bone contusions. There is focal full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus.LIGAMENTS: There is complete disruption of the proximal and mid substance fibers of the ACL, consistent with the clinical concern for ACL tear. There is increased signal abnormality within the lateral collateral ligament proper indicating a sprain. The medial collateral ligament appears intact. The PCL appears intactEXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Complete rupture of the ACL.2. Tears of the medial and lateral meniscus. 3. Bone contusions and focal full-thickness articular cartilage degeneration as described above. 4. Large joint effusion and findings suggestive of disruption of the joint capsule as described above. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "A 23 year old male with sickle cell anemia and frequent blood transfusions referred to cardiac MRI to assess left ventricular function and iron overload. Left VentricleThe left ventricle is mildly dilated with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVEDV is 190 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 88 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 120 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Measured T2* is 34 for the myocardium and 14 for the liver. The myocardial T2* is consistent with no evidence of myocardial iron overload. There is evidence of iron in the liver.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 116 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9), and the RVESV is 103 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.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. The left ventricle is mildly dilated with low normal systolic function. The overall LV ejection fraction is 54%2. The right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%3. No evidence of myocardial iron overload. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for DJD, cervical stenosis. Signs and symptoms: Neck pain shooting down the right hand. Unenhanced simple MRI:There is normal signal intensity and alignment of vertebral column.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate asymmetric right-sided uncovertebral hypertrophy with resultant moderate right neural foraminal compromise (axial T2 series 7 image 18 sagittal T2 and T2 stir image 6). Mild central bulge of the disk and additional partial effacement of ventral subarachnoid space and subtle flattening deformity of the cord and results in mild central spinal stenosis. Tiny T2/T2 stir hyperintensity within the fundus of the disk in the midline is consistent with an annular fissure (sagittal T2/T2 stir image 8 and axial T2 series 7 image 19.C4 -- C5 demonstrates a mild right-sided uncovertebral hypertrophy with resultant mild right neural foraminal compromise and unremarkable otherwise.C5 -- C6 demonstrate mild lesion at this disease, mild loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in moderate bilateral (right greater than left) neural foraminal compromise and no central spinal stenosis.C6 -- C7 demonstrate minimal degenerative changes without spinal stenosis or neural foraminal compromise.C7 -- T1 is unremarkable.Uppermost visualized thoracic cord demonstrate a tiny focus of cord hyperintensity visible only on sagittal T2 stir image 7 measuring approximately 3 mm in size. There are no axial images acquired at this level. Finding cannot be identified on sagittal T1 or T2 weighted images. Although possibility of an artifact cannot be excluded follow-up with a dedicated MRI of thoracic spine is recommended.", "output": "1.There is mild central spinal stenosis only at C3 -- C4 secondary to degenerative disease.2.Mild degenerative changes of cervical spine with resultant moderate right neural foraminal compromise at C3 -- C4, mild right neural foraminal compromise at C4 -- C5 and moderate bilateral ( R>L ) neural foraminal compromise at C5 -- C6 levels.3.Tiny midlie annular fissure at C3 -- C4 is noted.4.There is a tiny focus of cord hyperintensity visible only on sagittal T2stir at T3 level and follow-up with dedicated thoracic MRI is recommended. Please see above comments. Normal signal intensity of the cervical cord."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Pituitary microadenoma. Signs and symptoms: Cushing's disease. Pre- and post enhanced pituitary MRI:Examination is degraded due to motion artifact. Multiple sequences were repeated however without significant improvement.Within these limitations there is no convincing evidence of a pituitary mass. However suboptimal quality of images precludes detection of subtle small pituitary lesions. Pituitary gland demonstrate fairly homogeneous pattern of enhancement and with normal enhancement of the pituitary stock in midlinePituitary gland measures approximately 3.2 mm in the midline.No detectable abnormality within the basal cistern or the hypothalamic region. No detectable abnormality of the cavernous sinuses.Extensive sphenoid and ethmoid sinus disease with intense mucosal enhancement is noted.Additional axial fat sat post enhanced images of entire brain is also acquired which demonstrate a small right posterior temporal-occipital cortical enhancement (series 1701 image 11 through 13) which could represent a focus of enhancing subacute stroke or infection/inflammatory process. There are no prior exams for comparison. Follow-up with dedicated brain MRI with contrast is recommended. There is no additional detectable foci of parenchymal or leptomeningeal enhancement.", "output": "1.Suboptimal exam due to motion artifact without improvement after repeat sequences.2.Within this limitation there is no convincing evidence of pituitary mass. Please see above comments.3.Incidental note is made of a small focus of cortical or leptomeningeal enhancement in the right posterior temporal/occipital region. Finding could represent an enhancing subacute ischemic stroke or representing a focus of leptomeningeal enhancement of unknown etiology. Recommend follow-up with dedicated pre and postcontrast enhanced brain MRI. "}
{"instruction": "Generate impression based on findings.", "input": "Full term infant. Respiratory insufficiency and abnormal involuntary movements. Evaluate for infarct. There is minimal T1-hyperintense, T2-hypointense material layering in the posterior horns of the lateral ventricles consistent with blood products as there is prominent susceptibility. There is a similar intensity subdural hemorrhage posteromedially in the the posterior fossa, more pronounced on the right with a maximum thickness of 4 mm, without resultant mass effect on the brain. Trace subdural blood products are also identified along the tentorium cerebelli and posterior falx. All of these show susceptibility artifact.A 3 mm but somewhat elongated focus of T1-hyperintense, T2-hypointense signal in the left parietal periventricular white-matter without susceptibility artifact may represent sequela of prior insult. The brain parenchyma otherwise shows no significant abnormality. Myelination is appropriate for age. There is no mass effect or midline shift. The ventricles and the other CSF-containing spaces are normal in size.Mild diffuse T2 hyperintensity throughout the scalp especially near the vertex likely reflects residual caput succedaneum. Scalp swelling is slightly more focal in the right parieto-occipital scalp and may represent minimal subgaleal effusion. There is no displaced skull fracture.", "output": "1.Minimal intraventricular hemorrhage without hydrocephalus.2.Minimal posterior fossa subdural blood products without mass effect on the brain, likely birth related.3.Minimal intraparenchymal left parietal hemorrhage.4.Mild caput succedaneum and probable small right parieto-occipital subgaleal effusion."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Daily and nocturnal headaches. Evaluate suspected right frontal lipoma. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates normal anatomical variation all cavum septum pellucidum and Vergae without change since prior exam. The anatomical morphology and the signal intensity of the brain parenchyma otherwise remains within normal on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Negative post enhanced images.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.Calvarium demonstrate a punctate focus of fatty signal intensity within the marrow space in the right frontal skull without change since prior exam or any clinical significance.", "output": "1.No detectable acute intracranial process.2.Unremarkable pre-and post enhanced brain MRI and without change since prior exam.3.Tiny focus of fatty signal intensity within the right frontal skull without change since prior exam from 2010 and of no clinical significance."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C cirrhosis, cholangiocarcinoma with ascites consistent with atypical cells. Status post right hepatectomy October 8, 2014. Exploratory laparotomy, lysis of adhesions and radiofrequency ablation of the right hepatic lobe January 6, 2016. ABDOMEN:LIVER, BILIARY TRACT: There is decreased size of a fluid-filled cavity measuring 7.5 x 4.5 cm (series 41, image 27), consistent with prior partial right hepatectomy. At the site of prior enhancement along the right hepatectomy margin, there is persistent nodular enhancement, though decreased in size compared to prior, measuring 1.9 x 1.4 cm (series 12 2, image 296), previously 2.2 x 1.4 cm. Comparison is limited due to differences in technique and modality. There is a new area of T1 hyperintensity within the hepatic dome, presumably blood products related to recent ablation. SPLEEN: Subcentimeter T2 hyperintense nonenhancing splenic lesion, probable cyst, not visualized on prior, probably due to technique. Mild splenomegaly.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.BONES, SOFT TISSUES: Soft tissue thickening along the anterior abdominal wall, possibly postsurgical. No suspicious osseous lesion. OTHER: Small right pleural effusion. Small volume ascites.", "output": "1.Interval radiofrequency ablation of segment 8, with decreased but persistent enhancing nodular tissue along the right partial hepatectomy margin, suspicious for residual tumor and follow-up recommended.2.Ventral abdominal soft tissue thickening, nonspecific and may be postsurgical. Small ascites and right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": " BRAIN:No intracranial mass or mass-effect. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are a few scattered periventricular and subcortical white matter T2 hyperintensities which are nonspecific. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. CERVICAL SPINE:There are postoperative changes of C3 through C7 laminoplasty which are new from the prior MRI but similar to the CT of 7/15/2014. There is interval increase in CSF space dorsally. There is anterior fusion from C5 through C7 with anterior plate and screws. Evaluation of this region is limited due to susceptibility artifact. There are intervertebral spacers at C5-C6 and C6-C7. Desiccation and C3-C4 is unchanged. Mild straightening of the cervical spine appear similar to the prior exam. Subtle increased T2 signal from C4-6 is again seen and may suggest mild gliosis. No new cord signal abnormality.C1-C2: No spinal canal stenosis or neuroforaminal narrowing.C2-C3: Small central posterior disk osteophyte complex without spinal canal or neuroforaminal stenosisC3-C4: Small left central posterior disk osteophyte complex. Mild narrowing of the spinal canal, improved from the prior exam. No neuroforaminal stenosis.C4-C5: Central posterior disk osteophyte complex with mild ligamentous thickening. Mild impression on the ventral cord again seen with increase in CSF space dorsally related to decompressive surgery. Moderate to severe right and mild left neuroforaminal stenosis. C5-C6: Small central posterior disk osteophyte complex. There is mild effacement of the ventral thecal sac, however central canal narrowing seen previously has improved. Moderate left and mild right neuroforaminal narrowing, unchanged.C6-C7: Mild thickening of the posterior longitudinal ligament. No significant central or neuroforaminal stenosis.C7-T1: No significant central or neuroforaminal stenosis.Right paraspinal cysts at the level of the right lung apex is unchanged.", "output": "1. Postsurgical changes of C3 through C7 laminoplasty and anterior fusion of C5 through C7 with overall improvement in caliber of the spinal canal post laminoplasty. 2. There is mild indentation of the ventral cord at C4-5 as was seen previously. Subtle increased T2 signal from C4-6 is again seen and may suggest mild gliosis. No new cord signal abnormality. 3. Moderate neural foraminal stenosis on the right at C4-5 and on the left at C5-6 as seen previously.4. Few scattered periventricular and subcortical white matter T2 hyperintensities which are nonspecific and favored to represent mild chronic small vessel ischemic changes. "}
{"instruction": "Generate impression based on findings.", "input": "Lung cancer, with brain metastasis. Status post palliative radiotherapy in 2014 and status post 4 months erlotinib treatment for EGFR L858R mutation. Evaluate response. There is no intracranial mass or abnormal enhancement to suggest metastatic disease. Minimal enhancement along the frontal horn margins is favored to be vascular. There is no acute infarct or intracranial hemorrhage. No evidence of intracranial mass effect, midline shift, or herniation. Diffuse confluent T2-hyperintensity in the cerebral white-matter has not significantly changed since the previous examination and possibly reflect previous treatment. The ventricles remain enlarged as well as the other CSF-containing spaces, reflecting global brain volume loss.The major intracranial vascular flow voids remain preserved. Right mastoid fluid has improved since the previous examination. Left mastoid fluid remains minimal. There is no gross orbital abnormality.", "output": "1.No intracranial mass or abnormal enhancement to suggest metastatic disease are appreciated.2.Extensive cerebral white-matter abnormality is not significantly changed and compatible with posttreatment related change."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with history of recurrent prostate cancer. PELVIS:PROSTATE:Prostate: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No MR evidence of disease recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: Brain metastasis s/p SRS- surveillance exam History: Brain metastasis s/p SRS- surveillance exam 53 years Female (DOB:11/10/1963)Reason: Brain metastasis s/p SRS- surveillance exam History: Brain metastasis s/p SRS- surveillance examPROVIDER/ATTENDING NAME: STEVEN J. CHMURA RIMAS V. LUKAS Right basal ganglia lesion shows interval increase in size (from 17 mm to 31 mm) and surrounding edema also appear to be slightly increased in its extent since prior scan.In addition, the degree of midline shift measured on axial scan at the level of foramen of Monro has been increased from 9 to 13 mm.Right cerebellar hemispheric hemorrhagic lesion is again seen, unchanged since prior scan.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1. Interval increase in size of the right basal ganglia lesion as well as the extent of surrounding edema and the degree of midline shift toward left side.2. Unchanged right cerebellar hemispheric hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": "A 70 year old female with persistent atrial fibrillation and anomalous pulmonary venous connection drainage from the right lung to the superior vena cava. Referred to cardiac MRI to evaluate the anatomy before a decision about atrial fibrillation ablation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), the LVEDV is 123 ml (normal range 109+/-23), the LV end systolic volume index is 24 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10), the LV mass index is 48 g/m2, and the LV mass is 81 g. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement.There is no intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is mildly dilated with preserved systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 100 ml/m2 (normal range 69+/-14), the RVEDV is 169 ml (normal range 110+/-24), the RV end systolic volume index is 49 ml/m2 (normal range 22+/-8), and the RVESV is 82 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Interatrial septumOn series 1501, cine imaging of 1 view (image 400) is suggestive of a small intra-atrial defect with possible left to right shunting at the expected location of the fossa ovalis. First pass imaging was performed and shunting was not demonstrated. Confirmation with echocardiography and/or contrast injection prior to atrial ablation may confirm a small defect in this location.Aortic ValveThe aortic valve is trileaflet and opens widely. There is mild aortic regurgitation visualized. Mitral ValveThe mitral valve opens widely. A small mitral regurgitation jet is visualized. This was not quantified.Pulmonic ValveThe pulmonic valve opens widely. There is no pulmonic regurgitation visualized. Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is normal in size. The left pulmonary artery and lobar branches are normal in caliber and course. The right lobar pulmonary arteries are tortuous and small in caliber.Venous AnatomyThere is an anomalous right superior pulmonary vein that drains high into the superior vena cava. This vein is approximately 14 mm as it drains into the superior vena cava. The drainage point into the superior vena cava is approximately 1.7 cm inferior to the inflow of the right brachiocephalic vein. No additional anomalous pulmonary vein drains into the superior vena cava.The SVC and IVC are normal in size and drain normally into the right atrium. Pulmonary VeinsThe two left pulmonary veins drain normally into the left atrium. There is one normally sized superior pulmonary vein that drains into the superior left atrium. No inferior left pulmonary vein is present.Qp:QsThe calculated Qp:Qs is 1.7.PericardiumThere is no pericardial effusion.There is a focus of high signal at the infralateral pleural surface which may represent sequestration or hypoplastic right lower lobe. There is right-sided volume loss with a history of hypoplastic right lung.", "output": "1. The left ventricle is normal in size and systolic function, the LVEF is is 67%. There is no late gadolinium enhancement.2. The right ventricle is mildly dilated with preserved systolic function, the RVEF is 51%. 3. On one axial cine view, there is suggestion of a small interatrial defect with left to right shunting at the valve of the fossa ovalis. This was not well demonstrated on first pass imaging. No evidence of superior sinus venosus shunting was identified. However, in the setting of anomalous right superior pulmonary vein, a small superior sinus stenosis defect cannot be entirely excluded. Both areas of potential shunting can be further evaluated with echocardiography and/or direct contrast injection left pulmonary vein ablation. 4. The two left pulmonary veins drain normally into the left atrium. One right superior pulmonary veins drains into the superior left atrium. No right inferior pulmonary vein drains into the left atrium. There is an anomalous right superior pulmonary vein that drains high into the superior vena cava. There is a question of a right apical pulmonary AVM with a high signal focus (possible nidus) in the right apex that provides the anomalous pulmonary vein. This can be better evaluated with a CT PE thorax.7. The calculated Qp:Qs is 1.7.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " MRI images of the sella demonstrate a focus of relative hypoenhancement centered within the right pituitary gland measuring 16 mm transverse by 13 mm craniocaudal by 14 mm AP dimensions. This partially enters the right cavernous sinus, however without associated right cavernous carotid encirclement or narrowing. It also displaces the pituitary stalk to the left. Compared to be 2014 study, there has been significant decrease in size, and it no longer approaches the optic apparatus.Evaluation of the brain demonstrates the ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. 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 essentially clear.", "output": "MRI images of the sella demonstrate a focus of relative hypoenhancement centered within the right pituitary gland measuring 16 mm transverse by 13 mm craniocaudal by 14 mm AP dimensions. This partially enters the right cavernous sinus, however without associated right cavernous carotid encirclement or narrowing. It also displaces the pituitary stalk to the left. Compared to be 2014 study, there has been significant decrease in size, and it no longer approaches the optic apparatus."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Quadriplegia, C5-C7 incompleteClinical question: s/p spinal cord bxSigns and Symptoms: weakness The cervical vertebral bodies are appropriate in overall alignment and height. The patient is status post recent multilevel laminectomies at C5, C6, C7. There is redemonstration of a T2 hyperintense mass extending from the C5-6 disc space level down to the T1 vertebral level. There is some heterogeneous enhancement associated with this lesion which is eccentric towards the right half of the spinal cord. The spinal cord is enlarged at the level of the tumor. There is no spinal fluid surrounding the spinal cord at the levels of the tumor.There are signal changes and contrast enhancement along the paravertebral musculature extending from approximately C1 down to T1 which are probably related to partial operative effects.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 loss of disc space height, endplate reactive change, central disc protrusion, endplate and uncovertebral osteophytes and narrowing of the neural foramina bilaterally and encroachment of exiting nerve roots. The endplate reactive changes are high signal on T2 and display enhancement following gadolinium administration.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. There are endplate and uncovertebral osteophytes present at this level associated with a disc bulge associated with endplate reactive change.The vertebral artery flow voids appear to be intact.", "output": "1.The patient is status post recent laminectomies in the lower cervical spine. There are associated postoperative changes present.2.There is a mass redemonstrated which is centered in the lower cervical spinal cord and eccentric to the right side. Differential considerations include astrocytoma and ependymoma.3.There are multilevel degenerative changes present in the cervical spine associated with the encroachment of exiting nerve roots bilaterally at C5-6. Spinal stenosis at the C5-6 level has been alleviated compared to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Chronic headaches, occipital and then generalized. Now with new complaint of seeing double. Evaluate anatomy. No evidence of hemorrhage, edema, mass effect among midline shift or hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns are essentially within normal limits for patient's stated age of 6. Calvarium, paranasal sinuses and in the tibial blastic air cells and middle ear cavities are also within normal. Considering provided clinical date of follow up examination with an MRI is recommended.", "output": "Negative nonenhanced CT of brain."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Low back pain. Signs and symptoms: Low back pain and spasms. Nonenhanced brain MRI:T12 -- L1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.At L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. Tiny annular fissure far laterally on the right (sagittals T2/T2 stir image 12).L2 -- L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, moderate bilateral ligamentum flavum and moderate right facet hypertrophy changes. Constellation of changes result in mild central spinal and right neural foraminal compromise.L4 -- L5 demonstrate mild disk disease, mild (right greater than left) facet and ligamentum flavum hypertrophy is present. Although there is subtle flattening deformity of the thecal sac secondary to ligamentum flavum hypertrophy there is no central spinal stenosis in the AP axis. Mild compromise of the lateral recess of the canal bilaterally is noted.L5 -- S1 demonstrate moderate disk disease and loss of disk height, moderate to significant asymmetric right-sided ligamentum flavum and facet hypertrophy changes are present. Constellation of changes results in mild right neural foraminal compromise and no central spinal stenosis. Examination at this level also demonstrates a tiny central annular fissure is appreciated on sagittal T2 stir series 50 on image 8.", "output": "1.Degenerative changes at the L3 -- L4 with resultant mild central spinal and right neural foraminal stenosis.2.Degenerative changes at the L4 -- L5 results in compromise of the lateral recesses bilaterally. Mild compromise of transverse axis of thecal sac however no spinal stenosis in AP axis.3.At L5 -- S1 asymmetric right-sided facet and ligamentum flavum hypertrophy results in mild right neural foraminal compromise.4.Tiny annular fissures in the midline at L5 -- S1 and far right at L1 -- L2 as detailed."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with pain and weakness. Evaluate post rotator cuff repair one year ago. Evaluation of the greater tuberosity and adjacent soft tissue is limited due to metallic susceptibility artifact from orthopedic hardware.ROTATOR CUFF: At the 12:00 position, a thin supraspinatus tendon can be followed from the myotendinous junction to the greater tuberosity at the vicinity of aforementioned orthopedic hardware. This intact portion of the tendon measures approximately 1.5 to 2 cm in AP dimension. We suspect that there is delamination of the undersurface fibers of the supraspinatus with retraction to the level of the glenohumeral joint, but this may represent pre-existing undersurface tearing rather than postoperative tearing. There is a fluid-filled gap along the anterior margin of the remaining supraspinatus tendon insertion compatible with a full-thickness tear of the anterior fibers of the supraspinatus, but again we are uncertain if this represents a pre-existing tear or tear which occurred following surgery. There is mild atrophy of the supraspinatus muscle. The infraspinatus muscle and tendon appear intact, although there is perhaps mild fatty infiltration along the myotendinous junction. The teres minor muscle and tendon appear intact. Subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is mild widening of the acromioclavicular joint indicating prior surgery. There is a small amount of fluid within the subacromial bursa. There is anterior spurring of the acromion process.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. We see no evidence of joint effusion. Branching intermediate signal intensity within the superior labrum as well as attenuation of the posterior labrum may reflect degenerative tearing.BICEPS TENDON: The biceps tendon is noted anterior to the proximal humeral diaphysis but this disappears within the bicipital groove, presumably representing prior tenotomy.", "output": "1. Fibers of the thinned supraspinatus tendon can be traced to their insertion on the greater tuberosity. There appears to be delamination of the undersurface fibers of the supraspinatus tendon, with retraction proximally, as well as full-thickness tearing of the anterior most fibers of the tendon. However, we cannot state with certainty if this represents pre-existing tearing or tearing that is occurred since surgery.2. Postoperative changes of the greater tuberosity, acromioclavicular joint, and biceps tendon as described above.3. Degeneration of the glenoid labrum."}
{"instruction": "Generate impression based on findings.", "input": "Reason: pain History: right hip pain ACETABULAR LABRUM: There is linear increased signal in the anterior superior labrum, which is consistent with a tear. Incidental note is made of anterior extravasated contrast, which is likely of no current clinical significance.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL", "output": "Tear of the anterior superior labrum as above."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Seizure workup. Please performed on the post enhanced images; patient already had the nonenhanced exam. Signs and symptoms: As above. Post enhanced brain MRI:Examination demonstrates no evidence of abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.There is normal enhancement of intracranial venous sinuses.Supratentorial ventriculomegaly is again noted without change.", "output": "No detectable abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "Muscle weakness (generalized)Unspecified ptosis of eyelid. Paralytic strabismus, fourth or trochlear nerve palsyL ptosis, L leg weakness, L-sided sensory deficit since this amevaluate steno-occlusive disease.Mild nonproliferative diabetic retinopathy MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a T2 and FLAIR sequence hyperintense focus centered in the left centrum semiovale measuring 15x6mm axial dimensions as well as several punctate foci of signal hyperintensity in the left frontal and parietal subcortical white matter and left sided periventricular white matterNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left A1 segment is small.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is medium sized. The left posterior cerebral artery has fetal origin. The left p1 segment is medium sized. The vertebral arteries are similar in size. There is extracranial origin of the left PICA.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The LCCA originates from the innominate artery.", "output": "1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.There is lesion in the left centrum semiovale associated with several punctate lesions in the left periventricular and subcortical white matter which are most likely vascular related possibly from prior small ischemic event now in a chronic stage."}
{"instruction": "Generate impression based on findings.", "input": "89 years, Female, altered mental status, unable to walk. There are multiple foci of restricted diffusion in the right frontal lobe including the right forceps minor, centrum semiovale and along the cortex of the right superior and middle frontal gyri consistent with acute infarct. Again seen is evidence of multiple prior infarcts including relatively larger areas of encephalomalacia involving the left posterior temporal and occipital lobes, which is new/much larger than prior from 10/20/2004. There is also extensive encephalomalacia involving the right cerebellar hemisphere which has evolved compared to prior study. Multiple chronic infarcts involving the midbrain, pons, left cerebellar hemispheres, basal ganglia and thalami are also noted, some of which were acute at the time of prior study from 2004. There is also more diffuse confluent T2/FLAIR hyperintensity in the periventricular and subcortical white matter which is compatible with chronic small vessel ischemic disease.There are foci of susceptibility compatible with chronic hemorrhage involving the left cerebellar hemisphere parenchyma as well as along the surface of the encephalomalacic right cerebellar hemisphere. No intracranial mass or mass effect. There is global parenchymal volume loss. No hydrocephalus or extra-axial collections. There is ex vacuo dilatation of the left lateral ventricle. Paranasal sinuses and mastoid air cells are grossly clear. Evidence of intraocular lens replacement. Chronic fracture deformity involving the right medial orbital wall better seen on recent CT. Bone marrow signal and extracranial soft tissues are otherwise unremarkable.", "output": "1. Several foci of acute infarct involving the right frontal lobe as described above.2. Numerous chronic supratentorial and infratentorial infarcts, some of which were acute at the time of prior study from 10/20/2004.3. Chronic blood products involving the bilateral cerebellar hemispheres.Dr. Ali discussed findings with Dr. Raychaudhuri at 10 am on 8/27/2015."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with HCC status post TACE/RFA ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. An ablation cavity is noted within segment six of the liver measuring 4.3 x 4.0 cm. T1 hyperintensity within the ablation cavity is again noted. There is no evidence of an arterially enhancing lesion.Cholelithiasis. The common bile duct is normal in caliber.The hepatic vasculature is patent.SPLEEN: Splenomegaly measuring 19 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered gastrohepatic ligament, periportal, and aortocaval lymph nodes. Mildly enlarged right cardiophrenic lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Limited examination as described in the technique section above.2.Segment six lesion cavity without evidence of recurrent or residual disease. No new suspicious liver lesions.3.Cirrhotic morphology with splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: possible lumbar hemangiomaSigns and Symptoms: lumbar hemangioma Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. There is mild anterior subluxation of L4-L5 and left lateral translation of L2 on L3. The conus medullaris on sagittal imaging is grossly intact. There is sigmoid curvature to the lumbar spine. Within the sacrum there is a predominantly T2 hyperintense lesion which displays a low but of enhancement and has a spiculated pattern. Part of the lesion is hyperintense on T1. This sacral lesion is 28 x 14 mm greatest sagittal dimensions on the current exam than on the prior exam was 21 x 12 mm sagittal dimensions indicating that it has mildly enlarged.There is a similar signal characteristic lesion present within the T11 vertebral body measuring 15 x 11 mm sagittal dimensions which previously measured 11 x 8 mm sagittal dimensions the previous exam.There is redemonstration of endplate reactive changes at L2-3 where there are Schmorl's nodes present. These endplate reactive changes are lower signal on T1 and higher signal on T2 and have not changed substantially since the prior exam. They do demonstrate enhancement following contrast administration. There is mild left lateral translation of L2 on L3 present. This was also present on prior exam and does not appear to have changed substantially.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy at this level and a mild degree of anterior subluxation of L4 on L5 as well as a small left lateral recess disc protrusion. These findings were also present on the previous exam and have not changed substantively. There is some mild encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The right ureter and right renal pelvis are larger than on the prior exam. There a mass present in the pelvis which measures approximately 5 cm in diameter. It is eccentric towards the right side and appears to impress on the right ureter.", "output": "1.There is redemonstration of a multilevel degenerative changes present in the lumbar spine which have not changed significantly since 2009. This is associated with left lateral translation of L2 on L3, mild anterior subluxation of L4 on L5 and a sigmoid curvature to the lumbar spine as well as some encroachment of the left-sided exiting nerve roots at L4-5 within the neural foramen.2.There is sacral lesion and a T11 lesion present which have mildly enlarged since the prior exam from 2009. These could represent atypical hemangiomas.3.Findings suggest a right-sided hydroureter and hydronephrosis. There appears to be a mass in the pelvis which is incompletely visualized on this exam which impresses on the right ureter. Additional imaging of the pelvis may be of further benefit in evaluating this. Please refer to the MRI of the pelvis from 9/4/2015 for further comments on this.4.An email was sent to Dr Schwartz with the above findings."}
{"instruction": "Generate impression based on findings.", "input": " Postoperative changes from small left prior burr hole are seen, with rounded area of peripheral susceptibility likely relating to previous biopsy. There is redemonstration of a stable area of T2/FLAIR hyperintensity involving the left superior frontal gyrus with mild associated cortical thickening anteriorly, with signal abnormality extending into the left frontal centrum semiovale and periventricular white matter. There is a prominent area of central cystic degeneration. Anterior to the cystic area within the thickened cortex there is a small area of enhancement which appears slightly increased from prior examination (series 1302, image 152-155) especially the medial component. The ventricles are nondilated. The cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. Enhancement and osseous thickening along the medial right orbital roof is again noted, possibly representing an area of fibrous dysplasia. There is a left maxillary sinus retention cyst.", "output": "There is slight increased foci of enhancement along the anteromedial margin of the cystic area of degeneration in the left frontal lobe suspicious for tumor progression."}
{"instruction": "Generate impression based on findings.", "input": "Ms Wachowski is a 59-year-old female with history of right breast lumpectomy for DCIS/IDC in 2009, followed by radiation and hormonal therapy. Personal history of benign MRI-guided biopsy of the left breast in 2009. No family history of breast cancer. Asymptomatic patient presenting for annual follow-up. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. A linear marker is placed on the scar overlying the right breast. There are stable post-lumpectomy changes present in the right breast, including architectural distortion, increased density, benign dystrophic calcifications and surgical clips. Biopsy clip marker within the left inner central breast is redemonstrated from prior benign MRI biopsy. There are no new masses, suspicious microcalcifications or areas of architectural distortion identified in either breasts.", "output": "Stable postsurgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 63 years old Reason: evaluate for osteomyelitis History: necrotic 1st toe with draining ulcer There is increased STIR signal in the distal tuft of the great toe with corresponding confluent low T1 signal consistent with osteomyelitis. There is no enhancing fluid collection to suggest abscess. There is increased STIR signal in the adjacent soft tissues consistent with edema. There is also edema type signal in the soft tissues about the metatarsals.", "output": "Findings compatible with osteomyelitis involving the distal tuft of the great toe."}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of head, face and neck [C76.0], Reason for Study: ^Reason: eval for vasogenic edema History: known brain mets, nausea, vomiting Brain MRIMotion artifact degraded exam quality.In particular, previously seen enhancing parenchymal nodular lesions at the right temporal lobe mesial aspect, right cerebellar hemisphere and left occipital lobe are not this conspicuous as prior. However, there are subtle enhancing lesions seen on the same locations thus could represent unchanged/stable nodular enhancing lesions.However, on FLAIR/T2 images, the left occipital lobe shows increased signal intensity which may represent post radiation changes of the left occipital lobe lesion more likely. Differential diagnosis could include localized venous congestive encephalopathy based on the findings of distal superior sagittal sinus thrombosis.Soft tissue lesions which is occlusive for the distal superior sagittal sinus to the level of Torcular Herophili appear to be stable. There is no evidence of prominent cortical veins on post contrast scan.Soft tissue mass on the midline occipital scalp is again seen, unchanged since prior scan.Scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter are unchanged and indicate non specific small vessel ischemic disease. The ventricles, sulci and cisterns are unremarkable. The gray-white matter differentiation is normal. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Right sphenoid sinus mucosal thickening is seen.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate occlusion of the distal Superior Sagittal Sinus (SSS). However, proximal SSS, bilateral transverse sinus and bilateral sigmoid sinuses appear to be normal and patent. Visualization of the deep venous system including bilateral internal cerebral veins, vein of Gallen and straight sinus appear to be patent without evidence of occlusive lesion.", "output": "1. Interval development of left occipital lobe FLAIR/T2 high signal intensity. This finding more likely represent post radiation changes. Differential diagnosis though less likely include localized venous congestive encephalopathy.2. Unchanged distal SSS occlusion, midline occipital area scalp mass and although not as conspicuous as prior multiple brain parenchymal enhancing lesions since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion.4. Occlusion of the distal SSS on MRV. However, other cranial venous drainage system appears to be patent with no evidence of occlusive lesion. 5. Due to significant motion artifacts, precise evaluation for new enhancing nodule is not possible."}
{"instruction": "Generate impression based on findings.", "input": "History of renal cancer status post nephrectomy. Presents for surveillance scan. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense hepatic foci are unchanged and are likely cystsSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy without evidence of local recurrence. No regional lymphadenopathy.The left kidney is normal in appearance without a suspicious lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Stable small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence of local recurrence or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Female, 35 years old, with subacute left-sided weakness and history of multiple sclerosis. Brain:Multiple new T2 hyperintense lesions are seen scattered through the cerebral hemispheres, the brainstem and cerebellum. A number of these lesions demonstrate either solid or rim enhancement. No evidence of significant parenchymal edema or mass effect is observed. Brain volume is within normal limits. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. Ventricular size and morphology are within normal limits.Cervical spine:Multiple scattered T2 hyperintense lesions are seen within the cervical spinal cord. The largest lesion is located dorsally and spans approximately 13 mm at the C4-5 level. This lesion does not enhance, but several of the smaller lesions at the cervico-medullary junction and at C3 do enhance.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is seen. The spinal canal and neural foramina are patent. No disc degeneration is seen.Thoracic spine:Multiple T2 hyperintense lesions are demonstrated through the thoracic spinal cord including large lesions at T5-6 and T10 which measure up to 15 mm in length. Both of these lesions, and several smaller lesions, demonstrate enhancement on postcontrast images.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is seen. The spinal canal and neural foramina are patent. The intervertebral discs are normal.", "output": "1.Multiple new and enhancing lesions are evident within the brain compatible with interval progression of demyelinating disease and with the presence of actively inflamed lesions.2.No prior examination is available for comparison in the spine. However, numerous enhancing and nonenhancing spinal cord lesions are also demonstrated."}
{"instruction": "Generate impression based on findings.", "input": "73 year old female who is status post left lumpectomy for ILC, resulting in positive surgical margins. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a post-surgical seroma cavity in the left lateral breast, measuring 68 x 64 x 42 mm (AP x LR x CC). At the anterior-inferior margin of the seroma, there is an irregularly shaped enhancing mass, measuring 11 x 13 x 11 mm, which is suspicious for residual lesion.No abnormal enhancement is seen in right breast. Mild post-surgical changes are seen in the left axilla.No abnormal lymph nodes are identified in either axillary region.", "output": "1. Status post lumpectomy in the left breast. A residual tumor is suspected at anterior-inferior margin of the seroma.2. No MRI evidence of malignancy in the right breast.3. No abnormal lymph nodes in either axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old with personal history of right breast cancer status post lumpectomy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. There is mild motion artifact, though the exam remains diagnostic. No suspicious enhancement is seen in either breast. Postlumpectomy change in the right breast again noted. Low T2 non-enhancing masses bilaterally, more on the left, are stable. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "History of left breast ILC status post mastectomy. There is heterogeneous amount of fibroglandular tissue in the right breast. The patient is status post left mastectomy.Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in the right breast or left chest wall. Scattered non-suspicious foci are present in the right breast, none with suspicious kinetics. These foci are most similar to her oldest comparison MRI from 2013. No abnormal axillary lymph nodes are identified in either axillary region. Post surgical change is noted in the left axilla.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Large liver mass on outside imaging ABDOMEN:LIVER, BILIARY TRACT: Large T2 hyperintense mass replacing nearly the entire right hepatic lobe, internal heterogeneity and septations seen, measures 17.8 x 13.3 x 20.7 cm (series 3, image 18; series 7, image 17). The mass is T1 hyperintense and exerts mass effect upon the right kidney. Additional T2 hyperintense/T1 hypointense nonenhancing foci are noted throughout the liver, likely cysts. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "Large cystic mass replacing the right hepatic lobe with imaging characteristics suspicious for a biliary cystadenoma/cystadenocarcinoma (particularly given the internal heterogeneity of the structure evident on T2 imaging) or a giant biliary hamartoma, no associated enhancement seen."}
{"instruction": "Generate impression based on findings.", "input": "Small lung cancer with brain metastasis. Confusion and slurred speech. The numerous contrast-enhancing lesions which are predominantly distributed along the cortical surface have progressed since the previous examination, as well as the vasogenic edema associated with some of the lesions. The lesions are most coalescent along the left sylvian fissure, where they are also associated with increased subjacent vasogenic edema and slight mass-effect on the adjacent structures. For example, one of these lesions now measures transaxially 2.4 cm x 1.8 cm compared to 2.0 cm x 1.0 cm previously. Some of the lesions in the occipital lobes are not clearly appreciated on prior and may be new. There is no midline shift or brain herniation. The lesions are associated with mild diffusion restriction, probably reflecting their dense cellularity. The nonspecific periventricular T2/or hyperintense signal in both cerebral hemispheres remain unchanged and probably reflect a combination of microvascular ischemia and treatment effect.The orbits are grossly unremarkable. There is no destructive skull lesion.", "output": "1.Since previous MRI of March 2016, there has been progression of intracranial metastatic disease with enlargement of numerous intraparenchymal lesions which are predominantly along the cortical surface. There is also mild increase in the associated vasogenic edema, particularly in the left insular region. There is no midline shift or herniation.2.Unchanged periventricular cerebral white-matter T2-hyperintensity probably represents chronic microvascular ischemia and treatment effect. "}
{"instruction": "Generate impression based on findings.", "input": "Right knee pain No fracture or malalignment. No joint space narrowing. Moderate to large joint effusion. Please see recent prior knee MRI for details.", "output": "No fracture or malalignment."}
{"instruction": "Generate impression based on findings.", "input": " Multiple sequences are motion degraded. Given this caveat:Brain:Within the bilateral globus pallidus there are foci of restricted diffusion with matching ADC hypointensity, T2 hyperintensity, without T T1 signal change.The ventricles and sulci are normal in size. 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 mastoid air cells are clear. Cervical spine:There is a linear focus of T2 hyperintensity within the cervical cord just inferior to the cervicomedullary junction measuring up to 8 mm in craniocaudal dimension without mass effect.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The visualized paraspinal contents are unremarkable.C2/3: No significant stenosisC3/4: No significant stenosisC4/5: Mild to moderate right neural foraminal stenosisC5/6: Mild bilateral neural foraminal stenosisC6/7: No significant stenosisC7/T1: No significant stenosisThoracic spine:There are bilateral pleural effusions.There are no acute fractures or subluxations. Marrow signal intensity is benign throughout. The spinal cord is normal in signal.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates disc bulge abutting the cord without stenosis. 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 a left paracentral disc protrusion abutting the cord without stenosis. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Increased T1 hyperintensity within L5 as well as the sacrum suggests previous radiation therapy to the region.The left kidney is atrophic, as demonstrated on previous abdomen CT exams.There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level.L1/2: Asymmetric bulge to the left and bilateral facet hypertrophy without stenosis.L2/3: Asymmetric bulge to the left, ligamentum flavum thickening, and facet hypertrophy. There is mild left neural foraminal stenosis with adjacent nerve root abutment lateral to the neural foramen.L3/4: Disc bulge, ligamentum flavum thickening, and facet hypertrophy, without stenosis.L4/5: Asymmetric bulge to the right with a prominent annular tear, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild right neural foraminal stenosis with adjacent nerve root abutment lateral to the neural foramen.L5/S1:Mild disc bulge and bilateral facet hypertrophy. There is moderate left neural foraminal and mild right neural foraminal stenosis.", "output": "1.Multiple sequences are motion degraded.2.Acute to subacute ischemia within the globus pallidus bilaterally. The differential diagnosis for this most likely includes a metabolic or toxic etiology, and less likely hypoxic.3.Tiny syrinx within the cervical cord just inferior to the cervicomedullary junction.4.Bilateral pleural effusions.5.No cord or conus compression.6.Mild degenerative changes of thoracic spine without significant stenosis.7.Increased T1 hyperintensity within L5 as well as the sacrum suggests previous radiation therapy to the region.8.L2/3: Mild left neural foraminal stenosis with adjacent nerve root abutment lateral to the neural foramen.9.L4/5: Mild right neural foraminal stenosis with adjacent nerve root abutment lateral to the neural foramen.10.L5/S1:Moderate left neural foraminal and mild right neural foraminal stenosis.11.No MRI evidence of osseous spinal metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "53 years Female (DOB:4/21/1963)Reason: r/o lesions, hx of left visual loss History: same as abovePROVIDER/ATTENDING NAME: ANTHONY T. REDER MINDY ALYCE SCHWARTZ The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Apparent FLAIR signal hyperintensity involving the midportion of the midbrain extending into the superior cerebellar peduncles was also present on the previous exam. It is not associated with T1 hypointensity and is not associated with T2 hyperintensity suggesting this may represent artifactNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "Findings are suggestive of artifact within the midbrain which could obscure an underlying abnormality. The appearance is stable."}
{"instruction": "Generate impression based on findings.", "input": "Severe migraines and family history of cerebral aneurysm. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions or cerebral aneurysms.", "output": "1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant steno-occlusive lesions or cerebral aneurysms."}
{"instruction": "Generate impression based on findings.", "input": " Redemonstrated are lesions of low susceptibility signal, a few with corresponding T1 hypointensity and less conspicuous central T2 hyperintensity dispersed throughout the brain, which are unchanged from the previous study except for the lesion seen previously in the left frontal lobe which has increased in size from 4 mm to 7 mm demonstrating new perilesional edema and enhancement.Punctate nonspecific foci of T2 and FLAIR high signal are again seen in the corona radiata and the centrum semiovale, unchanged from the previous study.The ventricles and sulci are within normal limits. The basilar cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening in the maxillary sinuses. The left parotid gland is again diminutive in volume, which may be postoperative or post treatment in nature.", "output": "1.A left frontal lobe lesion has increased in size with new perilesional edema and new enhancement. The constellation of these features are worrisome for progression of a metastasis and less likely changes within a cavernoma.2.The remainder of the previously identified lesions are unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Male, 54 years old, with history of multiple myeloma, as well as herpes zoster, with confusion and unsteady gait. Assess lytic lesions and mass described on recent CT. Also evaluate for CNS myeloma involvement and CNS herpes zoster. Bone marrow signal characteristics are diffusely heterogeneous including both the calvarium and the visualized upper cervical spine.An enhancing mass is centered on the floor of the right middle cranial fossa with both intracranial and extracranial components measuring up to 21 mm in thickness. This lesion indents the adjacent anterior temporal lobe, but the interface between brain and tumor remains smooth and there is no evidence of parenchymal enhancement or edema to suggest brain invasion at this time.Numerous additional smaller areas of pathologic marrow enhancement are seen, none of which is associated with any large or significant intracranial or extracranial components.The dura along the bilateral convexities and along the right temporal bone is mildly and smoothly thickened, likely a reactive phenomenon to the overlying bony disease.No areas of pathologic parenchymal enhancement are seen. No parenchymal edema is detected. Mild periventricular T2 hyperintensities are a nonspecific finding. Diffusion weighted images are within normal limits.No abnormal extra-axial fluid collections are seen. No evidence of intracranial hemorrhage is detected. The ventricular system is normal in size and morphology.The skin of the right frontal and periorbital regions may be slightly edematous but this is an equivocal finding.", "output": "1.Diffuse abnormality of the bone marrow compatible with the stated history of multiple myeloma.2.A localized tumor deposit is evident centered on the floor of the right middle cranial fossa. This lesion has both extracranial and intracranial components. The intracranial component indents the adjacent anterior temporal lobe but without clear evidence of brain invasion.3.Smooth dural thickening likely reflects a reactive process to the overlying bony disease. No additional areas of significant intracranial tumor are suspected.4.No specific findings are seen to suggest active herpetic encephalitis or other acute abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: evaluate for bleeding, characterize hypoattenuating genu lesion seen on CTSigns and Symptoms: R eye pain/R sided headache, bilateral blurred vision x1-2 daysDiagnosis: Headache Headache MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small 6 mm focus of diffusion restriction present along the right superior temporal gyrus near to the junction with the inferior parietal lobule. There is a more subtle 2.5 mm focus of diffusion restriction present along the right inferior parietal lobule close to the junction with the occipital lobe. These can also be identified on the FLAIR MRI images.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR punctate hyperintense foci are present in the thalami. Patchy T2 and FLAIR hyperintense lesions are present in the brainstem.There is a heterogeneous focus of T2 and FLAIR signal hyperintensity along the genu of the corpus callosum eccentric towards the left side measuring approximately 30 x 10 mm axial dimensions. It is low signal on T1-weighted imaging but heterogeneous. It does not enhance following gadolinium administration. It does not appear to be associated with any significant diffusion restriction. There is no associated susceptibility effect appreciated.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .", "output": "1.There is a heterogeneous looking lesion along the genu of the corpus callosum. It is not associated with any contrast enhancement. It is nonspecific. Differential considerations include demyelination as well as a low-grade glioma and prior injury.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. Additional lesions are present in the brainstem as well as the thalami.3.There are small foci of diffusion restriction present in the right superior temporal gyrus and adjacent inferior parietal lobule. The possibility that these are related to microinfarcts is raised. These correspond to the territory of the right angular artery."}
{"instruction": "Generate impression based on findings.", "input": "69 year old man with PVC initiated VT/VF, referred for cardiac MRI for evaluation of scar burden prior to ablation. Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 117 ml/m2 (normal range: 74+/-15), the LVEDV is 242 ml (normal range 142+/-34), the LV end systolic volume index is 85 ml/m2 (normal range 25+/-9), the LVESV is 176 ml (normal range 47+/-19), the LV mass index is 48 g/m2 (normal range 85+/-15), and the LV mass is 100 g (normal range 164+/-36). LV dysfunction is global with regional variation.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 35%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 62 ml/m2 (normal range 31+/-9), and the RVESV is 129 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.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 grossly normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsProminent left chest ICD artifact is noted. 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. The left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 27%.2. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 35%.3. The presence or absence of late gadolinium enhancement could not be determined in this study. Although gadolinium was administered, only one post-contrast image was acquired and the patient refused to complete the study due to discomfort in left chest wall. Subsequent exam suggested musculoskeletal cause of discomfort. No evidence of ICD problems by exam and interrogation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with proximal weakness of the lower extremities. Evaluate for progression of fatty atrophy or gadolinium enhancement within the muscles. Left femur:Again seen is severe fatty atrophy of the quadriceps musculature with relative sparing of the rectus femoris, appearing similar to the prior study. There is mild to moderate fatty atrophy of the semitendinosus, appearing similar to the prior study. There is severe fatty atrophy of the remaining hamstring musculature appearing similar to the prior study. There is relative sparing of the adductor musculature as well as the sartorius. There is no enhancement of the remaining musculature to indicate inflammation. The bone marrow signal intensity is within normal limits.Right femur:Again seen is severe fatty atrophy of the quadriceps musculature with relative sparing of the rectus femoris appearing similar to the prior study. There is severe fatty atrophy of the hamstring musculature appearing similar to the prior study. There is relative sparing of the adductor musculature as well as the sartorius. There is no enhancement of the remaining musculature to indicate inflammation. There is a small knee joint effusion as well as mild synovitis of the knee joint. The bone marrow signal intensity is within normal limits.", "output": "Severe fatty atrophy of the anterior and posterior musculature of the thighs appearing similar to the prior study. We see no definite progression of atrophy nor do we see gadolinium enhancement to suggest active inflammation."}
{"instruction": "Generate impression based on findings.", "input": "46 year old female with newly diagnosed multivessel coronary artery disease after admission for non-ST elevation myocardial infarction. Risk factors included hypertension, hyperlipidemia. She is referred for cardiac MRI for assessment of viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 131 ml/m2 (normal range: 65+/-11), the LVEDV is 254 ml (normal range 109+/-23), the LV end systolic volume index is 95 ml/m2 (normal range 18+/-5), the LVESV is 185 ml (normal range 31+/-10), the LV mass index is 34 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). There is hypokinesis of the basal anterolateral wall, the mid anteroseptum, anterior, anterolateral, and inferolateral walls; and the entire apex. The majority of the left ventricle is free of myocardial infarction and viable. However, there is a small transmural myocardial infarction involving the basal to mid anterolateral wall which is not likely to be viable. There is a non-transmural myocardial infarction involving the mid anterior and anterolateral walls which has an intermediate probability of viability. A small apical anterior transmural myocardial infarction is noted and this segment is not viable. Additionally there is a mid-wall stripe of late gadolinium enhancement involving the basal to mid septum. This pattern of late gadolinium enhancement is not typical for prior myocardial infarction and suggests the presence of a concomitant non-ischemic cardiomyopathy. No left ventricular thrombus is noted. The pre-contrast native myocardial T1 relaxation times are elevated (~1200 ms) which suggests presence of underlying fibrosis. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 100 ml/m2 (normal range 69+/-14), the RVEDV is 195 ml (normal range 110+/-24), the RV end systolic volume index is 59 ml/m2 (normal range 22+/-8), and the RVESV is 115 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. 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 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 mildly dilated. Venous AnatomyThe SVC and IVC are dilated and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall bilateral pleural effusions are noted. 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. The left ventricle is severely dilated with severely reduced systolic function (LVEF 27%).2. The right ventricle is mildly dilated with mildly reduced systolic function (RVEF 41%).3. The majority of the left ventricle is free of myocardial infarction and viable. However, there is a small transmural myocardial infarction involving the basal to mid anterolateral wall which is not likely to be viable. There is a non-transmural myocardial infarction involving the mid anterior and anterolateral walls which has an intermediate probability of viability. A small apical anterior transmural myocardial infarction is noted and this segment is not viable. Additionally there is a mid-wall stripe of late gadolinium enhancement involving the basal to mid septum. This pattern of late gadolinium enhancement is not typical for prior myocardial infarction and suggests the presence of a concomitant non-ischemic cardiomyopathy. 4. Biatrial enlargement. 5. The SVC and IVC are dilated.6. Moderate tricuspid regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female with history of lung cancer and probable metastases in left anterior pons Previously described on the recent MRI left anterior pons hemorrhagic lesion appears hyperdense on the nonenhanced CT and it is associated with extensive areas of hypoattenuation involving the pons, mid brain, cerebellum, left thalamus, and posterior limb of the internal capsule. There is no evidence of other hemorrhagic foci in the brain parenchyma. There is no evidence of extra axial fluid collection/hemorrhage or midline shift. The ventricles and basal cisterns are normal in size and configuration.Again noted diffuse calvarial diploic widening, coarsened trabecula and thick cortices with focal areas of sclerotic lesions that are stable compared to prior examination compatible with Paget's disease. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1.Stable hyperdense lesion in anterior pons associated with extensive vasogenic edema corresponding to the hemorrhagic lesions seen on recent MRI. No other foci of intraparenchymal high density suggestive of hemorrhage are identified.2.Paget's disease involving the skull."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with abdominal pain, fever, chronic cystitis, self-catheterization. Status post appendectomy. Creatinine is 1.7. This examination is limited by the absence of intravenous contrast. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is extensive fat stranding surrounding the right kidney. In the right midpole region there is a faintly seen cystic mass which measures approximately 4 cm in diameter. CT or MRI examination with contrast would be required to further delineate this potential lesion. There is mild right hydronephrosis and hydroureter. No renal calculus are present. There are several small calcifications in the course of the distal ureter and in the pelvis, but these cannot be convincingly demonstrated to be within the ureter. There is a left midpole faint hypodensity measuring approximately 1.8 cm in diameter which may be a simple cyst. The left kidney is otherwise within normal limits. The findings in the right kidney are most likely due to pyelonephritis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: UTERUS, ADNEXAE: No significant abnormality notedBLADDER: There is a small amount of air within the bladder compatible with history of self-catheterization.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted", "output": "Fat stranding, mild hydronephrosis and hydroureter of the right kidney compatible with pyelonephritis. No definite evidence of renal stones. Bilateral renal cortical hypodensities are faintly seen, but cannot be further characterized without IV contrast. Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Known numerous CCM lesions with history of 3 craniotomies for lesion resection: headaches and seizures. There a postoperative findings related to left parietal craniotomy for resection of a left parietal cavernous malformation with unchanged diffuse susceptibility effect along the surgical cavity margins and confluent surrounding T2 hyperintensity. There are also unchanged posteroparietal findings in the left posterior fossa. There are numerous remaining supratentorial and infratentorial cavernous malformations, which are unchanged. For example, the largest remaining supratentorial lesion is located in the left anterior frontal lobe, which measures up to approximately 20 mm, and the largest infratentorial lesion is in the right cerebellar hemisphere, which measures up to 8 mm. There is no evidence of acute intracranial hemorrhage or 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 unchanged.", "output": "No significant interval change in the postoperative findings and numerous remaining cerebral cavernous malformations."}
{"instruction": "Generate impression based on findings.", "input": "Sustained an injury six weeks ago. Persistent pain in left shoulder. Rule out labral tear of the left shoulder. ROTATOR CUFF: There is perhaps minimal undersurface tearing of the supraspinatus tendon, but otherwise the tendon and muscle appear normal. The infraspinatus tendon and muscle appear normal. The teres minor muscle and tendon appear normal. The subscapularis tendon is intact. There is a small amount of contrast infiltrating the subscapularis muscle, likely iatrogenic.SUPRASPINATUS OUTLET: Tiny acromioclavicular joint osteophytes suggest minimal osteoarthritis. I see no frank impression upon the superior fibers of the supraspinatus.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. Articular cartilage of the glenohumeral joint appears normal. There is detachment of the superior labrum and anterosuperior labrum from the underlying glenoid from approximately the 11:00 position to the 3:00 position. While it is possible that this could represent an unusually prominent sublabral sulcus combined with a normal variant sublabral foramen, I suspect that it represents a true labral tear. The inferior labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL", "output": "Detachment of the superior and anterosuperior labrum from the underlying glenoid as described above. While it is possible that this could represent an unusually prominent sublabral sulcus coupled with a normal variant sublabral foramen, I suspect that it represents a true labral tear."}
{"instruction": "Generate impression based on findings.", "input": "Right side meningioma: surveillance. There is an unchanged enhancing dural-based lesion overlying the right peri-rolandic region, measuring approximately 6 mm in thickness, without significant mass effect upon the brain. There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged minimal scattered foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is right aphakia. There is mild scattered paranasal sinus mucosal thickening.", "output": "1. No significant interval change in a the small extra-axial dural based enhancing lesion overlying the right peri-rolandic region, which may represent a meningioma. 2. Minimal probable chronic small vessel ischemic disease, without evidence of acute infarction. "}
{"instruction": "Generate impression based on findings.", "input": " The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.Mild degenerative changes are seen including disc bulges and uncovertebral hypertrophy at the C5-C6 and C6-C7 levels. There is mild effacement of the thecal sac at the C5-C6 and C6-C7 levels without significant spinal canal stenosis overall. There is mild to moderate bilateral C5-C6 neural foraminal stenosis and mild bilateral C6-C7 neural foraminal narrowing. Remainder of the cervical spinal canal and neural foramina are patent.THORACIC SPINE", "output": "1. There is no mass or abnormal enhancement within the cervical, thoracic, or lumbar spine to suggest leukemia involvement.2. Mild degenerative changes are seen in the spine as described above without significant spinal canal stenosis at any level. There is mild to moderate bilateral neural foraminal stenosis at the C5-C6 level. No significant neural foraminal stenosis in the thoracic or lumbar spine. Please see additional details above.3. Small bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "72 year old woman with history of coronary artery disease who presents with chest pain and shortness of breath. Patient presents for cardiac MRI to evaluate for myocardial ischemia.MEDICATIONS: carvedilol, furosemide, lisinopril, simvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 43 %, the LV end diastolic volume index is 96 ml/m2 (normal range: 65+/-11), the LVEDV is 210 ml (normal range 109+/-23), the LV end systolic volume index is 54 ml/m2 (normal range 18+/-5), the LVESV is 118 ml (normal range 31+/-10), the LV mass index is 63 g/m2, and the LV mass is 139 g. There is global mild hypokinesis.No intracardiac thrombus.Left AtriumThe left atrium is moderately to severely dilated in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 195 ml (normal range 110+/-24), the RV end systolic volume index is 52 ml/m2 (normal range 22+/-8), and the RVESV is 114 ml (normal range 35+/-13). 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 pericardial effusion.", "output": "1. No perfusion defects/ \"ischemia\" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is mildly dilated with reduced systolic function (LVEF 43%).4. The right ventricle is normal in size with mildly reduced systolic function. (RVEF 42%).5. Left atrial enlargement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with left lumbar radicular pain, left leg pain, and low back pain; history L4/5 disc herniation The signal intensity in the alignment the vertebral column remains unremarkable. Moderate degenerative disk disease at L4/5 and L5/S1 levels are again noted. The conus terminates at an appropriate level and is normal in signal as well as morphology. The visualized paraspinal contents are unremarkable.T12/L1 through L3/4: Redemonstrated are minimal to mild degenerative changes and no central spinal stenosis or neural foramina compromise. L4/L5: There is a new left paracentral disc protrusion which effaces the left lateral recess and causes a moderate degree of central stenosis. Previously demonstrated mild degenerative disk disease and hypertrophic changes of posterior elements are again noted without significant neural foramina compromise.L5/S1: Redemonstrated is degenerative disk disease with disk bulge and loss of disk height and signal intensity.There is no central spinal stenosis or neural foramina compromise. A previously suspected small herniated disk in the left paramedian location not evident on the current exam.", "output": "L4/L5: There is a new left paracentral disc protrusion which effaces the left lateral recess and causes a moderate degree of central stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Prostate malignancy PELVIS:PROSTATE:Suboptimal assessment due to patient motion artifact and extensive T1 hyperintense signal throughout peripheral zones, consistent with hemorrhage.Prostate Size: 4.6 cm in transverse dimension x 4 cm in craniocaudal dimension x 4.8 cm in AP dimension.Peripheral Zone: Globular right-sided mid peripheral zone posterolaterally located T2 hypointense lesion measuring 8 x 6 mm on image 38 series 701, focus abuts prostatic capsule without definite extracapsular extension. Possible mild corresponding decreased ADC signal suggested. Mild adjacent as well as contralateral peripheral zone linear scarring seen as evidenced by focal sites of curvilinear T2 hypointense signal. Additional apical right-sided paramedian 9 x 6 mm focus demonstrating similar signal characteristics seen on image 12 series 501.Central Gland: Moderate degree BPH visualized. Seminal Vesicles: Unremarkable, symmetric in appearance.Extracapsular Extension: Right-sided mid peripheral zone lesion alluded to above abuts prostatic capsule without definite extracapsular extension.BLADDER: Extrinsic impression by prostate gland.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Small left-sided fat-containing inguinal hernia.OTHER: Extensive T1 hyperintense signal seen throughout peripheral zones, consistent with hemorrhage. Colon diverticulosis.", "output": "1. Suboptimal assessment due to patient motion artifact and extensive T1 hyperintense signal throughout peripheral zones, consistent with hemorrhage.2. Indeterminate 8 mm right-sided mid peripheral zone focus with low T2 signal seen, corresponding decreased ADC signal not as well visualized (may be technical). Additional apical right-sided paramedian 9 x 6 mm focus demonstrating similar signal characteristics also seen."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Lindsey is a 24 year old female with personal history of right breast lumpectomy and sentinel lymph node biopsy in 2014 for IDC treated with neoadjuvant chemotherapy and radiation. She has no current breast related complaints. There is extreme amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Expected postsurgical changes are identified in the right central breast and right axillary region, compatible with provided history of right breast lumpectomy with sentinel lymph node biopsy. No abnormal enhancement is seen in either breast. There is an area of increased T2 signal in the right anterior lung, which corresponds to the known area of maturing radiation reaction better characterized on recent CT from September 2015. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "Expected postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "16-year-old female with chest heaviness, new reduced EF Clinical TTE. Evaluate for signs of myocarditis. Left VentricleFrequent ectopy limits quantification of ejection fraction. Wall motion is suggestive of frequent premature ventricular contractions during the entire examination. The left ventricle is visually normal in size. The LV systolic function is globally, mildly reduced. The overall LV ejection fraction is approximately 42%.On the short-axis view, there is minimal high signal intensity of the mid myocardium at the mid chamber of the inferior wall compatible with enhancement. This is a focal, limited to the inferior wall. No other enhancement is identified, specifically no enhancement is identified at the interventricular septum.No intracardiac thrombus is present.Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is mildly dilated. The RV systolic function is moderately reduced. The overall RV ejection fraction is 35%.Right AtriumThe right atrium is mildly dilated.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. PericardiumNo significant pericardial effusion, pericardial enhancement or thickening.", "output": "There is a linear mid myocardial high signal at the inferior wall at the mid chamber of the left ventricle. This is compatible with limited gadolinium enhancement. There is global, mildly reduced systolic function with an approximate left ventricular ejection fraction of 42%. Preventricular contractions are noted throughout the entire examination. The wall motion abnormality is disproportionate to the extent of enhancement.The right ventricle and atrium appear mildly dilated; no associated enhancement of the right ventricle is noted. The constellation of imaging findings, along with negative serology at the time of imaging, raises a question of a remote or subacute myocarditis with possible remodeling of the right ventricle. The ventricular ectopy may be related to prior inflammation.Dedicated imaging does not suggest pericardial inflammation at this time. The results were discussed with Dr. Arredondo."}
{"instruction": "Generate impression based on findings.", "input": " Examination is again limited by lack of intravenous contrast. Redemonstrated is diffuse destruction and replacement of the L1-2 disc space, destruction of the adjacent endplates, and significant collapse of the L1 greater than L2 vertebral bodies. There is no significant change in residual abnormal T2/STIR hyperintensity involving the bone marrow and intervertebral disc. The degree of moderate retropulsion appears similar at the L1 level with unchanged moderate spinal canal stenosis and bilateral L1-L2 foraminal stenosis. No other worrisome marrow signal is appreciated. Again seen are areas of T1 and T2 hypointensity involving the right greater than left psoas musculature which are again seen and not significantly changed compared to 4/1/2015; these correspond to sites of previously seen abscesses and may represent areas of cavitation/necrosis. No discrete fluid collections to suggest abscess. More extensive diffuse STIR hyperintensity in the iliopsoas and paraspinous musculature similar to prior and compatible with combination of atrophy and edema. The lumbar spine is otherwise in stable alignment. The vertebral body and disc heights are otherwise unchanged. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. The previously described degenerative changes appear similar. Again noted is prominence of the epidural fat including focal epidural fat along the right lateral aspect of the thecal sac at the L3-4 level. Partially imaged are bilateral renal atrophy with innumerable microcysts. There is clumped appearance of the cauda equina nerve roots suggestive of arachnoiditis and present previously.", "output": "1. Lack of contrast again limits evaluation. Compared to 6/3/2015 and 5/6/2015, there is no significant change in residual signal abnormalities related to L1-L2 discitis-osteomyelitis. Please note imaging findings often lag behind clinical response and do not necessarily imply residual discitis-osteomyelitis. No worsening marrow or disc signal abnormalities to suggest progression of infection. 2. No significant change in compression fractures of the L1 greater than L2 vertebral bodies. No significant change in osseous retropulsion at L1 with associated moderate spinal canal stenosis as well as moderate to severe bilateral L1-L2 neural foraminal stenosis. 3. Extensive signal abnormality involving the iliopsoas and paraspinous musculature as described above compatible with combination of atrophy and edema. No convincing evidence of residual abscess. No new fluid collections."}
{"instruction": "Generate impression based on findings.", "input": "Male, 60 years old. Evaluate for ligament injury or quadraceps/sartorious tendon or distal muscle belly tear. History of knee pain and swelling. MENISCI: There is mild fraying of the free margin of the posterior horn of the medial meniscus, otherwise the medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is surface fraying of the medial facet of the patella. There is thinning of the articular cartilage of the lateral femoral condyle and full-thickness fraying of the articular cartilage of the medial femoral condyle. No bone marrow edema or evidence of fracture. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is near full-thickness tear of the quadriceps tendon which is detached at the patella with only the deep layer remaining intact. There is retraction of the tendon measuring approximately 2 to 3 cm. There is moderate to severe tendinosis of the quadriceps tendon. The patellar tendon is intact.ADDITIONAL", "output": "1. Near full-thickness tear of the quadriceps tendon with retraction.2. No evidence of fracture.3. No significant ligamentous or meniscal injury."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female. Status post OATS procedure to the MFC. Continued pain medially. MENISCI: Globular signal abnormality in the posterior horn of the medial meniscus consistent with intrasubstance degeneration, similar to prior study. No discrete tear is evident. The lateral meniscus is normal in signal intensity and morphology.ARTICULAR CARTILAGE AND BONE: Again seen are two adjacent osteochondral transplant grafts, each approximately 2 cm in diameter, in the medial femoral condyle. The marrow edema type signal in the more posterior graft has nearly completely resolved while the marrow edema type signal in the anterior graft is not significantly changed. The overlying articular cartilage is normal in signal and is flush with the native articular cartilage surface. The alignment of these grafts is unchanged with approximately 3.5 mm cortical concave stepoff between the two grafts.Marked thinning of the patellofemoral cartilage, most pronounced at the medial patellar facet, without underlying marrow edema, not significantly changed. New small area of deep fissuring of the lateral femoral trochlear articular cartilage. Mild diffuse thinning of the lateral femoral condyle articular cartilage, similar to prior study. Small tricompartmental osteophytes. LIGAMENTS: ACL, PCL, MCL, and LCL are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL", "output": "Medial femoral condyle osteochondral transplant grafts with near complete resolution of edema in the more posterior graft and similar amount of edema in the anterior graft. Unchanged alignment of these grafts with intact overlying cartilage. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: 3T; chronic right middle cerebral artery occlusion with no evidence of ischemic symptoms, carotid aneurysm, annual surveillance for stability History: near syncope and muscle tightening in past, migraines. Brain MRI:Again noted are minimal and scattered T2/FLAIR hyperintense foci in the left frontal white matter that are nonspecific, unchanged as compared to prior exam. There is no mass effect or midline shift. There is no intracranial hemorrhage. There is no abnormal brain diffusion restriction. The dural venous sinuses are patent. The visualized paranasal sinuses are clear.Cranial MR Angiography:Again noted is fusiform dilatation and tortuosity of the supraclinoid/intradural segment of the right internal carotid artery, with a maximum diameter of 8 mm, extending into and mildly involving the right A1 segment and proximal portion of the right A2. There is infundibulum along the origin of lenticulostriate artery trunks at the distal right internal carotid artery and the proximal right anterior cerebral artery A1 segment which collateralize to reconstitute the right middle cerebral artery. There is enlargement of the right recurrent artery of Heubner which supplies right sided lenticulostriate arteries to the right basal ganglia and also collateralizes to the right middle cerebral artery through these lenticulostriate arteries. The tortuous fusiform dilatation results in mild mass effect on the right uncus is unchanged. An anterior communicating artery is present. There are dilated pial vessels along the watershed zone between the right anterior middle cerebral arteries suggesting leptomeningeal collateral reconstitution of the right middle cerebral artery.There is a developmental venous anomaly present along the right thalamus.The left internal carotid artery is preserved in caliber and flow-related signal. The left anterior and middle cerebral arteries are preserved as well. The basilar artery is codominantly supplied by the vertebral arteries. The right posterior communicating artery is medium-sized. The left posterior communicating artery is very small. Anterior communicating artery is medium-sized. There is triplication of the anterior cerebral artery. The vertebral arteries are similar in size.", "output": "1.Fusiform aneurysmal dilatation of the distal ophthalmic and communicating segment of the right internal carotid artery with extension into the right A1 and proximal right A2 segment are stable compared with the prior exam.2.There is a redemonstration of occlusion of the right middle cerebral artery at its origin with collateral reconstitution through lenticulostriate arteries as well as well as leptomeningeal collaterals. This gives a unilateral moyamoya like picture.3.Several punctate left frontal T2/FLAIR periventricular and subcortical white matter lesions are nonspecific and unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Male, 71 years old, with altered mental status. Assess for stroke. A 4 mm focus of mildly restricted diffusion is seen within the white matter adjacent to the left ventricular atrium. A similar lesion was seen on the prior examination at 6/18/2015 but is now reduced in signal intensity. No other definite diffusion restricting lesions are seen.Motion artifact substantially degrades image quality on most of the other sequences. Mild patchy foci of T2 hyperintensity are evident within the cerebral white matter and the pons. Scattered foci of susceptibility are also evident, the largest of which are within the inferior aspect of the right postcentral gyrus, stable, and along the right basal ganglia, possibly new.Postcontrast images are degraded, but no definite pathologic intracranial enhancement is seen.Thin bilateral subdural collections are evident along the cerebral hemispheres demonstrating T2 hyperintense and T1 isointense signal. These collections are symmetric bilaterally and measure no more than 3 mm in thickness. They exert no significant mass effect upon the brain.The ventricles and sulci are stable in caliber relative to the prior exam.", "output": "1.Small evolving late subacute small vessel stroke within the left periatrial white matter.2.Evidence of chronic small vessel ischemic disease and scattered microhemorrhage.3.Interval development of small symmetric bilateral subdural collections which could represent very small subdural hemorrhages or nonhemorrhagic effusions. These exert no significant mass effect upon the brain. Imaging follow-up is suggested to document resolution."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with history of testicular cancer. Evaluate for metastatic disease. Due to a technical malfunction, the precontrast T1 and majority of postcontrast images of the abdomen were reviewed on a separate imaging viewing system.ABDOMEN:LIVER, BILIARY TRACT: No hepatic lesions. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate T2 hyperintensities are too small to characterize. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:Due to a technical malfunction, only the three-minute postcontrast series of the pelvis was available on PACS.PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No evidence for abdominopelvic metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Known CCM lesions, yearly follow up,. There is an unchanged punctate focus of susceptibility effect in the right pons. There is no evidence of acute intracranial hemorrhage or acute cerebral infarct. There is no abnormal intracranial enhancement. 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": "Unchanged punctate right pontine lesion that is compatible with a cavernous malformation."}
{"instruction": "Generate impression based on findings.", "input": "28 year old male with a history of non-ischemic cardiomyopathy s/p heart transplant in 4/2016, hypertension, history of pericarditis now with chest pain. Referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 59 ml/m2 (normal range: 74+/-15), the LVEDV is 140 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 28 g/m2 (normal range 85+/-15), and the LV mass is 66 g (normal range 164+/-36). There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation times are normal (1000-1050 ms). The ECV fraction is also within normal limits. The global relative enhancement ratio is mildly elevated (4.8).Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 134 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.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 evidence of pericardial late gadolinium enhancement suggesting pericardial inflammation or fibrosis. There is no CMR evidence of constriction based on myocardial tagging and absence of interventricular septal variation with respiration. Extracardiac FindingsThere are sternotomy wires present consistent with previous surgery. 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. The left ventricle is normal in size and systolic function (LVEF 55%) without any late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size and normal in systolic function (RVEF 50%).3. There is evidence of pericardial late gadolinium enhancement suggesting pericardial inflammation or fibrosis. No evidence of pericardial constriction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "57 years, Female, with history of multiple sclerosis. Off treatment for over one year. Several T2/FLAIR hyperintense lesions are seen in the periventricular and deep white matter, many are ovoid and perpendicular to the corpus callosum, similar in distribution and size compared to prior study, and compatible with known demyelinating disease. No new lesion is appreciated, with mild motion degradation and slight differences in technique slightly limiting comparison of small lesions. There is mild to moderate burden of T1 hypointense foci, unchanged. Mild parenchymal volume loss similar to prior. No abnormal enhancement.", "output": "Compared to 10/12/2009, there is no evidence of progression of demyelinating disease."}
{"instruction": "Generate impression based on findings.", "input": "Known mycosis fungoides and CNS involvement. Brain: There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. There is no evidence of acute infarct. There is persistent diffuse enhancement of the cisternal segments of the bilateral trigeminal nerves and oculomotor nerves, left more than right. There also appears mild diffuse enhancement involving the bilateral facial nerves. There are persistent mild nonspecific patchy areas of high T2 signal in the cerebral white matter bilaterally. The rest of the brain parenchyma appears to be unremarkable. 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.Orbits: There is persistent mild high T2 signal and hyperenhancement of the left inferior, medial, and superior oblique muscles. The high T2 signal in the right inferior recuts muscle appears to have resolved. The bilateral globes, lacrimal glands, and optic nerves are otherwise unremarkable.", "output": "1. Persistent enhancement of multiple cranial nerves related to lymphoma.2. Residual mild denervation edema in the extraocular muscles supplied by the left oculomotor nerve."}
{"instruction": "Generate impression based on findings.", "input": "Elevated alkaline phosphatase. Evaluate bile ducts,? PTLD. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion is identified. Mild extrahepatic biliary ductal dilatation. The common duct measures up to 10 mm. However it tapers smoothly and is well seen to the level of the ampulla. No evidence of choledocholithiasis or pancreatic head mass.SPLEEN: Spleen measures upper limits of normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Kidneys are atrophic and demonstrate bilateral simple cysts. Few complex left renal cysts. No hydronephrosis or hydroureter. Right iliac fossa renal transplant is partially imaged and incompletely evaluated.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy is identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right lower quadrant renal transplant", "output": "1.No specific evidence of post transplant lymphoproliferative disorder.2.Mild dilation of common bile duct. No evidence of pancreatic head mass or choledocholithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Male, 57 years old, with atypical facial pain, pre-DBS evaluation. No evidence of parenchymal edema or mass effect is seen. A 5 mm thick plaque-like area of dural enhancement along the left aspect of the interhemispheric falx at the paracentral lobule may represent a meningioma. No pathologic parenchymal enhancement is seen. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Ventricular size and morphology are within normal limits.", "output": "No significant parenchymal abnormalities are detected. A small area of dural thickening along the interhemispheric falx may represent an incidental meningioma."}
{"instruction": "Generate impression based on findings.", "input": "Female, 28 years old. Reason: eval for stress fracture femoral neck History: hip pain for 6 weeks while training for a marathon. Localized to groin and joint. There is abnormal signal on T2 sequences along the medial aspect of the left distal femoral neck/proximal diaphysis adjacent to the lesser trochanter. There is minimally decreased signal locally on T1 sequences. No discrete fracture line is seen. Findings are consistent with a stress reaction.The remainder of the bone marrow appears normal. The musculature is unremarkable.", "output": "Findings compatible with a stress reaction along the left distal femoral neck/proximal diaphysis. No discrete fracture line is seen."}
{"instruction": "Generate impression based on findings.", "input": "Foot swelling MRI of the forefoot and midfoot was performed although the most proximal aspect of the cuboid and navicular are not included in the coverage.Within the limits of the provided field of view, there are no findings to suggest the presence of abscess. There are also no marrow abnormalities to confirm osteomyelitis. Muscles and tendons are unremarkable. There is mild osteoarthritis of the midfoot and moderate to severe osteoarthritis of the first MTP joint. A small focus of signal void is noted medial to the head of the first metatarsal which may represent susceptibility artifact from prior intervention.", "output": "Osteoarthritis without evidence of abscess or osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: hx of prostate cancer, scheduled for prostatectomy, evaluate further to guide nerve sparing and for extraprostatic disease History: see aboveBiopsy 3/22/2016: Right base Gleason 6, right mid Gleason 6, right apex Gleason 7, left apex Gleason 7 PELVIS:PROSTATE:Prostate Size: 4.4 x 2.8 x 3.4 cmPeripheral Zone: There is ill-defined low T2 signal in the left mid and apex peripheral zone (801/10) without early enhancement, suspicious for prostate adenocarcinoma. In the left apex, this lesion measures approximately 2.0 x 1.2 cm and has an ill-defined capsule with enhancing spiculations (801/11), suggestive of extracapsular extension.Central Gland: BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The left apical lesion lies immediately adjacent to the capsule which is ill-defined with enhancing spiculations, suggestive 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.Ill-defined region of low T2 signal in the left mid and apex peripheral zone is suspicious for prostatic adenocarcinoma with findings suggestive of extracapsular extension.2.No pelvic lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: L1 bone and sacrum biopsy History: pt with bil. lower extremity pain Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. There is anterior fusion of T12 on L1.", "output": "L1 vertebral bone biopsy under CT guidance. A total of seven samples were delivered to pathology for analysis. One sample for flow cytometry and six for surgical pathology."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with history of AML status post embolization. Limited exam; only wide field of view survey images obtained.Multiple bilateral renal lesions are incompletely evaluated. Gravid uterus.", "output": "Limited exam as above. Bilateral renal lesions are incompletely evaluated. Recommend patient returns to complete exam when clinically appropriate."}
{"instruction": "Generate impression based on findings.", "input": "18 year-old male with rupture of previous left knee ACL reconstruction. Evaluate tunnel position.IMAGE ACQUISITIONS: CT of the left knee; IV administration of 80 cc of iodinated contrast at 2 cc/sec. Transverse, coronal, sagittal re-formations provided. Patient is status post ACL reconstruction, although the graft appears disrupted as seen on recent MRI study. The tibial tunnel begins at the intercondylar eminence between the medial and lateral tibial spines and courses anteriorly and medially through the proximal tibia, breaching the anteromedial cortex. The slope of the tunnel is greater than that of Blumenstadt's line.The femoral tunnel originates near the junction of the physeal scar and posterior femoral cortex and courses superomedially, where it intersects with two tunnels created by crossed pins.Please note that the ACL itself is not well seen on this CT study nor are the menisci. The PCL is seen on the sagittal reformatted images. A small joint effusion is noted. The remaining visualized bone and soft tissue structures are within normal limits.", "output": "Postoperative changes as described above."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with history of HCV cirrhosis and liver lesions who presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology with the liver measuring 18-cm in length. There is no suspicious arterially enhancing and washing out lesion to suggest hepatocellular carcinoma. Subcentimeter foci of arterial enhancement scattered at the periphery of the liver, likely perfusional abnormality.SPLEEN: Spleen measures 11 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral subcentimeter 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": "Cirrhosis without evidence of suspicious arterially enhancing and washing out lesion."}
{"instruction": "Generate impression based on findings.", "input": "Low back pain radiating to the left leg. There is a disc desiccation and bulge at L4-L5 with superimposed disc extrusion that extends into the left lateral recess with impingement upon the descending left L5 nerve roots. There is no significant neural foramen stenosis. There are trace effusions in the L5-L5 facet joints bilaterally with an associated subcentimeter posterior right synovial cyst. There is mild loss of the usual lumbar lordosis. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.", "output": "Disc desiccation and bulge at L4-L5 with superimposed disc extrusion that extends into the left lateral recess with impingement upon the descending left L5 nerve roots."}
{"instruction": "Generate impression based on findings.", "input": " Again seen are postsurgical changes of a right frontal craniotomy with resection of a right middle frontal gyrus lesion. At the superior margin of the resection cavity, there is again a non-specific enhancing nodule which measures approximately 5 mm in greatest dimension. This has not significantly changed since the prior examinations dating back to 7/5/2016. There are foci of susceptibility artifact again seen within the surgical bed, likely related to hemosiderin deposition. A heterogeneous ring-enhancing lesion is again seen extending into the trigone of the right lateral ventricle, which measures 21 x 15 mm (series 1100, image 90) compared to 21 x 16 mm previously. Portions of the wall of the lesion again demonstrate restricted diffusion and enhancement, similar to the previous examination. Stable FLAIR signal abnormality surrounding the lesion is consistent with vasogenic edema. No new enhancing lesions are identified.Scattered foci of signal hyperintensity on FLAIR and T2-weighted images in the periventricular and subcortical white matter likely reflect chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.", "output": "1.A right periventricular white matter lesion appears stable compared to the prior exam on 11/24/2016. No new enhancing lesions are identified.2.Stable appearance of the right middle frontal gyrus resection cavity."}
{"instruction": "Generate impression based on findings.", "input": "History of elective carotid stenting on 11/2/15 for an incidental 2.3 cm right-sided carotid aneurysm. The stent was deployed in the appropriate location, but the superior portion of the stent retracted into the aneurysmal sac and was unable to be re-wired. The patient complained of a headache and nausea the following morning which prompted a CT head which demonstrated a new region of hypodensity in the lateral right precentral gyrus. There are multiple foci of restricted diffusion and corresponding T2 hyperintensity involving the grey-white matter junctions in the right cerebral hemisphere. The largest area is in the right frontal opercular region and measures up to approximately 20 mm. There is a partially-imaged stented pseudoaneurysm that measures up to 25 mm in width. In particular, the superior end of the stent lies within the pseudoaneurysm sac, rather than within the parent vessel, which appears to be compressed by the pseudoaneurysm. There is no evidence of intracranial hemorrhage or mass. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is high T2 signal and enhancement surrounding the root of a left mesiodens.", "output": "1. Multiple acute to early subacute right cerebral hemisphere infarcts essentially scattered throughout the middle cerebral artery territory, which may represent an embolic stroke related to the recent endovascular stenting of the right cervical internal carotid artery pseudoaneurysm. 2. The cervical right internal carotid pseudoaneurysm has not decreased in size and the superior end of the stent lies within the pseudoaneurysm sac, rather than within the parent vessel. Dedicated vascular imaging may be useful for further evaluation.2. Possible inflammatory changes associated with a left mesiodens."}
{"instruction": "Generate impression based on findings.", "input": " There is a subcentimeter T2 hyperintense enhancing focus within the dorsal columns of the cervical cord at the level of the C3 vertebral body, without appreciable expansion of the spinal cord. At C3-4, there is a posterior disc-osteophyte complex that slightly effaces the anterior thecal sac CSF. At C4-5, there is a disc-osteophyte complex with an eccentric left disc protrusion that indents the anterior aspect of the spinal cord. At C5-6, there is a disc-osteophyte complex that mildly indents the spinal cord. There is no significant neural foraminal stenosis in the cervical spine. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. The cerebellar tonsils extend up to 2 mm inferior to the foramen magnum.THORACIC SPINE", "output": "1. A subcentimeter enhancing lesion within the cervical spinal cord at the level of C3 may represent active demyelinating disease, an infectious myelitis, or autoimmune process, or vasculitis, for example. A brain MRI with contrast may be useful for further evaluation of disease extent if clinically warranted.2. Multilevel posterior disc-osteophyte complexes within the cervical spine, with impingement upon the spinal cord at C4-5. 3. The thoracic spine is unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "Patient is a 53-year-old man with end-stage hepatitis B liver cirrhosis and portal hypertension who presented with altered mental status, acute respiratory and renal failure and hypotension now with multiorgan failure status post intubation with unclear neurological prognosis. Please evaluate for ischemia, cerebral edema, and encephalopathic changes. There is no evidence of intracranial hemorrhage, mass or edema. There are no CT findings of stroke, however if stroke is of clinical concern recommend MRI.The ventricles and basal cisterns are normal in size and configuration. There are no CT findings of cerebral edema.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Normal brain CT."}
{"instruction": "Generate impression based on findings.", "input": "Pain status post fall. Evaluate for fracture. Right hip: The bones appear demineralized, suggesting osteopenia/osteoporosis. Mild osteoarthritis affects the right hip. I see no fracture.Left hip: The bones appear demineralized, suggesting osteopenia/osteoporosis. Mild osteoarthritis affects the hip. I see no fracture line. A faint triangular-shaped density is noted within the soft tissues projecting lateral to the ischium. I see no donor site, and this may be chronic in etiology. However, if the patient complains of pain along her left ischial tuberosity, then CT or MRI may be considered to assess for a hamstring avulsion fracture.", "output": "No fracture line is evident. A faint triangular-shaped density within the soft tissues projecting lateral to the ischium may be chronic in etiology; however, if the patient complains of pain along her ischial tuberosity, then CT or MRI may be considered to assess for hamstring avulsion fracture."}
{"instruction": "Generate impression based on findings.", "input": "Knee pain MENISCI: There is deformity of the posterior horn of the medial meniscus likely relating to an overlying osteochondral lesion however there is no discrete tear identified. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: An osteochondral lesion is seen involving the medial femoral condyle measuring 1.6 cm in both the AP and transverse dimensions. There is loss of the overlying articular cartilage with increased marrow signal within the femur suggesting some component of instability. The lateral compartment is normal. There is mild irregularity of the articular cartilage of the medial patellar facet without full-thickness defect. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Osteochondral defect within the medial femoral condyle measuring approximately 1.6 cm. There is slightly increased marrow signal surrounding the lesion which may suggest a component of instability however there is no fluid signal undercutting the lesion and no evidence of detachment."}
{"instruction": "Generate impression based on findings.", "input": "Left shoulder pain The examination is limited by motion and by the patient's body habitus.ROTATOR CUFF: There is increased signal of the supraspinatus tendon particularly near its insertion on the greater tuberosity. This likely reflects tendinopathy with interstitial or partial thickness tearing although no discrete full-thickness tear of the rotator cuff is identified. There is a similar appearance of the infraspinatus tendon although again no discrete full-thickness tear is appreciated. There is tendinopathy of the supraspinatus tendon without evidence of full-thickness tear. There is no significant muscle atrophy.SUPRASPINATUS OUTLET: Mild hypertrophic changes of the acromioclavicular joint noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is increased signal of the anterior inferior labrum suggesting tearing but no full-thickness detachment is appreciated. There is loss of the articular cartilage of the glenohumeral joint and subchondral cystic changes noted at the insertion of the rotator cuff on the greater tuberosity.BICEPS TENDON: Mild amount of fluid is seen surrounding the biceps tendon which is otherwise intact. ADDITIONAL", "output": "Limited examination secondary to motion artifact and the patient's body habitus. There is suspected high-grade partial-thickness articular surface tearing of the supraspinatus superimposed upon severe tendinopathy. Similar tendinopathic changes of the infraspinatus are also noted without evidence of discrete full-thickness tear. Additional findings are described above."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate intracranial hemorrhage. Signs and symptoms: Headache with seizure. CT of brain without infusion:No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Vertical sulci, ventricular system and all CSF cisterns remain within normal. There are subtle foci of low-attenuation in the subcortical white matter of both cerebral hemispheres. These findings are suspect that for small vessel disease of indeterminate age. These findings were noted on prior MRI examination from 3 -- 16 -- 2009. In comparison with prior CT examination from 11 -- 5 -- 2009 no definitive appreciable interval change is detected.Calvarium, limited view of paranasal sinuses and mastoid air cells are also unremarkable.", "output": "1.No evidence of hemorrhage as clinically is suspected.2.Findings consistent with small vessel disease of indeterminate age."}
{"instruction": "Generate impression based on findings.", "input": "History of numbness and pain in the lower extremity, history of metastatic prostate cancer with known spinal metastasis. Rule out cord compression. Motion degraded exam. No definite abnormal signal intensity within the cord to suggest acute cord compression. No definite compromise of the spinal cord. There are extensive metastatic bony lesions involving all vertebral body levels as seen on prior nuclear medicine bone scan. Posterior disc osteophyte complex at C6-C7 without compromise of the cord. Prominent dorsal epidural lipomatosis in the thoracic spine and lumbar spine levels.", "output": "Limited exam due to motion artifact. Within this limitation, no cord compression is identified. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Extensive osseous metastatic lesions throughout the spine.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral shoulder pain. Right hip pain. Right shoulder:Moderate to severe osteoarthritis with bulky osteophytes, sclerosis, and subchondral cysts.Left shoulder:Osteoarthritic changes appear mildly progressed with new chondrocalcinosis.Right hip:Moderate to pronounced osteoarthritic changes. The femoral head shape is preserved.", "output": "1. Moderate to severe bilateral shoulder osteoarthritis.2. Moderate to pronounced osteoarthritic changes of the right hip."}
{"instruction": "Generate impression based on findings.", "input": "Patient with history of parotitis and sialolithiasis status post endoscopic removal of stones. Now with right parotid cutaneous fistula and infection, recurrent abscess in the past 3 months. There has been interval removal of the right parotid duct calculi. However, there is now a tract that extends from the overlying skin to the and decreased inflammation involving the junction between the parotid gland and parotid duct. There is diffuse enhancement of the right parotid gland and overlying subcutaneous tissues, but this is less extensive than on the prior exam and there is no evidence of abscess or discrete tumor. There are mildly prominent right parotid lymph nodes, which are likely reactive. The left parotid gland and submandibular glands appear to be unremarkable. There is interval resolution of the fluid and mucosal thickening within the right maxillary sinus. There is a ovoid cystic lesion in the left auricle, which may represent an inclusion cyst. There is a partially-characterized left supraclinoid internal carotid artery aneurysm that measures up to approximately 15 mm.", "output": "1. Interval removal of the right parotid duct calculi with development of a parotid-cutaneous fistula. Diffuse enhancement of the right parotid gland and overlying subcutaneous tissues related to parotitis, albeit less extensive than on the prior exam and no evidence of abscess or discrete tumor.2. Partially-characterized left supraclinoid internal carotid artery aneurysm that measures up to approximately 15 mm."}
{"instruction": "Generate impression based on findings.", "input": "61 years Male (DOB:4/12/1954)Reason: Brain tumor History: SeizuresPROVIDER/ATTENDING NAME: CHRISTOPHER M GOMEZ CHRISTOPHER M GOMEZ The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a 23 x 14 mm axial dimension right parafalcine mass located adjacent to the right cingulate gyrus. There is a cortical venous structure and an ACA branch interposed between the mass and the falx suggesting this mass is intra-axial. There is associated dural and leptomeningeal enhancement. There is adjacent vasogenic edema. There is redemonstration of leptomeningeal enhancement along the right cingulate sulcus adjacent to this above described mass. It is significantly larger compared to the December 2012 exam when it measured approximately 8 mm.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There is a mass present involving the right cingulate gyrus associated with some leptomeningeal enhancement. This mass demonstrated significant growth since December suggesting it is an aggressive/higher grade lesion. Differential considerations include primary brain tumor, metastatic disease, lymphoma, granuloma and infection. Given the leptomeningeal reaction this brings to mind lesions with a tendency towards leptomeningeal reaction such as pleomorphic xanthoastrocytoma, granuloma and lymphoma."}
{"instruction": "Generate impression based on findings.", "input": "Left lateral thigh numbness, history of breast cancer. 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 heterogeneous without discrete lesions appreciated. No abnormal enhancement. The conus medullaris is normal in position.Minimal 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: Minimal disc bulge eccentric to the right. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge eccentric to the right. Minimal right neural foraminal narrowing. No spinal canal or left neural foraminal stenosis. There is mild facet arthropathy, worse on the left.L5-S1: Disc desiccation with mild loss of height. No spinal canal or neural foraminal stenosis. Mild left-sided facet arthropathy.Paraspinous soft tissues are within normal limits.", "output": "1. Minimal degenerative changes in the lumbar spine as described above without significant spinal canal or neural foraminal stenosis at any level.2. No evidence of metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with right knee pain, evaluate for medial meniscal tear MENISCI: There is an oblique undersurface tear of the posterior horn of the medial meniscus that extends into the body. There is no associated flip fragment or meniscal extrusion. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a small focus of full-thickness cartilage loss at the medial trochlea that is approximately 6 mm. The articular cartilage is otherwise unremarkable.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1. Oblique undersurface tear of the posterior horn of the medial meniscus with extension into the body.2. Small focus of full-thickness cartilage loss at the medial trochlea."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with a painful growing mass. 2 vitamin E capsules overlying the medial soft tissues of the right foot, presumably corresponding to the patient's palpable area of concern. Interposed between these 2 markers is a lobulated focus of fluid signal intensity along the medial aspect of the navicular bone, measuring 1.5 x 1.0 x 1.1 cm with minimal peripheral enhancement on postcontrast sequences consistent with a ganglion. No additional enhancing mass lesions are identified. There is mild fatty infiltration of the flexor hallucis longus. The peroneal tendons appear intact. The extensor tendons appear intact. The flexor tendons appear intact. The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact. The imaged components of the deltoid ligament appear intact. There is a small amount of fluid within the tibiotalar joint without evidence of a large effusion. There is a small amount of fluid within the subtalar joint.", "output": "1.5 cm mass within the soft tissues along the medial aspect of the navicular bone most consistent with a ganglion. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: concern for cerebral venous thrombosis History: see MRI brain order - blurry vision, headache, D-dimer elevated and OCP use MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening along the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Low marrow signal in the visualized osseous structures is non-specific but probably at least in part related to the patient's younger age.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left transverse sinus, sigmoid sinus and jugular vein are larger than their right sided counterparts; this is a a normal variation.", "output": "1.No abnormal lesions are appreciated intracranially.2.MR venogram of the brain is within normal limits."}
{"instruction": "Generate impression based on findings.", "input": "Right leg weakness for months. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse patchy cerebral white matter T2 hyperintensity and a more focal areas of T2 hyperintensity in the right basal ganglia and pons. There are multiple scattered foci of supratentorial and infratentorial susceptibility effect. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is partially imaged multilevel degenerative spondylosis of the cervical spine.", "output": "Findings suggestive of chronic small vessel ischemic disease, scattered chronic microhemorrhages, and chronic right lacunar infarcts in the right basal ganglia and pons, but no evidence of acute intracranial hemorrhage, mass, or acute infarct."}
{"instruction": "Generate impression based on findings.", "input": "64 years, Female, evaluate for frontal meningioma, status post resection and radiation and continues to have headaches that are worse than usual. Also a seizure history. Examination is severely limited. Postsurgical changes of bifrontal craniotomy and encephalomalacia involving the inferior frontal lobes, left greater than right, again seen and better appreciated previously. No evidence of acute infarct. There is no gross intracranial mass effect, midline shift, or herniation. No hydrocephalus. Note this examination is not adequate to assess for small tumor recurrence.There appears to be diffuse opacification of the right frontal sinus and right posterior ethmoid air cells, which has been present on multiple prior studies.", "output": "1. Severely limited exam due to patient's claustrophobia; please see comment in technique section. There is no large mass, intracranial mass effect, midline shift, or herniation. Note this examination is not adequate to assess for small tumor recurrence.2. There appears to be diffuse opacification of the right frontal sinus and right posterior ethmoid air cells, which has been present on multiple prior studies."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old male patient with increased right knee pain and swelling. Known OCD lesion at the medial femoral condyle. Assess for loose body. MENISCI: The medial meniscus and lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: Again seen is a large ovoid focus of subchondral marrow signal abnormality within the medial femoral condyle consistent with a known osteochondral defect. The lesion is low signal intensity on T1-weighted images and heterogeneous on T2 weighted images. Extensive subchondral cyst formation is noted within this region along with bone marrow edema surrounding the defect within the posterior medial femoral condyle. The defect is similar in size to the prior examination measuring approximately 3 cm in the transverse dimension and 2.4 cm in craniocaudal dimension. The underlying cartilage appears degenerated though no intervening T2 signal is identified to suggest instability. There is a new crescentic region of signal abnormality within the anteromedial aspect of the medial femoral condyle consistent with an osteochondral defect. This defect measures approximately 1.3 cm in the AP dimension, 1.2 cm in the transverse dimension, and has a depth of approximately 0.9 cm. The defect itself demonstrates increased T2 signal though there is no intervening T2 signal to suggest instability. The underlying cartilage is degenerated without full-thickness defect.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1. New osteochondral defect with the anterior aspect of the medial femoral condyle. Similar appearance of an existing osteochondral defect with the posterior medial femoral condyle.2. Large Baker's cyst. No definite loose body."}
{"instruction": "Generate impression based on findings.", "input": " Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: There is left central disc protrusion which indents the anterior cord surface without intrinsic cord signal abnormality and no resulting stenosis.C4/5: Mild disc bulge containing a posterior central annular tear without cord abutment and no resulting stenosis.C5/6: Left paracentral disc protrusion which causes slight anterior left hemicord flattening without intrinsic cord signal abnormality and no resulting stenosis.C6/7: Tiny left paramedian disc protrusion without cord abutment and no resulting stenosis.C7/T1: Unremarkable", "output": "1.C3/4: Left central disc protrusion which indents the anterior cord surface without intrinsic cord signal abnormality and no resulting stenosis.2.C4/5: Mild disc bulge containing a posterior central annular tear without cord abutment and no resulting stenosis.3.C5/6: Left paracentral disc protrusion which causes slight anterior left hemicord flattening without intrinsic cord signal abnormality and no resulting stenosis.4.C6/7: Tiny left paramedian disc protrusion without cord abutment and no resulting stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Status post endoscopic third ventriculocisternostomy for hydrocephalus due to aqueduct stenosis. Scoliosis and lipomyelomeningocele status post L4 and L5 osteoplastic laminoplasty, repair, and subtotal resection of intradural lipoma causing spinal cord tethering. Brain: There are postoperative findings related to endoscopic third ventriculostomy. There is no discernible CSF flow across the third ventriculostomy. There is no significant interval change in the marked dilatation of the lateral and third ventricles with mild mass effect upon the brainstem and cerebellum. There is no evidence of acute infarction, hemorrhage, or tumors. There is no midline shift. The major cerebral flow voids are grossly intact. The skull and scalp soft tissues are unchanged. There is persistent fluid within the bilateral middle ears and mastoid air cells.Spine: There is unchanged cervicothoracic scoliosis and postoperative findings related to lipomeningocele surgery in the lumbar spine. There is persistent fluid signal within the central spinal cord diffusely, which measures up to 2 mm in width. The conus medullaris terminates at the L3-4 level. There is an unchanged fatty signal intensity of the filum terminalis and fat within the spinal canal extending from L5 to S3. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a distended urinary bladder.", "output": "1. No significant interval change in the hydrocephalus associated with the aqueductal stenosis.2. No discernible CSF flow across the third ventriculostomy.3. Unchanged cervicothoracic scoliosis.4. The conus medullaris terminates at the L4 level and there is an unchanged fibrofatty filum terminalis and fat within the spinal canal that extends from L5 to S3. 5. Unchanged long-segment syrinx. "}
{"instruction": "Generate impression based on findings.", "input": "54-year-old woman with history of meningioma. Postsurgical changes of a subtotal resection of sellar and suprasellar meningioma are again seen. Again seen is an avidly enhancing lesion in the pituitary fossa which extends along the planum sphenoidale and posteriorly along the clivus into the interpeduncular and prepontine cisterns. This lesion also surrounds the supraclinoid internal carotid arteries, right greater than left. The optic chiasm is indistinguishable from and surrounded by this lesion. This lesion has not changed in size compared with most recent as well as MRI examination on 11/17/2014. There is no new mass effect on the adjacent brain. There are postsurgical changes of prior bifrontal craniotomy with encephalomalacia and increased subcortical T2/FLAIR signal in the bilateral anterior and inferior frontal lobes.Additional, scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter is nonspecific but compatible with small vessel ischemic disease. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage. The ventricles are within normal limits in size and configuration. The major flow-voids are preserved. There is mucosal thickening with atelectasis of the left maxillary sinus, stable from prior examinations and compatible with chronic sinusitis.", "output": "Stable appearance of the residual meningioma and posttreatment changes."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female patient with chronic diarrhea, perianal abscess fistula. Confirm diagnosis of Crohn's. ABDOMEN:LIVER, BILIARY TRACT: A subcentimeter T2 hyperintense focus within the right hepatic dome too small to characterize, but likely a cyst. No intra or extrahepatic biliary ductal dilatation.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: There are no areas of bowel wall thickening, restricted diffusion, or abnormal enhancement. The terminal ileum is normal in appearance. No small bowel obstruction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No intraabdominal abscess is identified.PELVIS:UTERUS, ADNEXA: A cystic lesion within the right ovary is likely physiologic in a premenopausal female. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially imaged and assessed are bilateral perianal fistulous tracts, right greater than left, with the right fistulous tract extending to the right gluteal cleft. The origin of the fistulae is difficult to ascertain, though they appear to originate at approximately the 6 to 7 o'clock position. No associated abscess is identified.OTHER: No intrapelvic abscess is identified.", "output": "1. Partially assessed bilateral perianal fistulae as described above. No associated abscess.2. Relatively normal appearing small and large bowel otherwise. "}
{"instruction": "Generate impression based on findings.", "input": "Male 73 years old Reason: Adrenal and kidney lesion - please evaluate History: Adrenal and kidney lesion - please evaluate ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland nodule is mildly T2 hyperintense shows enhancement does not have significant intra-Voxel fat. There are small foci of signal dropout on out of phase imaging but the majority of the lesion does not lose signal.KIDNEYS, URETERS: Small bilateral renal cysts. Some of the cysts in the kidney have internal complexity and several septations. No hydronephrosis.The previously measured left upper pole renal lesion currently measures 3.3 cm likely due to differences in technique. The lesion is hyperintense on T2-weighted imaging and shows some hairline internal enhancement and is compatible with a minimally complex cyst.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Left adrenal gland nodule may represent a lipid poor lipoma given its signal characteristics. It remains indeterminate but probably benign given its size stability for a year.2.Bilateral small renal cysts some of which have increased complexity with internal septations.3.The 3.3 cm left upper pole renal cyst has minimal internal complexity."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Benign neoplasm of meninges, unspecifiedClinical question: change in meningiomaSigns and Symptoms: multiple unrelated There is redemonstration of a calcified focus present along the falx cerebri on the right side it is low signal on all pulse sequences and has susceptibility effect associated with it.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Exam is mildly degraded due to patient motion which may obscure more subtle abnormalities.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some scattered opacities in the maxillary sinuses which were also present on the prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.A right parafalcine lesion is calcified. It could represent a branch out meningioma for example. It is unchanged since previous exams2.Exam is mildly degraded due to patient motion which may obscure more subtle abnormalities.3.Periventricular and subcortical white matter signal changes of a mild degree are present. Given the small number, it is suspected that these are of little clinical significance."}
{"instruction": "Generate impression based on findings.", "input": "Anterior knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: The lateral and medial compartments are unremarkable. A bipartite patella is noted. The articular cartilage which overlies the interface of the bipartite patella demonstrates a small focus of low signal intensity which may represent an area of degeneration. Immediately deep to this area is an 8 mm rounded focus of near fluid signal intensity which is situated within the joint between the bipartite patella and anterior aspect of the lateral femoral condyle. The etiology of this finding is uncertain but may represent a small ganglion. The remaining femoral cartilage of the femoral trochlea and remaining patella is otherwise normal.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Subcentimeter nodular focus of near fluid signal intensity within the joint immediately anterior to the lateral femoral condyle and subjacent to the patella is of uncertain clinical significance but may represent a ganglion arising from focally degenerated cartilage overlying a bipartite patella. Remaining MRI evaluation of the knee is otherwise normal."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with type 2 diabetes mellitus with unspecified complication. Right diabetic foot ulcer. Rule out osteomyelitis. TENDONS: The flexor and extensor tendons appear grossly intact. The peroneal tendons appear intact. The Achilles tendon appears intact.LIGAMENTS: The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is increased signal abnormality within the fifth metatarsal remnant on fluid sensitive sequences with decreased signal abnormality on T1-weighted sequences consistent with osteomyelitis. There is cortical distinctness along the lateral aspect of the base of the fifth metatarsal consistent with osteolysis. No focal fluid collection is identified, although evaluation for abscess formation is limited on this noncontrast examination. Note is made of postsurgical changes of prior transmetatarsal amputation.ADDITIONAL", "output": "Findings consistent with osteomyelitis of the base of the fifth metatarsal remnant as described above. No focal fluid collection to suggest abscess formation, within the limitations of a noncontrast examination. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval for tFCC tear History: wrist pain for a month with tennis; history of tfcc tear on left LIGAMENTS: No contrast is present in the mid carpal row, suggesting the scapholunate and lunate-triquetral ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC is in contact, no contrast is seen in the distal radioulnar joint.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL", "output": "Normal examination of the right wrist."}
{"instruction": "Generate impression based on findings.", "input": "Male, 41 years old, with anaplastic astrocytoma, follow-up exam. Again seen are sequelae of right frontal craniotomy and right frontal lobe surgery for tumor resection. Heterogeneous extradural and probable subdural collections along the craniotomy flap have not significantly changed from the prior examination. A thick rim of enhancement along the periphery of these collections, best seen on delayed postcontrast images, likely represents granulation and is not significantly changed.The right frontal lobe is severely encephalomalacic. The right frontal horn shows ex vacuo dilatation, more pronounced than on the prior exam. T2 hyperintensity and gyral thickening within the inferior right frontal gyri are not significantly changed when compared to the prior two examinations. T2 hyperintensity within the right middle and superior frontal gyri is slightly progressed from the exam of 11/10/2014, but similar to that seen on 7/12/2014. A small focus of white matter T2 hyperintensity along the posterior right lateral ventricle body is new.T2 hyperintensity and thickening of the genu of the corpus callosum, with some associated diffusion restriction appears similar to the prior exam of 11/10/2014, and improved when compared to 7/12/2014. T2 hyperintensity extending into the left periventricular white matter has progressed when compared to both prior exams.Single and multi voxel spectroscopy was performed on the areas of signal abnormality surrounding both the left and right frontal horns. No unequivocally suspicious choline elevation is seen, and most voxels show either benign or nonspecific metabolite patterns. rCBV mapping was also performed which shows low blood volume correlating to most of the periventricular T2 hyperintense regions. Some elevated blood volume is suspected within the far anterior left frontal lobe but this is of uncertain significance as the parenchyma in this region does not appear thickened or infiltrated.No evidence of pathologic parenchymal enhancement is seen. No new mass effect is detected. Apart from progressive ex vacuo dilatation of the right frontal horn, the ventricular system is not significantly changed.", "output": "1.Demonstration of extensive postoperative findings related to prior right frontal tumor resection.2.T2 hyperintensity within the white matter surrounding the right frontal horn, as well as more posteriorly along the body of the right lateral ventricle, and along the left frontal horn, has progressed compared to the immediate prior examination. There is no associated enhancement in these areas. Spectroscopy and rCBV mapping of this tissue show no definite concerning features. As such, this may simply represent treatment effect with progressive tumor considered less likely.3.Abnormal signal and thickening of the genu of the corpus callosum is similar to that seen on the prior exam, and is improved relative to older studies."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with shoulder pain. ROTATOR CUFF: There is a full-thickness insertional tear of the supraspinatus tendon extending slightly posterior to involve the anterior fibers of the infraspinatus as well, measuring approximately 13 mm in the AP dimension, with approximately 1 cm of retraction of the bursal surface fibers. There is increased signal abnormality of the supraspinatus suggesting mild tendinosis. There is minimal fatty atrophy of the supraspinatus muscle at the level of the myotendinous junction. The supraspinatus muscle appears intact. There is mild interstitial tearing and fatty infiltration of the infraspinatus along the myotendinous junction. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Minimal osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Given the limitations of a non arthrogram study, we see no evidence of a labral tear. There is no joint effusion.BICEPS TENDON: The tendon of the long head of the biceps is normal in appearance.", "output": "Full-thickness insertional tear of the supraspinatus/infraspinatus with mild retraction. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Multiple sclerosis. Follow-up progression. There are numerous periventricular and subcortical FLAIR hyperintense lesions, as well as additional lesions within the brainstem and cerebellum. There is no significant interval change. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. A cavum septum pellucidum et vergae is incidentally noted, a normal variant.", "output": "No significant interval change in numerous FLAIR hyperintense lesions, consistent with history of multiple sclerosis."}
{"instruction": "Generate impression based on findings.", "input": "43 year-old status post left lumpectomy in July 2015 and re-excision in September 2015 for DCIS. Final pathology reported negative surgical margins. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are post-surgical changes, including a seroma, mild architectural distortions and a few surgical clips at 12:00 position in the left breast. No abnormal enhancement is seen near the surgical site in the left breast. An enhancing focus is unchanged in the left breast at upper outer quadrant. No suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. Stable enhancing focus in the left upper outer quadrant.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "NF-2 and bilateral vestibular schwannomas. Prior subtotal resection of right vestibular tumor in 2015. Headaches. There are postoperative findings related to right suboccipital craniotomy, with mild encephalomalacia in the right cerebellar hemisphere. There is an enhancing mass in the right cerebellopontine angle cistern with slight extension into the right internal auditory canal that measures up to 30 mm, previously 25 mm. There is associated mass effect upon the adjacent brainstem and right cerebellar hemisphere. There is also an enhancing lesion in the left cerebellopontine angle cistern internal auditory canal that measures up to 12 mm, previously 10 mm, without significant mass effect upon the cerebellum or brainstem. There is an enhancing lesion along the posterior falx cerebri, measuring up to 5 mm in thickness. There is no evidence of acute infarction. The ventricles are unchanged in size. There is no midline shift or herniation. There is a left maxillary sinus retention cyst.", "output": "1. Interval increase in size of the bilateral vestibular schwannomas, right larger than left.2. A small lesion along the posterior falx cerebri likely represents a meningioma. "}
{"instruction": "Generate impression based on findings.", "input": "Female 87 years old with a 22mm x 14mm mass in pancreatic head biopsy with EUS 5/25/16. Needle aspiration indicated high-grade neuroendocrine tumor. Evaluate for pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is no suspicious, enhancing hepatic lesion. The hepatic vasculature is patent. Please note that the right hepatic artery arises from the SMA.The gallbladder is collapsed. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The tail of the pancreas is atrophic. There is a 20 x 19 mm round, T2 hyperintense, avidly arterially enhancing lesion at the junction of the pancreatic head and uncinate process (series 12, image 134). The pancreatic duct is not dilated. The pancreatic duct crosses the common bile duct suggesting pancreas divisum.ADRENAL GLANDS: Mild nodular thickening of the left adrenal gland is nonspecific.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is a prominent right retrocrural lymph node within normal appearing fatty hilum. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.29 x 19 mm enhancing lesion in the uncinate process of the pancreas is consistent with history of a pancreatic neuroendocrine tumor. 2.No evidence of metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "43 year old male with paroxsymal atrial fibrillation, refractory to medical therapy and plan for atrial fibrillation ablation. Pre procedure MRI. Left VentricleThe left ventricle is normal in size with globally decreased function. The overall LV ejection fraction is 37%. The LVEDV is 220 ml (normal range 142+/-34), the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVESV is 82 ml (normal range 47+/-19) and the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9). The LV mass is 203 g (normal range 164+/-36) and the LV mass index is 30 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is dilated. The left atrial appendage appears free of clot. Right VentricleThe right ventricle is normal in size with reduced function. The overall RV ejection fraction is 34%. The RVEDV is 264 ml (normal range 142+/-31), RV end diastolic volume index is 117 ml/m2 (normal range 82+/-16), the RVESV is 175 ml (normal range 54+/-17), and the RV end systolic volume index is 78 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, 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 mild 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 FindingsSmall scattered pulmonary micronodules. Probable left renal cyst. Enhancing left thyroid lobe nodule measuring at least 2.9 cm. 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": "2.9 cm enhancing left thyroid lobe nodule. Correlation with thyroid ultrasound and possible tissue sampling depending on the ultrasound appearance of this lesion is suggested.Left ventricle is normal in size with globally decreased function. The overall LV ejection fraction is 37%. Right ventricle is normal in size with reduced function, RVEF is 34%There are 4 pulmonary veins draining into the left atrium. Left atrial appendage free of clot. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " The last well formed disk space is referred to as L5-S1, consistent with the last exam. There are findings consistent with bilateral L5 pars inter-articularis defects with no significant spondylolisthesis. There is persistent 15-mm wide defect in the anterior/superior endplate of L4 vertebral body with mild loss of signal and height at the L3-4 disk space. There is persistent stable apparent defect in the left posterior elements of S1 consistent with spina bifida occulta. There is no osseous marrow edema. The conus terminates at L1-2.There is no significant spinal canal or neural foraminal stenosis, or disk herniation at any level of the lumbar spine.", "output": "Unchanged bilateral L5 spondylolyses without spondylolisthesis, S1 spina bifida occulta and L4 superior endplate Schmorl's node."}
{"instruction": "Generate impression based on findings.", "input": "Chronic headaches, occipital and then generalized. Now with new complaint of seeing double. Evaluate anatomy. No evidence of hemorrhage, edema, mass effect among midline shift or hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns are essentially within normal limits for patient's stated age of 6. Calvarium, paranasal sinuses and in the tibial blastic air cells and middle ear cavities are also within normal. Considering provided clinical date of follow up examination with an MRI is recommended.", "output": "Negative nonenhanced CT of brain."}
{"instruction": "Generate impression based on findings.", "input": "38 years Female (DOB:12/12/1977)Reason: patient with metastatic breast cancer with recent photosensitivity, please evaluate for brain mets History: patient with metastatic breast cancer with recent photosensitivityPROVIDER/ATTENDING NAME: RITA NANDA RITA NANDA The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There is no evidence for brain metastases."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old male with right pelvic schwannoma Again visualized is a heterogeneously T2 bright, inhomogeneously enhancing mass in the right hemipelvis extending through the sciatic notch. The cranial portion of the bilobed mass measures 6.5 x 4.7 cm and previously measured 6.5 x 4 .3 cm (image 25 series 1001, minimally increased in size. There is mass effect on the posterior aspect of the bladder. The osseous structures appear unremarkable.", "output": "Pelvic mass consistent with recurrent schwannoma, minimally increased in size."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old with past medical history of bilateral mastectomies with breast cancer with thickening of the left flap. Postoperative changes of bilateral mastectomies. There is diffuse skin thickening on the left without abnormal enhancement. A focal region of postsurgical scarring and fat necrosis in the left axillary region measures 25 x 15 x 21 mm. On postcontrast images, no suspicious enhancement or mass is seen.No abnormal axillary lymph nodes are identified in either axillary region.Note is made of a T2 bright lesion in the right hepatic lobe which appears similar to prior CT given differences in technique.", "output": "Skin thickening of the left breast without abnormal enhancement and postsurgical changes/fat necrosis as described above. No MRI evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Female, 65 years old, with history of lymphoma, left lower extremity weakness and pain, right upper extremity weakness. Evaluate for cord compression, vertebral body involvement or metastases. No acute cord compression is seen. No significant compromise of the spinal canal is noted. The spinal cord as assessed on sagittal imaging is within normal limits.Spinal alignment is anatomic. However, there is patchy marrow replacement compatible with osseous metastatic involvement involving the spine and sacrum. Vertebral body heights are preserved and there does not appear to be any significant epidural disease extension. Multiple intra-abdominal masses are partially visualized as well.", "output": "No evidence of acute cord compression. However, there are findings to suggest scattered osseous metastatic involvement."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male with history of kidney cancer ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter liver cyst in the hepatic dome, unchanged. No significant abnormality noted.SPLEEN: Subcentimeter T2 hyperintense focus in the spleen is unchanged, possibly a complicated cyst or lymphangioma. No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrent disease.Multiple T2 hyperintense simple appearing renal cysts in the left kidney, unchanged since prior exam.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.No evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": " This exam is degraded by motion artifact.Pituitary gland is overall normal in height without discrete mass appreciated. Centrally there is appearance of a partially empty sella. There is however thickened appearance of the pituitary tissue involving the peripheral aspect of the sella, anteriorly where it measures 4 mm in the AP dimension and 11 mm in height as well as posteriorly where it measures 4 mm in the AP dimension and 8 mm in height. Similarly there is prominence of the pituitary tissue involving the lateral aspects of the sella particularly on the left. There is a small defect involving the inferior aspect of the sella on the left with mild associated soft tissue extending inferiorly into the sphenoid sinus measuring approximately 4 mm. Combined the mildy hypoenhancing soft tissue in the left lateral aspect of the sella measures 14 x 11 mm in the craniocaudal and transverse dimensions.(coronal post gad image 6/18). No evidence of cavernous sinus invasion, suprasellar extension, or mass effect on the optic chiasm. The infundibulum is midline. The optic chiasm, cavernous sinuses and intracranial portions of the optic nerves are normal in appearance.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are multiple unchanged punctate foci of T2 hyperintensity within the supratentorial and infratentorial white matter including the brainstem. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are bilateral lens implants. There is an apparent partially imaged unchanged expansile mass within the left hemi-maxilla.", "output": "1.Pituitary gland appears normal in height centrally with partially empty sella appearance. There is however prominence of the soft tissue in the peripheral aspects of the sella particularly anteriorly and the left lateral aspect of the sella where there is focal downward bowing/dehiscence of the left sellar floor and extension of 4 mm soft tissue into the left sphenoid sinus. Findings are favored to represent residual pituitary adenoma. Overall appearance is unchanged since 8/30/2013. No suprasellar extension or mass effect on the optic chiasm. Comparison with remote priors may be helpful if available.2.Unchanged mild to moderate chronic small vessel ischemic disease within the supratentorial and infratentorial white matter including the brainstem.3.Unchanged left hemi-maxilla expansile mass is compatible with the presumed fibro-osseous lesion as seen on CT neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female with history of Devics disease. Patient presents with 3 day history of left-sided numbness and right-sided weakness. There is no evidence of intracranial hemorrhage, mass or edema. Patchy diffuse white matter changes compatible with patient's previous MRI. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses, although limited appear patent and mastoid air cells are normally pneumatized.", "output": "No acute intracranial abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Left neck and shoulder pain. Prior cervical spine MRI was attempted on 4/15/2016, which was prematurely terminated due to patient's pain. Examination is mildly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. There is nonspecific heterogeneity of the bone marrow with T1 shortening involving the lower cervical vertebral bodies, possibly related to radiation/radioiodine ablation.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex. No significant compromise to the spinal canal. There is moderate narrowing of the bilateral neural foramina related to uncovertebral hypertrophy and facet arthropathy.C4-5: Minimal disc osteophyte complex and uncovertebral hypertrophy. No significant compromise to the spinal canal. Mild right and mild to moderate left neural foraminal narrowing.C5-6: There is a small disc osteophyte complex including a left foraminal disc extrusion. No significant compromise to the spinal canal. There is moderate left neural foraminal narrowing and mild right neural foraminal narrowing. C6-7: Minimal disc osteophyte complex. Mild to moderate narrowing of the left neural foramen. No significant spinal canal or right neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal. Moderate narrowing of the neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "Multilevel degenerative changes in the cervical spine without significant spinal canal stenosis at any level. Motion degradation limits optimal evaluation, however there is neural foraminal narrowing at multiple levels, particularly on the left as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "91 years, Female, intracranial mass on head CT. Evaluate for abscess versus neoplasm.. There is a 2.2 x 2.2 x 2.0 cm (AP x transverse x craniocaudal) mass with nodular peripheral enhancement and central necrosis involving the lateral aspect of the right middle frontal gyrus. There is extensive surrounding FLAIR hyperintensity consistent with vasogenic edema. There is mild restricted diffusion involving the peripheral aspect of the lesion. No central restricted diffusion to indicate pus. There are punctate foci of susceptibility along the peripheral aspect of the lesion compatible with microhemorrhages. There is local mass effect with mild sulcal effacement as well as mild effacement of the right lateral ventricle. There is minimal leftward midline shift measuring 3 mm at the foramen of Monro.There is a 5 mm lesion with peripheral enhancement and minimal associated edema involving the left anterior middle frontal gyrus. There is also a 5 mm lesion involving the left paramedian parietal lobe.There is a punctate focus of susceptibility likely indicating chronic microhemorrhage in the right anterior frontal lobe and nonspecific. Patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter is nonspecific but compatible with chronic small vessel ischemic disease.No hydrocephalus. No extra-axial collections. Major flow-voids are preserved. Sella and orbits are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening. Calvarium and extracranial soft tissues are also grossly unremarkable.", "output": "2.2x2.2x2.0 cm mass in the right frontal lobe with peripheral nodular enhancement as well as 5 mm left frontal and left parietal lesions are highly suspicious for metastatic disease. Imaging features are not compatible with pyogenic abscesses although atypical infection may be considered in the appropriate clinical setting."}
{"instruction": "Generate impression based on findings.", "input": "cT1N0 squamous cell carcinoma of the left lateral tongue.. There is a left lateral oral tongue enhancing lesion that measures up to approximately 5 mm in depth, 18 mm in length, and 18 mm in height. There is no evidence of extension into the tongue base or mandible. There is no evidence of significant suprahyoid lymphadenopathy. The salivary glands are unremarkable. The orbits are also unremarkable. There are bilateral retropharyngeal carotid arteries. There is minimal scattered paranasal sinus mucosal thickening. There is periventricular cerebral white matter T2 hyperintensity and partially-imaged right frontal encephalomalacia. There is multilevel degenerative spondylosis, with apparent indentation of the spinal cord at C6-7.", "output": "1. A left lateral oral tongue squamous cell carcinoma measures up to approximately 5 mm in depth, 18 mm in length, and 18 mm in height. 2. No evidence of significant suprahyoid lymphadenopathy. 3. Partially-imaged right frontal lobe chronic infarction.4. Multilevel degenerative spondylosis, with apparent indentation of the spinal cord at C6-7."}
{"instruction": "Generate impression based on findings.", "input": "Right lumbar radicular pain for several weeks. The most superior nonrib-bearing vertebral body is labeled as L1. There are hypoplastic ribs associated with the T12 vertebral body. There are 4 lumbar type vertebral bodies and a fifth sacralized transitional segment labeled S1 for the purposes of this study. Vertebral body heights are within normal limits. There are multiple small Schmorl's nodes, relatively more prominent at the inferior T11 and superior inferior L1 endplates. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Mild multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge without significant spinal canal stenosis. There is mild left and minimal right neural foraminal stenosis. L3-L4: Mild disc bulge with small central protrusion, ligamentum flavum thickening, and mild to moderate facet arthropathy without significant central spinal canal stenosis. There is partial effacement of the lateral recesses and mild left worse than right neural foraminal stenosis.L4-S1: Disc bulge with small central protrusion, ligamentum flavum thickening, and mild to moderate facet arthropathy. There is partial effacement of the lateral recesses without significant central spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.S1-S2: No significant disc disease, spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.", "output": "1. Mild multilevel degenerative changes as described above without significant central spinal canal stenosis at any level. There is mild or mild to moderate neural foraminal stenosis at multiple levels. No higher grade foraminal stenoses is appreciated.2. Transitional lumbosacral junction anatomy as described above with four lumbar type vertebral bodies."}
{"instruction": "Generate impression based on findings.", "input": "Knee injury, swelling. MENISCI: There is a complex tear with both vertical and horizontal components of the posterior horn and posterior aspect of the body of the medial meniscus. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is denuding of the articular cartilage of the lateral patellar facet with underlying subchondral edema which extends to the median eminence. There is significant thinning of the articular cartilage of the femoral trochlea with a region of full-thickness cartilage loss. There is complete loss of articular cartilage of the anterior and near-complete loss of the weight-bearing portion articular cartilage of the lateral femoral condyle up to above the posterior horn of the lateral meniscus. There is thinning of the posterior articular cartilage of the lateral femoral condyle. There is complete loss of the cartilage of the weight-bearing portion of the medial femoral condyle above the posterior horn with significant thinning of the remaining articular cartilage. Additionally there is complete loss of articular cartilage of the medial tibial plateau from the mid to posterior portions. Tricompartmental osteophytes are noted.There is increased T2 signal within the posterior medial tibial plateau with a linear component of low T1 and T2 signal which most likely represents a insufficiency fracture with surrounding edema. LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1. Insufficiency fracture of the medial tibial plateau.2. Complex tear of the medial meniscus.2. Chondromalacia is described above."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other disorders of facial nerve Unspecified abnormal involuntary movements Occlusion and stenosis of basilar arteryClinical question: Pt with multiple abnormal involuntary movements resembling hemifacial spasm, hemiballismus, tremorSigns and Symptoms: Pt with multiple abnormal involuntary movements resembling hemifacial spasm, hemiballismus, tremor MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The right AICA is duplicated. The right AICA meatal loop is readily identified in the right internal auditory meatus and originates from the superior origin of the right AICA. Together the AICA branches are dominant over the PICA. The left PICA is dominant. There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There is no major artery abutting the trigeminal nerves.The anterior communicating artery is identified and is medium size. The left posterior communicating is very small. There is fetal origin of the right PCA. The right P1 segment is tortuous and small. The vertebral arteries are similar in size.", "output": "1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.MRI of the brain is within normal limits. No abnormal enhancing mass lesions are appreciated in the brain or skull base to explain hemifacial spasm.4.No arterial loop is identified to explain hemifacial spasm."}
{"instruction": "Generate impression based on findings.", "input": "Lumbar pain, leg pain, evaluate for spinal stenosis or nerve entrapment. Ataxia. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. There is mild diffuse heterogeneity of the bone marrow signal without discrete destructive osseous lesions. Small foci of T1 hyperintensity such as at L3 are compatible with foci of fat or small hemangiomas. The conus medullaris is normal in position.Mild 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: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation with small right annular fissure and right foraminal disc protrusion. There is mild narrowing of the right neural foramen with contact of the right L4 nerve root without clear evidence of impingement. No spinal canal or left neural foraminal narrowing. Mild bilateral facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.", "output": "1. Mild degenerative changes in the lumbar spine including a small right foraminal disc protrusion at L4-L5 with mild right neural foraminal narrowing. Otherwise no significant spinal canal or neural foraminal stenosis in the lumbar spine.2. Mild facet arthropathy in the lower lumbar spine at L4-5 and L5-S1, which may be contributing to patient's low back pain. 3. Diffuse heterogeneity of the bone marrow signal which is nonspecific and can be seen with marrow reconversion related to chronic illnesses, anemia, and marrow proliferative disorders among various other etiologies. No discrete suspicious osseous lesion is demonstrated."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: History of GBM, status post chemotherapy RT, surveillance MRI. Signs and symptoms: None. Pre and postcontrast enhanced brain MRI:Negative diffusion-weighted images.Examination demonstrates significant interval improvement in postoperative changes of a large right anterior frontal and temporal craniotomy since prior exam.There is interval complete resolution of subgaleal CSF density collection over the craniotomy flap likely secondary to CSF leakage since prior exam. Extra-axial serosanguineous collection along the inner table of the surgical flap in the right frontal lobe is within expected postop change and measures approximately at maximum of 9.5 mm thickness. There is also overlapping pleural thickening with enhancement also within expected postop change.A well-demarcated CSF signal intensity surgical cavity in the right anterior/inferior frontal lobe measures approximately at 33 x 61 mm and with interval decreased size since prior study.There is mild surrounding FLAIR hyperintensity suggestive of residual edema or gliosis.There is a thin and uniform enhancement of the surgical cavity wall with significant interval improvement since prior exam. There is no convincing evidence of residual tumor on this exam at this time. Further follow-up is needed to exclude recurrence.Lateral ventricles are slightly prominent however without interval change or deviation of the midline. Revisualization of a chronic retention cyst in the sphenoid sinus.", "output": "1.No acute intracranial process.2.Interval improvement of postoperative changes of right anterior frontal lobe with decreased size of surgical cavity and interval decreased enhancement along the surgical cavity wall as detailed above. No convincing evidence of residual tumor.3.Interval complete resolution of right frontal subgaleal fluid collection over the craniotomy flap since prior study.4.Epidural collection along the inner table of craniotomy flap measuring maximum of 7.5 mm in thickness. Overlapping dural thickening with enhancement which is inseparable from the surgical cavity."}
{"instruction": "Generate impression based on findings.", "input": "Other speech disturbance(784.59)Clinical question: stroke?Signs and Symptoms: right side weak MRI of the brainThere is a 16x8mm axial dimension focus of diffusion restriction in the left pons associated with T2 and FLAIR signal hyperintensity.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is 70% stenosis at proximal portion of the intracranial RVA.There is 65% stenosis at the distal opthalmic segment of the RICA.There is 50% stenosis at the distal opthalmic segment of the LICA.There is 40% narrowing of the left PCA at the p2 segment.There is 67% stenosis of the right PCA at the p2 segment.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are tiny. The left vertebral artery is larger than right right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch.On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the left vertebral artery. There is high grade stenosis at the origin of the right vertebral artery.The right vertebral artery is smaller than the left vertebral artery.", "output": "1.Acute infarction along the left pons.2.There is high grade stenosis at the origin of the right vertebral artery.3.There is 70% stenosis at proximal portion of the intracranial RVA.4.There is 65% stenosis at the distal opthalmic segment of the RICA.5.There is 50% stenosis at the distal opthalmic segment of the LICA.6.There is 67% stenosis of the right PCA at the p2 segment.7.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female presenting for bracketed preoperative needle localization for right breast cancer. On review of the prior studies, disease on MRI spreading almost 40 mm is visualized about 3.5 cm from the nipple. Target mixed calcifications morphology are located in the right breast in the upper inner quadrant region located in mid-breast 1 o\u2019clock. A bracketed needle localization is performed. The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, two 7 cm Kopans needle was placed adjacent to the lesion, one anteriorly and one posteriorly. On orthogonal mammography, adequate positioning of the needles were confirmed after adjusting depth so the needle tip was approximately 2cm deep to the centers of the targets. A spring wire was then deployed through each needle. Repeat two view orthogonal mammograms reveal the spring wires to be in adequate position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Drs. Nagaraju and Tremblay performed the procedure under direct supervision of Dr. Abe, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the calcifications and clip and spring wires to be within the specimen. Dr. Jaskowiak excised more superolateral tissue (not imaged).", "output": "Successful bracketed needle localization of the right breast calcifications.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male status post transphenoidal hypophysectomy. There is no evidence of intracranial hemorrhage or edema. Reidentified is a large, pituitary macroadenoma with extensive expansion of the sella and invasion of the sphenoid sinus and clivus which appears to be overall slightly smaller in size when compared to be presurgical MRI. There is no extension into the pre-pontine cistern There is bilateral involvement of the cavernous sinuses. There is significant extension of the tumor into the basal cistern.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. The paranasal sinuses and sphenoid sinus demonstrate opacification and air fluid levels which may be consistent with postsurgical blood and or packing material.", "output": "Expected postsurgical changes as described above."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with recent mammogram without evidence of disease but with right-sided breast pain requesting MRI There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "History of recurrent squamous cell carcinoma of the right face involving the parotid gland. There are postoperative findings related to right parotidectomy with flap reconstruction. There is tumor along the right trigeminal nerve in the parapharyngeal space. The tumor measures up to approximately 30 mm in length and 7 mm in width. The tumor extends towards the foramen ovale, but there is no definite intracranial extension. There are denervation changes in the right masticator muscles. There are bilateral lens implants. There is no evidence of significant cervical lymphadenopathy. There is a chronic left basal ganglia infarct.", "output": "Postoperative findings related to right parotidectomy with flap reconstruction with evidence of perineural tumor spread along the right trigeminal nerve into foramen ovale and associated right masseter muscle denervation. However, characterization is limited due to the lack of intravenous contrast."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Unspecified convulsionsClinical question: posterior circulation occlusionSigns and Symptoms: altered mental status MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small focus of encephalomalacia along the right inferior lobule. There is T2/FLAIR signal hyperintensity associated with local volume loss within the subcortical white matter of the left inferior parietal lobule.There is a small focus of signal loss on SWI within the right temporal lobe adjacent to the temporal horn of the right lateral ventricle. It measures 1.5mm on T2 imaging. There is an adjacent venous structure suspected to represent DVA draining into the right lateral atrial vein.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. There is triplication of the ACA. The posterior communicating arteries are small. The vertebral arteries are asymmetric in size. The right vertebral artery is significantly larger than the left vertebral artery. There is extra-cranial origin of the left PICA.", "output": "1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is a small focus of encephalomalacia along the right inferior parietal lobule. One possibility is that this is related to a vascular insult.4.There is an old microhemorrhage in the right temporal lobe. This is associated with a DVA. The lesion is too small to characterize further on this exam.5.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. "}
{"instruction": "Generate impression based on findings.", "input": "Female 69 years old Reason: diminished ROM History: pain in the shoulder. ROTATOR CUFF: There is a full thickness tear of the distal fibers of the supraspinatus tendon, with retraction of the tendon fibers to beneath the distal clavicle. The tear measures approximately 1.0 cm in the AP dimension. There is mild to moderate fatty atrophy of the supraspinatus muscle. Mild tendinosis affects the infraspinatus tendon with possibly a small undersurface tear at its insertion. There is minimal fatty atrophy along the myotendinous junction. The teres minor tendon and muscle appear normal. There is thickening and increased signal intensity of the distal subscapularis tendon indicating tendinosis and, perhaps, undersurface fraying at its insertion. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: There is mild to moderate osteoarthritis of the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid in the glenohumeral joint with extension into the subscapularis recess. There is also fluid anterior to the subscapularis tendon, suggesting a subcoracoid bursitis. The glenoid labrum appears normal for age. Mild osteoarthritis affects the glenohumeral joint.BICEPS TENDON: There is increased signal intensity within the tendon of the long head of the biceps compatible with mild tendinosis. The tendon also appears perched on the lesser tuberosity, which may reflect pulley dysfunction. There is a small amount of fluid in the biceps tendon sheath of questionable significance.", "output": "1.Full thickness tear of the supraspinatus tendon and an additional rotator cuff tendinosis as described above.2.Degenerative arthritic changes of the acromioclavicular and glenohumeral joints.3.Tendinosis of the long head of the biceps and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Female 57 years old; Reason: Question of meniscal injury. History: Knee pain s/p fall MENISCI: There is increased signal within the inner fibers of the lateral meniscus extending to the free edge/undersurface of the meniscus suggestive of degenerative fraying/tearing which may not be of any current clinical significance. No fluid-filled defect or other abnormality is seen to suggest an unstable meniscal tear.ARTICULAR CARTILAGE AND BONE: There is moderate to severe loss of the articular cartilage along the patella, particularly at the medial facet where there are areas devoid of cartilage. Focal near-full-thickness to full-thickness cartilage defects are also seen along the inferior aspect of the medial and lateral trochlear facets with associated underlying bone marrow reactive changes. There is focal degeneration of the articular cartilage of the lateral tibial plateau, beneath the free edge of the posterior horn of the lateral meniscus. The articular cartilage of the medial compartment appears normal for the patient's age. We see no fracture. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Findings compatible with hematomas in the anterior subcutaneous fat of the knee.2. Cartilage degeneration as described above.3. Possible degenerative tearing/fraying at the inner edge of the body of the lateral meniscus, which may not be of any current clinical significance. No fluid-filled defect or other abnormality is seen to suggest an unstable meniscal tear."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: History of follicular lymphoma are the brain status post 4 cycles of MTR in need of restaging. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a slight prominence of cortical sulci and the supratentorial ventricular system without interval change since prior MRI exam from Michigan state University dated 12 -- 10 -- 14. Nonspecific band of flair hyperintensity surrounding the periventricular white matter without enhancement or interval change since prior exam is noted. Signal intensity of brain parenchyma is otherwise unremarkable.Post-enhanced images demonstrate no detectable abnormal parenchymal, leptomeningeal or calvarial enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses, mastoid air cells and bilateral middle ear cavities demonstrate normal pneumatization signal pattern.", "output": "1.Negative diffusion weighted images.2.Mild prominence of supratentorial ventricular system for age with a surrounding nonspecific thin band of flair hyperintensity without enhancement. Finding could represent post treatment change.3.Unremarkable pre-and post enhanced brain MRI otherwise.4.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.5.No appreciable interval change since prior brain MRI exams from Michigan state University dated 12 -- 10 -- 14"}
{"instruction": "Generate impression based on findings.", "input": "New right pronator drift. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are are a few unchanged scattered foci of T2 hyperintensity and susceptibility effect in the cerebral white matter. 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, and scalp soft tissues are grossly unremarkable. There are retention cysts in the right sphenoid and left ethmoid sinuses, as well as in the nasopharynx.", "output": "1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. A few unchanged scattered foci of T2 hyperintensity and susceptibility effect in the cerebral white matter may represent chronic small vessel ischemic disease and chronic microhemorrhages, respectively. "}
{"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 \u201ctime-out\u201d form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 13 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 Marcaine, 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\u2019s 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: 0:39 minutes", "output": "Successful fluoroscopically guided contrast injection of the right hip with MRI to follow."}
{"instruction": "Generate impression based on findings.", "input": "right hip septic arthritis status post surgical drainage and IV antibiotics. There is a small amount of fluid signal intensity anterior to the right femoral head and deep to the the tensor fascia lata and iliopsoas muscles which demonstrates enhancement on postcontrast images which is compatible with postsurgical change. The right hip joint effusion seen on the previous study has resolved but there is persistent enhancement of the synovium which is not unexpected. There is high T2 and low T1 signal within the posterior acetabulum on the right which has not progressed in size since the previous exam, this area has abnormal enhancement on postcontrast images. Mild enhancement is also seen along the medial aspect of the right acetabulum and the lateral aspect of the obturator internus muscle although this has improved markedly compared to the prior exam.The remaining osseous structures are within normal limits for the patient's age.There is no pelvic free fluid. No evidence of bowel obstruction.", "output": "1.Resolution of the right hip effusion status post surgical drainage. There is persistent synovial enhancement which is not unexpected given the history of septic joint and surgical intervention.2.Osteomyelitis of the posterior right acetabulum appears similar to the previous exam, clinical correlation is needed as imaging finding may lag behind clinical response. 3.Edema and subperiosteal fluid medial to the acetabulum on the right have improved.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "4 y/o ex-26 week M with no significant PMH who presents with new onset seizure without any inciting factors on history and without concern on physical examination. Please evaluate for structural brain abnormality, mass, or evidence of prior insult History: first time seizure lasting 8 minutes per parental report, sounds generalized tonic clonic per history. Brain parenchyma appears within normal limits. There is mild prominence of the perivascular spaces in the periatrial region which is a normal variation. There is minimal nonspecific FLAIR hyperintensity in the adjacent posterior periventricular white matter. There is 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. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There is moderate opacification throughout the paranasal sinuses. There is also diffuse right mastoid opacification. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.", "output": "1. Brain parenchyma appears within normal limits. Specifically, no findings to suggest seizure focus are appreciated.2. Diffuse opacification of the paranasal sinuses as well as the right-sided mastoid air cells, which can be correlated with clinical findings."}
{"instruction": "Generate impression based on findings.", "input": "Disorientation, unspecified [R41.0], Reason for Study: ^Reason: R/O CNS lymphoma History: HIV patient with AMS Especially post contrast scans' image quality are significantly degraded due to motion artifact. No evidence of acute ischemic or hemorrhagic lesion.Minimal high signal intensities on bihemispheric periventricular white matter and minimal brain atrophy are seen which are non specific. The FLAIR/T2 high signal intensity lesions are not confluent nor mainly located on deep white matter. Comparing to prior scan, there is no significant interval change. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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 mastoid air cells are clear.Sphenoid sinus shows mucosal thickening.", "output": "Unchanged non specific periventricular white matter FLAIR high signal intensity with minimal to mild diffuse brain atrophy since prior scan.No evidence of acute ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Spasticity. Signs and symptoms: Spasticity. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrate normal signal intensity of brain parenchyma on all MRI sequences. Post enhanced images demonstrate no detectable abnormal enhancement of brain parenchyma or the leptomeninges.There is uniform slight prominence of cortical sulci for patient's stated age which could be within upper limits of normal. Unremarkable ventricular system, CSF spaces and brain myelination otherwise.There is normal visualization of signal void of major intracranial arterial branches.The signal intensity of intracranial venous sinuses is within normal and the normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium, soft tissues of the scalp and without abnormal enhancement.Moderate size retention cyst in the right maxillary sinus and minute ethmoid sinus disease is noted.Pre- and post enhanced cervical MRI:Examination demonstrates unremarkable signal intensity of vertebral column and within normal anatomical alignment.There is mild degenerative disc disease throughout the cervical spine however without evidence of central spinal stenosis at any level.Degenerative changes however results in mild left neural foraminal compromise at C3-C4, moderate neural foraminal compromise on the right at C4-C5 moderate right and mild left neural foraminal compromise at C5-C6, mild neural foraminal compromise on the left at C6-C7.On post enhanced images there is no detectable abnormal enhancement of the cord, leptomeninges or the vertebral column.Pre- and post enhanced thoracic MRI:There is unremarkable signal intensity of vertebral column and within normal anatomical alignment.There is normal signal intensity and caliber of the thoracic cord.There is no evidence of spinal stenosis or definitive evidence of neural foraminal compromise at any level.There is no detectable abnormal enhancement of the vertebral column, thoracic cord or the leptomeninges.There is exaggerated left ligamentum flavum hypertrophy at T3 level with partial effacement of the dorsal subarachnoid space however without mass effect on the cord or central spinal stenosis.", "output": "1.Pre- and post enhanced brain MRI is unremarkable. Please see above comments.2.Pre-and post enhanced cervical MRI demonstrate mild degenerative changes without spinal stenosis however with neural foraminal compromise as detailed per level above. Normal signal intensity and caliber of cervical cord. No detectable abnormal enhancement of vertebral column, cord or the leptomeninges.3.Pre and post enhanced thoracic MRI demonstrate normal signal intensity and caliber of thoracic cord without abnormal enhancement. Mild degenerative changes without spinal stenosis or neural foraminal compromise at any level. No detectable abnormal enhancement of the vertebral column."}
{"instruction": "Generate impression based on findings.", "input": "61 years, Female, history of ALL undergoing clinical trial with new complaints of headaches Compared to prior examination from 14/2016, there has been interval development of leptomeningeal enhancement involving the sulci of the left occipital and temporal lobes. There is also dural thickening and enhancement along the left temporal and occipital convexities. There is corresponding diffusion hyperintensity. There is abnormal T2/FLAIR hyperintensity involving the adjacent cortex as well as nonsuppression of CSF on the FLAIR sequences. There is no intracranial mass effect, midline shift, or herniation. Ventricles are not significantly changed in size since prior. There is patchy FLAIR hyperintensity involving the bilateral frontoparietal white matter which has mildly increased when compared to the prior available FLAIR sequence from 1/13/2016 and likely represents treatment-related change. No evidence of acute ischemia or hemorrhage. There is heterogeneity of the bone marrow which is nonspecific and may be related to known leukemia. No destructive calvarial lesions are appreciated. There is moderate mucosal thickening involving the right maxillary sinus with fluid levels and frothy secretions which may represent acute sinusitis in the appropriate clinical setting. There is minimal mucosal thickening elsewhere in the paranasal sinuses.", "output": "1. Compared to prior exam from 1/14/2016, there has been interval development of abnormal leptomeningeal as well as dural enhancement in the left temporal and occipital lobes. Finding is favored to represent neoplastic meningeal infiltration, presumably from known leukemia. Inflammatory/infectious process seems less likely but can be correlated with CSF analysis.2. Slight increase in FLAIR hyperintensity involving the frontoparietal white matter likely representing posttreatment change.3. Moderate mucosal thickening involving the right maxillary sinus with fluid levels and frothy secretions, which may represent acute sinusitis in the appropriate clinical setting."}
{"instruction": "Generate impression based on findings.", "input": "History of portal vein thrombosis. Interval follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma has normal signal. No evidence of hepatic steatosis. There is abnormal morphology with hypertrophy of the right hepatic lobe, possibly related to chronic portal vein thrombosis. No focal suspicious parenchymal lesion.Similar to prior, the main portal vein is thrombosed. There are small intrahepatic portal vein branches indicating some residual flow through collateralization/cavernous transformation.No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Marked splenomegaly with the spleen measuring 17.8 cm in length.PANCREAS: The pancreas is mildly atrophic, but maintains normal signal. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No focal mass lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are multiple prominent gastroesophageal varices as well as splenorenal shunt collaterals.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.", "output": "1.Findings compatible with thrombosis of the main portal vein with cavernous transformation appearing similar to prior.2.Sequela of portal hypertension including marked splenomegaly, gastroesophageal varices formation, and prominent splenorenal shunt collateral veins."}
{"instruction": "Generate impression based on findings.", "input": "3 week old with hematoma and subdural bleed after birth. There is no evidence of residual intracranial hemorrhage. There is no evidence of intracranial mass or acute infarct. The brain parenchyma, brainstem, cerebellum, and pituitary gland appear unremarkable. There is a normal degree of myelination. 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. However, there is bilateral tympanomastoid fluid.", "output": "1. No evidence of residual intracranial hemorrhage.2. Nonspecific bilateral otomastoid effusions."}
{"instruction": "Generate impression based on findings.", "input": " There is an approximately 1.5 cm area of abnormal signal within the left precentral gyrus which exhibits increased signal on DWI images, isointense signal on ADC images, and increased signal on T2 images in pattern consistent with subacute infarction. There are additional punctate foci of increased DWI signal and decreased ADC signal compatible with acute microinfarctions within the superior paramedian pons, left middle cerebellar peduncle, left cerebellar hemisphere, and right ventral medulla. There is a small focus of chronic infarction within the right head of the caudate and anterior limb of the internal capsule with associated susceptibility artifact likely reflecting a small amount of mineralization and/or chronic blood products. There is additional confluent increased T2 signal within the bilateral periventricular and subcortical white matter compatible with moderate chronic small vessel ischemic changes. There is mild prominence of the ventricles including mild ex vacuo dilatation of the right lateral ventricle as well as prominence of the cortical sulci compatible with mild cerebral volume loss. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The vertebral artery flow voids appears slightly diminutive which may reflect atherosclerotic disease. Incidental note is made of a partially empty sella. Incidental note is made of hyperostosis frontalis interna. There is an approximately 1.6 x 1.0 cm lesion within the left frontal skull which displays decreased T1 signal, decreased T2 signal, and enhancement. There is a subcentimeter round lesion along the right anterior aspect of the falx without associated significant mass effect which demonstrates intrinsic T1 hyperintensity, possible mild enhancement, and susceptibility artifact which may be related to dural calcification or tiny meningioma.There is abnormally increased T2/FLAIR signal within the left globe, a fluid level within the posterior aspect of the left globe indicative of an effusion, and susceptibility artifact within the left globe reflecting mineralization or prior blood products. These findings may all be related to chronic retinal detachment.", "output": "1.Multifocal infarcts of different ages including acute, subacute, and chronic, as described above, including subacute infarct involving the left precentral gyrus and more acute microinfarcts within the superior paramedian pons, left middle cerebellar peduncle, left cerebellar hemisphere, and right ventral medulla. 2.Slightly diminutive flow voids within the intracranial vertebral arteries which may be related to atherosclerotic disease and could be further assessed with MRA or CTA if clinically indicated.3.Nonspecific 1.6 x 1.0 cm enhancing left frontal skull lesion. Comparison with prior outside examinations may be helpful.4.Incidental note of subcentimeter nodule in right parafalcine region which lacks mass effect and which may represent dural calcification or a tiny meningioma.Discussed with BURNS, MATTHEW at 11:50 a.m. on 9/11/2015. "}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: AMS; eval for leptomeningeal spread; NSCLC w mets to brain s/p recent stereotactic brain XRT History: see above There are a couple of focal enhancing lesion on the left posterior temporal lobe which are new lesions not seen on Apr 5 2016.Right frontal white matter lesion (series 12, image 9), right middle frontal gyrus (series 12, 7) image are seen, unchanged since prior scan.The right occipital intraaxial mass which abuts dura shows interval decrease in size since prior scan.  Patchy FLAIR high signal intensities on periventricular white matter indicating non specific small vessel ischemic lesions are seen, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.", "output": "1. Interval development of new nodular enhancing lesions on the left posterior temporal lobe.2. Interval decrease in size of the right occipital lobe lesion since prior scan.3. Small nodular enhancing lesions at the right frontal lobe do not show any significant interval change. "}
{"instruction": "Generate impression based on findings.", "input": "84-year-old male with bilateral neuropathy, primarily RLE weakness and R foot drop. Also fatigue. History of lymphoma with RChop therapy in 2013. No radiation. History of RA. Evaluate for lumbosacral plexopathy, with particular interest of the right, although there is bilateral neuropathy on the EMG. The exam is significantly limited by motion artifact. Please refer to the recent previous dedicated lumbar spine MRI for characterization of the lower lumbar spine levels. The right L4 nerve root is again seen and somewhat thickened and ill-defined compared to the left side which is unchanged. The configuration of the right sacral foramina and bony central spinal canal involving the upper to mid L4 level is similar prior exams, with slight expansion on the right, likely developmental. There is no definite abnormal enhancement or mass involving the lumbosacral plexus.", "output": "No abnormal enhancement or mass involving the lumbosacral plexus. Please refer to the recent previous lumbar spine MRI performed on 8/16/2016 for level by level characterization of the lower lumbar spine."}
{"instruction": "Generate impression based on findings.", "input": " There is an unchanged expanded-empty sella without evidence of mass lesions. The pituitary gland is markedly flattened along the superior aspect of the sella. The pituitary stalk lies in the midline. The optic apparatus and cavernous sinuses are intact. There are prominent arachnoid granulations in the left middle cranial fossa, into which the inferior temporal lobe slightly protrudes. There is a subcentimeter cystic lesion in the posterior nasopharynx, which may represent a retention cyst or Thornwaldt cyst.", "output": "Unchanged enlarged partially-empty sella and prominent left middle cranial fossa arachnoid granulations, into which the left inferior temporal lobe slightly protrudes, may be manifestation of pseudotumor cerebri."}
{"instruction": "Generate impression based on findings.", "input": "Male, 57 years old. Right shoulder pain. Evaluate for proximal biceps pathology. ROTATOR CUFF: There is a focus of increased signal in the supraspinatus muscle likely representing a intramuscular ganglion or sentinel cyst. This likely represents a laminar tear without evidence of retraction. There is intermediate signal within the supraspinatus tendon which likely represents tendinosis. There is no evidence of a full thickness tear. The remainder of the rotator cuff appears intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears grossly normal. The glenohumeral joint alignment is within normal limits.BICEPS TENDON: The biceps tendon is unremarkable. ADDITIONAL", "output": "Laminar tear of the supraspinatus with an intramuscular ganglion or a sentinel cyst. No evidence of retraction or full-thickness tear of the rotator cuff."}
{"instruction": "Generate impression based on findings.", "input": "Female, 51 years old, with epidural abscess status post debridement. Thoracic:Evidence of laminectomy is seen on one side or the other at most levels in the thoracic spine. The posterior operative soft tissues are edematous and tracking fluid is evident through the subcutaneous surgical plane most notably in the lower cervical and upper thoracic regions.On comparison with the preoperative examination, the extensive ventral epidural collection has significantly decreased in size. In most areas the collection has completely or nearly completely resolved. There is no longer any significant thecal sac encroachment or displacement of the spinal cord. No cord signal abnormality is detected.A deep concavity of the T12 superior endplate is unchanged. Vertebral body heights are otherwise preserved. Spinal alignment is anatomic. No evidence of marrow replacement or marrow edema is seen. No significant compromise of the spinal canal or neural foramina is noted. Scattered mild areas of disc degeneration are seen.Lumbar:The previously seen posterior fusion instruments at L4-5 have been removed, though the intervertebral device remains in place at this level. The large left paraspinal fluid collection that had previously encompassed the fusion instruments has nearly completely resolved. There remains a very small collection of fluid spanning the left L4-5 laminectomy bed which measures approximately 3 cm in length and approximately 1 cm in width when measured in the axial plane. This collection does extend into the lateral and ventral epidural space at L4-5 where it continues to narrow the thecal sac, but the degree of narrowing has improved.Evidence of laminectomy is seen on the left at L2 and on the right at L1. The epidural collection seen previously throughout the lumbar spine has improved though a predominately ventral collection does persist from L1 down to L3 measuring up to 9 mm in thickness. The thecal sac is narrowed but to a much lesser degree than on the prior examination.Spinal alignment is anatomic. Vertebral body heights are preserved. Endplate signal changes at L4-5 are again seen which may be postoperative in nature. No significant disc degeneration is detected. Apart from narrowing caused by epidural fluid, there is no additional superimposed spinal canal or foraminal stenosis.", "output": "Postoperative findings are seen compatible with removal of posterior fixation instruments at L4-5 and multilevel laminectomy for debridement of a large epidural abscess involving a majority of the spine. In the thoracic region, this epidural collection has completely or nearly completely resolved. In the lumbar spine, some residual epidural fluid persists, for example ventrally from L1 through L3. In addition, there remains a small fluid collection within the left laminectomy defect at L4-5 which extends into the lateral and ventral epidural space causing encroachment on the thecal sac. Both these areas of epidural fluid in the lumbar spine have significantly improved when compared to the preoperative examination."}
{"instruction": "Generate impression based on findings.", "input": "Male, 60 years old. Pain. ROTATOR CUFF: There is mild to moderate tendinopathy of the supraspinatus tendon without discrete tear identified. The infraspinatus and teres minor tendons and muscles are intact. Mild tendinopathy affects the subscapularis tendon. The subscapularis muscle is intact. There are small subchondral cysts at the humeral head.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is marked small subchondral cysts within the inferior aspect of the glenoid both anteriorly and posteriorly. Internal signal involving the inferior labrum is consistent with degeneration.BICEPS TENDON: The tendon of the long head of the biceps is visualized within the bicipital groove, but it is not visualized in the rotator interval, compatible with a tear. ADDITIONAL", "output": "1.Nonvisualization of the long head biceps in the rotator interval, compatible with a tear.2.Rotator cuff tendinopathy particularly involving the supraspinatus and subscapularis tendons, without discrete tear identified."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other disorders of orbitClinical question: New headaches and outside CT scan suggests mass at right posterior orbit and other calcified dural lesionsSigns and Symptoms: headache MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is redemonstration of a 3 mm extra-axial lesion at the right tentorial leaf which is bright on T1 and suppresses on the fat suppressed imaging. It is stable compared to the prior examNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cysts. The visualized portions of the mastoid air cells are clear. MRI orbits:There is an 18 x 14 mm axial dimension right intraconal space mass present which previously measured similar dimensions. It is located between the right lateral rectus muscle and the optic nerve and splays the 2 apart. It enhances homogeneously. It has similar signal characteristics to the extraocular muscles on T1. On the prior exam it had a fluid fluid level in it. This is also present on the prior exam and is more subtle.The eyeballs are intact. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .", "output": "1.There is redemonstration of an intraconal space mass on the right side which displaces adjacent structures (right optic nerve and right lateral rectus muscle). Its signal characteristics suggest that this may represent a venolymphatic lesion. It is stable when compared to the prior exam2.A tiny lesion along the right tentorial leaf is present which could represent a lipoma, a lipomatous meningioma or a dermoid. It is also stable compared to the previous exam."}
{"instruction": "Generate impression based on findings.", "input": "64 years Male (DOB:11/21/1951)Reason: evaluate for diffuse axonal injury vs. focal abnormality History: post-concussive symptoms 9 months after mTBIPROVIDER/ATTENDING NAME: NAOUM P ISSA NAOUM P ISSA The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several subcortical punctate-sized white matter lesions identified on FLAIR MRI and T2 MRI which were also present prior exam and have not changed. There is a one in particular in the left parietal lobe which was not clearly present on the prior exam but may have been obscured due to volume averaging because it appears to have been present on the prior coronal FLAIR MRI.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.No significant microhemorrhages are appreciated intracranially.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.The current exam appears be stable compared to the 2010 exam"}
{"instruction": "Generate impression based on findings.", "input": "Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: right temporal lesion crani planned for same day History: right temporal lesion Multiple fiducial markers attached on scalp during the scanning.There is a large intra-axial ring-enhancing mass on the right medial and posterior temporal lobe extended toward right side midbrain [34.8mm (RL) x 41.7mm(AP) x 39mm (CC)] , unchanged.Multiple satellite enhancing nodules were again seen, unchanged.Midline shift at the level of the foramen of Monro measured on axial scan is about 8mm, grossly unchanged. There is no evidence of trapped ventricle system or ventriculomegaly.The paranasal sinuses and mastoid air cells are clear.", "output": "Large peripherally enhancing high-grade intra-axial mass at the right posterior mesial temporal lobe with the multiple satellite lesions, and midline shift toward left side, unchanged since prior scan.."}
{"instruction": "Generate impression based on findings.", "input": " Intra-articular contrast is identified within the radiocarpal joint extending through the expected location of the scapholunate ligament. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 22 seconds", "output": "Successful fluoroscopic guided injection of dilute gadolinium into the midcarpal joint for subsequent MRI arthrogram examination."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: pre op planningSigns and Symptoms: tumor resection planning There is redemonstration of status post left-sided craniotomy for removal of a mass centered in the left inferior parietal lobule. There is T2 and FLAIR signal hyperintense lesion at the tumor bed. There is a masslike lesion measuring 18 x 15 mm axial dimensions along the posterior, medial and superior margins of the surgical site.An extra-axial lesion is present adjacent to the left temporal lobe which measures 11 mm on the current exam and 9 mm on the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Findings raise the question of local recurrence at the left parietal surgical site.2.An extra-axial mass adjacent to the left temporal lobe is slightly larger on the current exam when compared to the prior exam.3.Examination is limited and was performed for the purpose of the treatment planning."}
{"instruction": "Generate impression based on findings.", "input": " MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal T2/FLAIR hyperintensities scattered in the subcortical frontal white matter which is nonspecific. The brain parenchyma and pituitary gland otherwise appear 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. There is complete opacification of the right maxillary sinus which is underdeveloped.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms. The posterior communicating arteries are not well visualized.MRA Neck: There is a common origin of the left common carotid artery and brachiocephalic artery, with a separate origin of the left subclavian artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. However, the mid to distal right V2 segment appears irregular, although evaluation is limited due to surrounding venous structures. Similarly, the course of the proximal right V3 segment appears unusual with difficulty following the vertebral artery at this level, again with evaluation limited due to surrounding venous structures and possible collateral vessels. There is no evidence of definite flow-limiting stenosis or occlusion.", "output": "1.No evidence of intracranial abnormality. 2.Incomplete evaluation of the mid to distal cervical right vertebral artery, with evaluation somewhat limited due to surrounding venous contamination, although there is also concern for slight aberrant course of the distal right vertebral artery and possible collaterals. CTA neck recommended for further evaluation, to exclude possibility of previous dissection.3.Unremarkable MRA of the brain.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female patient with elevated LFTs. History of polycystic kidney disease. ABDOMEN:LIVER, BILIARY TRACT: Innumerable nonenhancing T2 hyperintense lesions throughout the liver are compatible with cysts with the suggestion of concomitant peribiliary cysts. No suspicious hepatic lesion is identified. There is no intrahepatic biliary duct dilatation. The proximal common bile duct is prominent in size measuring up to 7 mm in diameter, but smoothly tapers distally without evidence of an obstructing lesion. Trace dark signal within the mid-common bile duct may represent artifact or a small amount of pneumobilia.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Innumerable T2 hyperintense lesions throughout both kidneys without suspicious enhancement features are compatible with cysts. There is no hydronephrosis. Additional subcentimeter T2 hyperintense lesions are too small to characterize.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.No specific findings to account for the patient's symptoms. 2.Prominent proximal common bile duct without distal obstructing lesion. Trace dark signal within mid-common bile duct may represent artifact or trace pneumobilia; correlate with recent intervention. 3.Hepatic and renal cysts compatible with patient's diagnosis of polycystic kidney disease. "}
{"instruction": "Generate impression based on findings.", "input": "13-year-old female with right knee pain for 5 months. MENISCI: The lateral and medial menisci are intact and normal in appearance.ARTICULAR CARTILAGE AND BONE: There is a small focus of bone marrow edema affecting the medial intercondylar tubercle of the tibia. Otherwise, bone marrow signal intensity is normal. The articular cartilage is intact. No fracture.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral complex are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL", "output": "Contusion of the medial intercondylar tubercle of the tibia. "}
{"instruction": "Generate impression based on findings.", "input": "Synovial sarcoma. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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, and scalp soft tissues are grossly unremarkable. There is a persistent effusion within the left mastoid air cells and a small amount of fluid in the right mastoid air cells.Spine: There are postoperative findings related to C2-T2 laminoplasty and tumor debulking. There is perhaps slight interval increase in size and enhancement of the left paraspinal tumor with erosions of the vertebral bodies, encasement of the left vertebral artery at these levels, invasion of the corresponding neural foramina, and extension into the intraspinal epidural space, measuring up to 23 mm in width at the C3-4 level, previously 20 mm. There new and enlarging scattered enhancing bone marrow lesions in the cervical and upper thoracic spine and upper thoracic spine, but the vertebral body heights are preserved. There is a kyphotic curvature in the cervico-thoracic region, but no spondylolisthesis. The spinal canal is narrowed from C4 to T1, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. There is associated spinal cord flattening in this region, without spinal cord signal abnormality. There are partly imaged, but extensive mediastinal tumors. There are multiple nodules within the partially imaged right lung. There is a small right apical pneumothorax.", "output": "1. Postoperative findings related to C2-T2 laminoplasty and tumor debulking with apparent mild interval increase in size of the residual tumor in the treatment bed on the left side with associated vertebral body erosions, left vertebral artery encasement, and mild encroachment upon the spinal epidural space through the neural foramina. 2. New and enlarging scattered bone marrow lesions in the cervical and upper thoracic spine and upper thoracic spine, which may represent metastases. 3. The spinal canal is narrowed from C3-C7 with associated compression of the lower cervical and upper thoracic spinal cord, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. 4. No evidence of intracranial metastases.5. Partially imaged mediastinal tumors, pulmonary metastases, and bilateral small pleural effusions. Please refer to the separate chest CT report for additional details."}
{"instruction": "Generate impression based on findings.", "input": "Female, 63 years old, with worsening altered mental status, hepC cirrhosis with history of hepatic encephalopathy, hyponatremia, head CT today with new hyperattenuation in the pons. An area of susceptibility is seen within the central pons with surrounding T2 hyperintensity which fans up into the cerebral peduncles. A separate smaller focus of susceptibility with no associated T2 hyperintensity is seen within the posterior right frontal lobe.On T1 weighted images, the basal ganglia show mild symmetric intrinsic hyperintensity. No restricted diffusion is seen. Scattered small foci of T2 hyperintensity are present within the subcortical white matter of the cerebral hemispheres but without associated mass effect. Also noted, however, is asymmetric ependymal T2 hyperintensity along the right occipital horn.No pathologic extra-axial fluid collections are detected. Ventricular size is within normal limits.", "output": "1. A small pontine hemorrhage is detected, correlating with an abnormality noted on prior CT. This may simply reflect a coagulopathic hemorrhage without any additional underlying process. T2 hyperintensity within the pons may therefore simply reflect edema. However, in the context of rapidly corrected hyponatremia, the possibility of coexisting osmotic demyelination may also be considered.2. A smaller focus of chronic hemorrhage is seen within the right posterior frontal lobe.3. Scattered foci of subcortical T2 hyperintensity are nonspecific.4. Asymmetric ependymal signal abnormality along the right occipital horn could be a variation of normal, though the possibility of an underlying inflammatory or infectious process is not excluded.5. Intrinsic T1 hyperintensity within the basal ganglia is compatible with chronic hepatic encephalopathy. Typical findings for acute hepatic encephalopathy are not clearly present on this examination. Continued follow-up is advised."}
{"instruction": "Generate impression based on findings.", "input": "39 year old female with neurosarcoidosis. Interval change of the fourth ventricle. Shunt placement left frontal. Rest of provided clinical data is not legible. Transient alteration of awareness. Nonenhanced CT of brain:Images through posterior fossa demonstrate an enlarged fourth ventricle and no appreciable interval change since prior MRI exam.Images through supratentorial space demonstrate collapsed left lateral ventricle. This is similar to what was noted on prior MRI exam. Normal appearing right lateral ventricle and similar in size to prior MRI study.Third ventricle is small and in midline and with no interval change. Left-sided ventricular catheter traverses the left frontal lobe, enters the left frontal horn, traverses the midline and with the tip at the level of foramina of Monroe on the right. Small area of encephalomalacia in bilateral frontal lobes (right greater than left) shows no interval change since prior MRI. There is no evidence of hemorrhage, edema mass-effect or midline shift.", "output": "1.No evidence of new findings since prior MRI examination of brain.2.Dilated fourth ventricle and a small supratentorial ventricular system remains stable since prior study."}
{"instruction": "Generate impression based on findings.", "input": "Male 27 years old Reason: please evaluate for disease activity and peri-anal disease History: abdominal pain, weight loss, diarrhea 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: Multifocal areas of abnormality throughout the colon and rectum. There is a 4.0-cm segment of wall thickening, edema, mural hyper enhancement and luminal narrowing in the distal transverse colon (series 501, image 15). There is marked dilatation of the proximal transverse colon measuring up to 11.1 cm. There is a second more distal segment of severe luminal narrowing involving the descending colon which measures at least 17cm which persists throughout the study. There is mild associated mural edema and hyperenhancement. The proximal transverse colon measures 9.3 cm in dimension. The rectum is markedly abnormal with significant mural thickening, stratification and edema. There is mild engorgement of the adjacent vasa recta as well as fibrofatty proliferation. The 3 above described segments demonstrate diffusion restriction. The findings are consistent with stenotic disease with associated inflammatory changes which are most marked in the rectum.Evaluation of the terminal ileum is limited on postcontrast images however there is no significant hyperenhancement.Above average stool burden in the ascending colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild upper abdominal ascites.", "output": "1.Multifocal stenotic disease of the transverse, descending colon and the rectum with superimposed inflammatory changes which are most marked in the rectum. There is marked colonic dilatation proximal to the stenotic segments.2.Abdominopelvic ascites and diffuse anasarca.3. Evaluation for perianal disease as clinically queried is limited on this study. This would be better characterized with a dedicated pelvic MRI if clinically indicated.Findings discussed with Dr. Yarur at time of dictation 10:00 a.m. 03/30/15."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: New tiny a lesion on MRI. Concern for arteriovenous malformation. Evaluate for arteriovenous malformation. Signs and symptoms: Neck pain/stiffness/headaches. Non-enhanced CT of brain:Examination demonstrate no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. Previously noted mildly enhancing cranial mass is not identified on this exam. There was no evidence of arteriovenous malformation malformation on prior MRI exam or the current CT.Calvarium is intact.Mastoid air cells, middle ear cavities and limited view of the paranasal sinuses are within normal.CTA of intracranial circulation:Right internal carotid is well visualized across the skull base and through the cavernous sinus with no abnormality. Supraclinoid right internal carotid artery, right posterior communicating artery, right anterior and middle cerebral arteries and their branches are within normal limits.Left internal carotid is well visualized and unremarkable in its cavernous and supraclinoid portion. There is normal visualization of a small posterior communicating artery. The anterior and middle cerebral arteries are within normal limits. There is anatomical variation of hypoplastic left A1. There is no evidence of arteriovenous malformation.Vertebral basilar system, there is normal visualization of bilateral intracranial vertebral arteries. Normal appearing right pica is identified. There is no visualization of the left pica. Basilar artery, superior cerebellar arteries and posterior cerebral arteries are well visualized and within normal limits. There is no detectable arteriovenous malformation as clinically questioned. The findings in the pineal region noted on prior MRI is not consistent with an arteriovenous malformation and it represents a mass.65 cc of Omnipaque 350 is administered for above study.", "output": "1.Negative non-enhanced CT of brain. 2.Previously noted less than one CM mass in the pineal region is not identified on this non-infused head CT.3.No evidence of arteriovenous malformation on this CTA or prior MRI exam.4.Negative CTA of intracranial circulation."}
{"instruction": "Generate impression based on findings.", "input": "66 year old male with history of heart transplant in 9/2015 presenting for evaluation for function and evidence of rejection. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 198 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 98 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 89 g (normal range 164+/-36). There are no regional wall motion abnormalities. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. However, native myocardial T1 and myocardial ECV fraction are both elevated suggesting underlying inflammation, fibrosis, or infiltration.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 94 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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. The anastomosis of transplant and native aorta is well seen without any significant stenosis. 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 a trivial pericardial effusion. Extracardiac FindingsSternal wires are present. Right renal cyst. Can not rule out left renal mass, correlation with other imaging suggested. 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.Post transplant protocol values: Global relative enhancement 1.4 (normal < 4)T2 STIR Edema ratio 1.99 (normal < 2)Native T1 time: 1183 ms (normal < 1050ms)Extracellular volume fraction 33% (normal 20-30%)", "output": "1. The left ventricle is normal in size and low normal systolic function. The overall LV ejection fraction is 50%. There are no regional wall motion abnormalities. There is no LGE and normal myocardial global relative enhancement and T2 ratio; however, native myocardial T1 and ECV fraction are both elevated suggesting underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%.3. Mild mitral regurgitation.4. Extracardiac findings as above. Findings conveyed to referring team. "}
{"instruction": "Generate impression based on findings.", "input": "45 years, Female, trigeminal neuralgia, rule out brainstem lesion. Brain parenchyma appears within normal limits. Specifically no lesions within the brainstem are appreciated. 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.Sella and orbits are grossly within normal limits. There is moderate mucosal thickening involving the left sphenoid sinus. Bone marrow signal and extracranial soft tissues are within normal limits. Noted is an enhancing, likely small venous structure, coursing along the superior aspect of the cisternal segment of the right trigeminal nerve as well as along the medial aspect of the trigeminal nerve as it enters the Meckel's cave.", "output": "1. No brain parenchymal signal abnormalities or intracranial mass.2. There is an enhancing, likely small venous structure, coursing along the superior aspect of the cisternal segment of the right trigeminal nerve as well as along the medial aspect of the right trigeminal nerve as it enters the Meckel's cave. Finding is of uncertain significance and can be correlated with symptomatology (per EMR, patient's symptoms are left sided). Also note examination was performed per routine brain MRI protocol and additional high-resolution sequences of the trigeminal nerve including its extracranial course can be obtained if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Patient fell while skiing, pain medially but now more lateral. MENISCI: The medial meniscus is intact, however the lateral meniscus demonstrates a more complex tear within the body extending into the anterior horn with extension to both the superior and inferior articular surfaces (image 9 series 5). Additionally and more posteriorly is a second discrete abnormality involving the apical aspect of the posterior lateral meniscus. No distinct communication is seen with the anterior lesion and specifically this posterior horn abnormality involves the superior articular surface. Both menisci are properly anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Minimal edema observed in the medial femoral condyle and tibial plateau, suggesting mild contusion. The remaining marrow signal and cartilage are otherwise unremarkableLIGAMENTS: Thickening with increased internal signal in the medial collateral ligament proximally suggests a moderate strain. Fibers however appear intact. The LCL, ACL and PCL are all otherwise unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Acute lateral meniscal tears as described involving both the posterior and anterior horns."}
{"instruction": "Generate impression based on findings.", "input": "45 years, Female, Reason: Pt with intermittent vertigo, HA, diplopia, incoordination; rule out cerebellar abnormality, MS, or lesions. Also hyperreflexia and neck pain. Brain: No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few foci of T2/FLAIR hyperintensity are seen in the frontal subcortical white matter, which are nonspecific. There is a punctate focus of susceptibility in the left posterior temporal lobe subcortical white matter consistent with chronic microhemorrhage or calcification. Brain parenchyma is otherwise unremarkable for age. Developmental venous anomaly in the left cerebellar hemisphere is incidentally noted. No suspicious parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is a tiny mucous retention cyst in the left maxillary sinus. There is nonspecific prominence of the nasopharyngeal lymphoid tissue. Paranasal sinuses and mastoid cells are clear. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from mild reversal of cervical lordosis which may be in part positional. Bone marrow signal is benign including T1 hyperintense lesions involving the T1 and T2 vertebrae compatible with hemangiomas or foci of fat. The cervical spinal cord has normal signal characteristics.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Tiny central disc protrusion which contacts the ventral cord. No significant compromise to the spinal canal or neural foramina.C4-5: Disc osteophyte complex with effacement of the ventral thecal sac and overall very mild spinal canal stenosis. There is also mild right neural foraminal stenosis. Left neural foramen is patent.C5-6: Disc osteophyte complex and uncovertebral hypertrophy with mild to moderate spinal canal stenosis. There is also mild to moderate right and mild left neural foraminal stenosis.C6-7: There are edematous endplate marrow signal changes and small Schmorl's node involving the superior C7 endplate. There is disc osteophyte complex and ligamentum flavum thickening. There is moderate degree of spinal canal stenosis at this level with mild cord contour deformity but without cord signal abnormality. There is moderate right and mild to moderate left neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.There is a partially imaged enlarged left thyroid nodule measuring at least 4 cm in the transverse dimension and 5.2 cm in the craniocaudal dimension.", "output": "1. Brain parenchyma is essentially unremarkable. No intracranial mass or mass effect. There are minimal foci of T2/FLAIR hyperintensity in the bifrontal subcortical white matter which are nonspecific and not particularly suggestive of demyelinating disease. There is also a single punctate focus of susceptibility, which may represent a chronic microhemorrhage or focus of punctate calcification, in the left posterior temporal lobe.2. No signal abnormality or abnormal enhancement in the cervical cord. There are multilevel degenerative changes with moderate spinal canal stenosis at the C6-C7 level and to a slightly lesser degree at the C5-C6 level. Additional levels as above.3. Large left thyroid nodule which can be further assessed with ultrasound as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male. Cirrhosis status post OLT 4/90. Evaluate for lesions, assess hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with no suspicious focal lesions. Diffuse low T2 signal liver consistent with iron deposition, unchanged. Mild lacelike T2 hyperintensity that shows mild delayed enhancement in the right hepatic lobe consistent with confluent fibrosis, unchanged. Two small hepatic cysts. Portal vein and hepatic veins are patent. TIPS in expected position and with internal enhancement indicating patency.Gallbladder is not visualized, presumably resected. Multiple splenic and gastrohepatic varices are present, unchanged.Central intrahepatic biliary ductal dilatation, unchanged.SPLEEN: Stable moderate splenomegaly. Markedly enlarged splenic artery and vein, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral small 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": "Cirrhotic liver morphology with diffuse iron deposition without suspicious focal mass."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Lange is a 47-year-old female with BRCA1 mutation presenting for high-risk breast cancer screening. She has a personal history of right lumpectomy for IDC with medullary features in 2003. She is status post radiation and chemotherapy. She has a family history of breast cancer in her sister diagnosed at age of 28 and ovarian cancer in a paternal aunt. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the right upper outer breast and right axillary region. There is no abnormal enhancement seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: any change in plexiform mass History: plexiform, NF type 1, pt complaining of daily pain. Again seen is a trans-spatial plexiform mass centered in the left retropharyngeal soft tissues that spans from the level of the nasopharynx into the mediastinum, with extension and left carotid space with associated partial encasement of the great vessels, and into the left visceral space with associated distortion of the thyroid gland. The mass measures up to 4.6 x 3.8 cm in the AP and transverse dimensions, axial series 701 image 11, and is not significantly changed. More superiorly at the level of the oropharynx mass measures 2.0 cm in the short axis, series 701 image 29, which is also not significantly changed. Craniocaudal extension approximately 14 cm is also not significantly changed.Again seen is narrowing of the oropharyngeal airway as well as rightward deviation of the trachea. Partially imaged brain demonstrates multiple T2 hyperintense lesions in the cerebellum, brainstem, and middle cerebellar peduncles, similar to prior. Cervical and upper thoracic spinal canal remains patent.", "output": "1. Compared to 8/25/2015 and 3/23/2015, there is no significant change in size of the plexiform neurofibroma centered in the left retropharyngeal soft tissues with extension into the mediastinum. Mass effect on the oropharyngeal airway, rightward tracheal deviation, and partial encasement of the left carotid vasculature again seen. 2. Partially-imaged intracranial stigmata of neurofibromatosis type 1."}
{"instruction": "Generate impression based on findings.", "input": "Numbness/pain and tingling of left arm. The examination is limited due to extensive motion artifact.CERVICAL SPINE: The cervical lordosis is preserved, but there is mild retrolisthesis of C3 over C4, C5 over C6, and C6 over C7. There is congenital narrowing of the spinal canal. The spinal cord demonstrates grossly normal caliber and signal intensity. There is mild heterogeneity of the bone marrow signal. The paravertebral soft tissues are unremarkable.Additional findings by level:C2-3: There is no significant disc herniation, neural foraminal stenosis, or spinal stenosis.C3-4: There is a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in mild spinal cord impingement and probable mild bilateral neural foraminal stenosis.C4-5: There is a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in mild spinal cord impingement without significant neural foraminal stenosis.C5-6: There is a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in mild spinal cord impingement and at least mild bilateral neural foraminal stenosis.C6-7: There is a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in mild to moderate spinal stenosis without significant neural foraminal stenosis.C7-T1: There is no significant disc herniation or neural foraminal stenosis.THORACIC SPINE: The thoracic kyphosis is preserved. The vertebral body heights are maintained. There is heterogeneous bone marrow signal, with multiple T1 and T2 hyperintense lesions. The largest lesion is in the T5 vertebral body, measuring up to 2 cm. There are additional lesions in the T2, T7, T8, T10, and T12 vertebral bodies. There is no evidence for pathologic fracture. There is no evidence for tumor within the thoracic spine. The thoracic spinal cord demonstrates normal signal intensity and morphology. There are scattered intravertebral disc herniations. There is no significant disc herniation, spinal stenosis, or neural foraminal stenosis. The paravertebral soft tissues are unremarkable.", "output": "1. Limited examination without intravenous contrast demonstrates multifocal T1 and T2 hyperintense lesions throughout the thoracic spine, but no compression fractures. These likely represent atypical hemangiomas, but the possibility of metastatic disease is also a consideration.2. No evidence for tumor within the spinal canal although assessment is limited by the lack of contrast and extensive motion artifact.3. Degenerative spondylosis of the cervical spine superimposed upon congenital spinal canal narrowing with multilevel impingement upon the spinal cord.4. No significant thoracic spinal canal narrowing."}
{"instruction": "Generate impression based on findings.", "input": "History of NASH cirrhosis and hepatocellular carcinoma status post ablation. Interval follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology liver with nodular surface contour and widened fissures. There is redemonstration of a segment 8 ablation cavity. There is no adjacent early arterial enhancement to indicate recurrent disease. No suspicious arterial enhancing lesions elsewhere in the liver.The portal vein is borderline enlarged measuring 13 mm in diameter. The portal veins are patent. The hepatic veins and hepatic arteries are also widely patent. There is recanalization of the umbilical vein as well as multiple prominent splenorenal collaterals measuring up to 9 mm.Cholelithiasis with chronic gallbladder wall thickening. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Prominent splenomegaly with the spleen measuring 17.7 cm in length.PANCREAS: The pancreas has normal signal and morphology. The duct is within normal limits for size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts. No focal mass lesion. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Note is made of abdominal wall venous collaterals.OTHER: Trace perihepatic ascites.", "output": "1.Hepatic cirrhosis. Unchanged ablation cavity in segment 8. No suspicious arterial enhancing lesions to indicate new or recurrent disease.2.Findings of portal hypertension including splenomegaly, perihepatic ascites, and splenorenal shunt formation."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Unspecified dementia without behavioral disturbanceClinical question: cognitive declineSigns and Symptoms: memory loss, language problems, some behavior The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a cystic type lesion present along the right cerebellar medullary angle cistern which measures 22 x 18 mm in axial dimensions. It follows spinal fluid on all pulse sequences fairly closely. The adjacent nerve roots, right anterior inferior cerebellar artery and right vertebral artery drape around this cyst its superior extent is at the right cerebellopontine angle cistern where it abuts the right nerves VII and VIII.There is partial empty sella present.There is a T2 hyperintense and FLAIR hypointense lesion present in the left basal ganglia associated with some exact effect on the left lateral ventricle suspected represent an old lacunar infarct associated with some susceptibility effect around it.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Findings are compatible with an arachnoid cyst at the right cerebellar medullary angle cistern displacing the adjacent nerve roots and mildly impressing on the brainstem.2.No evidence for acute ischemic cerebral infarction.3.Findings are compatible with an old lacunar infarct involving left basal ganglia and centrum semiovale.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 54 years old, with unstable gait and brisk deep tendon reflexes, history of cervical laminectomy. Cervical:Evidence of anterior instrumented spinal fusion are seen from C5 through C7, similar to the prior examination. At least some degree of osseous fusion is evident across the disc space at C5-6 with only questionable fusion across C6-7.Spinal alignment is within normal limits. Apart from operative changes, the morphology and signal characteristics of the vertebral bodies are within normal limits. No pathologic marrow enhancement is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No pathologic spinal cord or leptomeningeal enhancement is seen.Incidental note is made of at least two nodules within the left thyroid gland.C2-3: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes.C3-4: Mild left facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes.C4-5: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes.C5-6: Mild facet hypertrophy. Fusion across the disc space. No significant spinal canal or foraminal stenosis. No interval changes.C6-7: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes.C7-T1: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes.Thoracic:Alignment is grossly anatomic. Vertebral body morphology is within normal limits. Signal characteristics suggesting a benign hemangioma are evident within the T7 vertebral body. No concerning marrow space signal abnormality or enhancement is seen.The visualized spinal cord demonstrates normal signal and morphology throughout. No pathologic cord or leptomeningeal enhancement is seen.A small left paracentral disc protrusion is evident at T8-9 which may have slightly increased in size from the prior examination. No other significant disc bulges or disc herniations are seen. The spinal canal and neural foramina are not significantly compromised at any level.", "output": "1.Redemonstration of findings related to anterior instrumented fusion from C5 through C7.2.Relatively mild degenerative findings are seen as described by level above.3.No areas of significant spinal canal or foraminal stenosis are detected in either the cervical or thoracic spine.4.No enhancing spinal lesions are demonstrated."}
{"instruction": "Generate impression based on findings.", "input": "Renal cell cancer, new onset terrible back pain. History of surgery in 2011. There is transitional anatomy at the lumbosacral junction with partial sacralization of the L5 vertebra which is better seen on prior CT. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5 as before. There are postsurgical changes of interbody as well as posterior spinal fusion at the L3-L4 and L4-5 levels with interbody implants and posterior pedicle screws and paraspinous rods extending from the L3-L5 levels. No bone marrow infiltrating or destructive osseous lesion is appreciated to suggest metastatic disease. No obvious epidural tumor within the limits of noncontrast study. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening which contribute to moderate to severe spinal canal stenosis and significantly progressed since prior MRI from 1/10/2012. There is also mild to moderate bilateral neural foraminal stenosis which has also progressed. There is distention of the facet joints.L3-L4: Prior left-sided laminectomy. Again seen is effacement of the left lateral recess and medial aspect of the neural foramen related to posterior displacement of the interbody implant and overlying disc protrusion. This finding is grossly similar to prior and is associated with deformity of the left ventral aspect of the thecal sac. Otherwise no significant central spinal canal stenosis. Mild bilateral neural foraminal narrowing. L4-L5: Spinal canal is surgically decompressed. This level is not well evaluated due to artifact from the hardware but the findings are grossly similar to prior. There is mild effacement of the left lateral recess and moderate to severe left foraminal stenosis related to left foraminal disc protrusion and osteophyte. There may be impingement of the left L4 nerve root. No significant central canal stenosis. Possible mild right neural foraminal stenosis but also grossly similar to prior.L5-S1: No significant spinal canal or neural foraminal stenosis. There appears to be contact of the left L5 nerve root with an osteophyte extra foraminally without clear impingement. There is facet arthropathy throughout the lumbar spine which was better seen on prior CT. Paraspinous soft tissues demonstrate no suspicious lesions. Atrophic right kidney. Left kidney surgically absent. Right iliac fossa transplant kidney partially imaged.", "output": "1. Postoperative changes of spinal fusion from L3 to L5 with development of moderate to severe spinal canal stenosis at the L2-L3 level. This finding is significantly progressed since prior MRI from 1/10/2012.2. No evidence of metastatic disease in the lumbar spine within the mild limitations of a noncontrast study. Patient refused IV contrast and was claustrophobic.3. Additional degenerative findings as detailed above including left L4-L5 neural foraminal stenosis. Effacement of the left lateral recess at the L3-L4 level related to posteriorly displaced interbody implant and overlying disc protrusion also again seen."}
{"instruction": "Generate impression based on findings.", "input": "Multiple sclerosis [G35], Reason for Study: ^Reason: History of MS, brain and spinal cord lesions, worsening symptoms History: Lower extremity weakness and spasticity Brain MRIMultiple various sized scattered T2/FLAIR high signal intensity lesions without mass effects are seen involving bilateral hemispheric white matter, midbrain and bilateral cerebellar hemispheres. The size, number and distribution patterns do not show any significant interval change since prior scan. These findings are consistent with demyelinating disease such as multiple sclerosis.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift. 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.Cervical MRIMotion artifacts degraded image quality.Subtle ill defined T2 high signal intensity lesions are redemonstrated from C2 to C6 level. Comparing to prior scan, these subtle high signal intensity lesions do not show any significant interval change.There is no evidence of focal spinal cord swelling.The cervical spine is straightened but the alignment appears to be normal.Vertebral body heights are maintained and there is no evidence of spinal canal stenosis.From C12 to C7T1, there is no evidence of neuroforaminal stenosis.", "output": "1. Multiple scattered bihemispheric white matter lesions which are consistent with demyelinating disease such as multiple sclerosis. No significant interval change of white matter lesions' number, size and pattern of distribution since prior scan.2. Ill defined patchy T2 high signal lesions from C2 to C6 level, unchanged since prior scan. However, due to motion artifacts, precise evaluation was not possible."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are:1. Diagnostic mammogram and ultrasound dated 2/24/2016 2. Right breast stereotactic biopsy and ultrasound-guided biopsy mammogram dated 9/8/20163. Breast MRI dated 9/24/2016 For comparison,1/21/2015, 7/14/2014, 7/3/2014 are available. Imaging performed at Northwestern Memorial Hospital. 1. Diagnostic mammogram and ultrasound dated 2/24/2016:Patient has a history of 2 stereotactic biopsies in 2014 with pathology reported as FEA.2 standard views of the right breast with spot magnification were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. X shaped and a hourglass trimark clip in the central inner right breast are unchanged from prior examination, consistent with prior benign biopsies.Grouped pleomorphic, linear branching calcifications spanning almost 40 mm are noted in the right lower inner quadrant medial to the 2 clips on CC view and between the 2 clips on the LM view.Ultrasound performed showed a few simple cyst in the right breast 3 and 4:00 position. An irregular hypoechoic area with few calcifications and blood flow is identified in the right breast 3:00 position 3 cm from the nipple.A diagnostic mammogram with ultrasound was performed on 8/17/2016, mammogram images have not been provided. Ultrasound dated 8/17/2016 shows a 6 mm irregular mass in the right breast 3:00 position for which ultrasound-guided biopsy was recommended. 2. Right breast stereotactic biopsy and ultrasound-guided biopsy mammogram dated 9/8/2016:An irregular hypoechoic lesion is identified in the right breast 3:00 position 3 cm from the nipple which was subsequently biopsied under ultrasound guidance. Targeting appears adequate and a coil clip was placed. Pathology is benign as per the report and appears concordant.As per the report is a coil clip did not correspond to the medications, subsequent surgical biopsy was performed and a venous clip was placed. Specimen radiograph has not been provided.Pathology revealed DCIS on samples with and without calcifications. Postprocedure mammogram demonstrates 2 additional clips, a venous clip from the stereotactic biopsy and a coil clip from the ultrasound biopsy in the right lower inner quadrant.3. Breast MRI dated 9/24/2016: Outside hospital protocol MRI uploaded on DYNACAD for post processing. Heterogeneously dense breast parenchyma noted bilaterally. Multiple cysts noted bilaterally. Multiple enhancing foci noted bilaterally none of them are uniquely enhancing.Extensive non mass enhancement in the right lower inner quadrant extending from 4 to 5:00 position measures 66 x 35 x 46 mm (AP X ML X CC) extending anteriorly to the nipple. 2 clip artifacts identified in the medial right breast from the venous and the coil clip. Nonmass enhancement is seen adjacent to the venous clip. The medialmost coil clip is close to the skin and nonmass enhancement is seen lateral to the clip.Outside hospital mentions an enhancing focus in the right upper-outer quadrant which appears to be in the spectrum of multiple enhancing foci or a benign intramammary lymph node. No abnormal axillary lymph nodes in the partially visualized axillary regions.", "output": "Stereotactic biopsy of increasing calcifications in the right lower inner quadrant, pathology revealed DCIS in samples with and without calcifications. MRI shows extensive nonmass enhancement, more than the calcifications seen on MRI, approximately 66 mm extending anteriorly to the nipple. MR guided biopsy of the anterior nonmass enhancement can be performed for tissue confirmation if needed.Multiple enhancing foci bilaterally none of them are uniquely enhancing.No abnormality in the left breast or visualized axillary regions. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Radiculopathy, lumbar regionClinical question: lumbar radiculopathySigns and Symptoms: back pain radiating to leg Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.There are large cystic type lesions present along the expected location of the right ovaries one measuring approximately 23 mm and the other one measuring approximately 43 x 31 mm in sagittal dimensions. They are adjacent to each other small amount of fluid is present in the uterus.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge which has progressed since the prior exam. There is now greater encroachment of the nerve roots at the lateral recess bilaterally on the current exam versus the prior exam. There is more encroachment of the nerve roots at the right lateral recess versus the left lateral recess at this level. There is mild facet and ligamentum flavum hypertrophy at this level.At L4-5 there is redemonstration of loss of disc space height and disc desiccation and a diffuse disc bulge associated with encroachment of the nerve roots at the left lateral recess. The encroachment of the nerve roots at the left lateral recess at this level appears slightly less prominent than on the prior exam. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.There are large ovarian cysts present on the right side. Please correlate with the patient's ultrasound results from 10/9/2015 for further comments. These cysts are incompletely visualized on the current exam2.Since the prior exam degenerative disc disease at L5-S1 has progressed. There is now greater encroachment of the nerve roots of the right lateral recess and to a lesser degree left lateral recess.3.Since the prior exam there is been some mild regression of disc disease at L4-5 with some encroachment of the nerve roots at the left lateral recess which is slightly less on the current versus the prior exam."}
{"instruction": "Generate impression based on findings.", "input": " Bone marrow appears benign. There is a minimal spondylolisthesis of L4 on L5. The vertebral bodies height appears normal. The conus medullaris ends at the level of L1. There are no paraspinal abnormalities.At the level of T12-L1 there is no evidence of spinal or nerve root compromise. At the level of L1-L2 there is no evidence of spinal or nerve root compromise.At the level of L2-L3 there is no evidence of spinal or nerve root compromise. There is mild hypertrophy of the ligamentum flavum and mild facet hypertrophy bilaterally.At the level of L3-L4 there is mild disc bulge with no evidence of spinal or nerve root compromise. There is a thickening of the ligamentum flavum. There is mild right facet hypertrophy and moderate left facet hypertrophy.At the level of L4-L5 there is mild disc bulge with no evidence of spinal compromise. There is mild bilateral neural foraminal narrowing. There is bilateral severe facet hypertrophy with small right facet effusion. There is hypertrophy of the ligamentum flavum.At the level of L5-S1 there is mild disc bulge with no evidence of spinal or nerve root compromise. There is moderate right facet hypertrophy and mild left facet hypertrophy.", "output": "Minimal spondylolisthesis of L4 on L5. At this level there is mild bilateral neural foraminal narrowing with bilateral severe facet hypertrophy containing a small right facet effusion."}
{"instruction": "Generate impression based on findings.", "input": "Tuberous sclerosis [759.5] / Benign neoplasm of kidney, except pelvis [223.0], Reason for Study: ^Reason: evaluate changes in renal angiomyolipomas s/p embolization History: tuberous sclerosis Multiple bihemispheric cortical high signal intensity lesions involving left superior frontal gyrus, left parietal lobe superior and inferior parietal lobule, left lateral orbital gyrus, left temporo-occipital gyri, right superior frontal gyrus, right inferior parietal lobule, right insular, right temporo-occipital gyri and right lateral orbital gyrus indicate cortical tubers, and they do not show any significant interval change in terms of size and MR characteristics since prior scan.High signal intensity lesions on the subcortical white matter on the right posterior temporal lobe, left trigone area, left lateral orbital gyrus subcortical white matter, no change since prior scan.Enhancing lesions on the left lateral ventricle occipital horn, left side foramen of Monroe and right lateral ventricle occipital horn area indicating subependymal giant cell astrocytomas do not show any significant interval change since prior scan in terms of size and MR characteristics.There are also various sized subependymal nodular lesions on bilateral lateral ventricles indicating subependymal hamartomas appear to be stable in terms of size, number and MR characteristics since prior exam.The ventricles, sulci and cisterns are symmetric and unremarkable. 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": "No interval change of above described cortical tubers, white matter abnormal signal intensities, subependymal hamartomas, and subependymal giant cell astrocytomas since prior scan. "}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female with AIH cirrhosis. HCC screening. ABDOMEN:LUNG BASES: Moderate right and small left pleural effusions, partially visualized. Small hiatal hernia.LIVER, BILIARY TRACT: Cirrhotic liver morphology with nodular surface contour and hypertrophy of the caudate and left lobes. No focal hepatic lesions. No biliary ductal dilation. Hepatic and portal veins are patent. Hepatic artery is patent. Small portosystemic shunts including esophageal varices noted. SPLEEN: Moderate splenomegaly with the spleen measuring up to 15.8 cm.PANCREAS: T2 hyperintense cystic focus in the anterior pancreatic body without mural nodularity or enhancement, measuring up to 18 mm craniocaudally (series 2/39). An additional smaller lesion is seen in the posterior pancreatic body, measuring up to 4 mm (series 7/23). These are most suspicious for small side branch IPMNs. Normal caliber of the main pancreatic duct measuring up to 1-2 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild body wall anasarca.OTHER: Moderate abdominal ascites.", "output": "1. Cirrhotic liver morphology without focal liver lesion.2. Findings suggestive of portal hypertension with splenomegaly, ascites, and small portosystemic shunts.3. Two cystic foci in the pancreatic body suspicious for small sidebranch IPMNs and for which follow-up imaging is recommended.4. Contrast extravasation occurred as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Complains of headaches. On Coumadin. Rule out chronic subdural? Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The pituitary gland appears a slightly enlarged and with apparent extension into the basal cistern. This is concerning for a pituitary adenoma and follow-up with an MRI exam is recommended. This finding measures approximately 15.2 mm in cranial cephalad access on sagittal reformatted images.The cortical sulci, ventricular system, cisterns cisterns and gray -- white matter differentiation is within normal limits.Calvarium is intact.Paranasal sinuses and mastoid air cells are well pneumatized and unremarkable.", "output": "1.Pituitary adenoma as described above. Follow-up with an MRI is recommended.2.Unremarkable non-infused CT of brain and calvarium.3.Visualized paranasal sinuses and mastoid air cells are unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "Reason: MS, f/u progression History: paresthesias Brain:Redemonstration of numerous T2 hyperintense lesions within the periventricular and to a lesser extent subcortical white matter, including within the corpus callosum. There is a single new lesion in the right posterior frontal lobe subcortical white matter (series 501 image 64 and series 801 image 47). This demonstrates mild enhancement compatible with an active lesion.There is no evidence of intracranial hemorrhage, or mass.The ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.Right maxillary sinus mucous retention cyst. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:Again noted are multiple poorly defined long segment foci of increased T2 signal within the cervical spine. There is no associated cord expansion. The vertebral column alignment is within normal limits. The vertebral body and disc heights are preserved. The vertebral bone marrow signal is unremarkable. No significant spinal canal or neural foraminal stenoses.", "output": "1. Numerous intracranial white matter lesions compatible with the history of multiple sclerosis. There is a single new right frontal lobe subcortical lesion which also demonstrates enhancement indicating an active lesion.2. Numerous long segment poorly defined intramedullary lesions in the cervical spine compatible with the history of MS. No significant interval change."}
{"instruction": "Generate impression based on findings.", "input": " Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and trifurcates into the left anterior descending, ramus intermedius, and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD. The distal LAD is diminutive, the LV apex is supplied by RV acute marginal branches.Ramus intermedius: No significant stenoses.LCx: The left circumflex coronary artery is non-dominant and small. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery, giving rise to a large RV marginal branches (which supply the usual territory of the distal LAD, a second RV marginal branch that supplies the usual territory of the posterior descending artery), a diminutive PDA, and a posterolateral branch. There are no significant stenoses in the right coronary artery.Left VentricleThe left ventricle is normal in size. There are at least two anatomic (but not functional) ventricular septal defects. The first is located immediately proximal to the aortic valve in the usual location of the distal RVOT. The second is a muscular VSD located in the apical septum. Both VSDs have been isolated from the right ventricle by a VSD patch. There appears to be no contrast communicating between the isolated anatomical VSDs and the functional right ventricle. This explains why no turbulent jet was seen through the \"VSD\" on the prior cardiac MRI.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated. Not well visualized on the recent cardiac MRI, it is apparent on this study that the RV was surgically foreshortened with a patch to exclude apical muscular septal defect.Right AtriumThe right atrium is mildly dilated dilated. The right atrial appendage is located in between the left atrium and the pulmonary and aortic roots. Aortic ValveThe aortic valve is superior, anterior and to the left of the pulmonary valve.Mitral ValveThe mitral valve has no calcification.Pulmonic ValveThe pulmonic valve is normal in caliber but located to the right and posterior to the aortic root; it arises from the basal anterior wall of the right ventricle, likely via a conduit. Tricuspid ValveThe tricuspid valve has no calcification.Great VesselsMain pulmonary artery trunk (and pulmonic valve) is located along the right inferior border of the aortic root. The pulmonary artery and pulmonic valve are attached via, what is presumed to be, a short conduit to the basal free wall of the right ventricle. The distal main pulmonary artery is mildly narrowed. There are mild stenoses of the proximal right and left pulmonary arteries. Distally, the right and left pulmonary arteries are each mildly dilated. The aortic root is rotated counter-clockwise, posteriorly, and superiorly. It is likely connected to the left ventricle via an intra-ventricular baffle. The aortic arch is right-sided. The left innominate artery originates most proximally, followed by the right carotid and then right subclavian arteries. Systemic Venous ReturnRight SVC and IVC normally drain into the right atrium. A persistent left SVC courses in between the left atrial appendage and left sided pulmonary veins ultimately draining into the right atrium via a dilated coronary sinus.Pulmonary Venous ReturnAll four pulmonary veins drain into the left atrium.PericardiumThere is no obvious pericardial disease.", "output": "1.Double outlet right ventricle s/p repair. See above for details. 2.There is normal origin of the coronary arteries. There are no significant coronary artery stenoses present. The distal LAD is diminutive; however, the LV apex is supplied by large acute RV marginal branches.3. There are at least two anatomic (but not functional) ventricular septal defects. The first is located immediately proximal to the aortic valve in the usual location of the distal RVOT. The second is a muscular \"VSD\" located in the apical septum. Both \"VSDs\" have been isolated from the right ventricle by a VSD patch. There appears to be no contrast communicating between the isolated anatomical VSDs and the functional right ventricle. This explains why no turbulent jet was seen through the \"VSD\" on the prior cardiac MRI.4. Normal LV size.5. Moderate RV dilation.6. Persistent left sided SVC draining to coronary sinus.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "History of concussion now with abnormal olfactory sensation, bifrontal headaches, and vision abnormalities. No lesions are identified in the anterior skull base or anterior frontal lobes to suggest an etiology for the patient's symptoms. No suspicious intracranial mass or evidence of mass effect. No suspicious lesions on the postcontrast images. Incidentally noted is a left temporal-occipital developmental venous anomaly. There is a 13 mm pineal gland cyst without solid or enhancing components. No significant associated mass effect. There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.Minimal mucosal thickening is present in the right anterior ethmoid air cells. There is a small left maxillary mucus retention cyst. Paranasal sinuses are otherwise clear. Calvarium and extracranial soft tissues are within normal limits.", "output": "There is a 13 mm pineal cyst with a benign appearance and likely an incidental finding. MRI of the brain is otherwise unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "Female 38 years old Reason: please evaluate vaginal cuff History: VAIN III on biopsy PELVIS:UTERUS, ADNEXA: Postsurgical changes related to transvaginal hysterectomy. No abnormal enhancement to suggest residual or recurrent tumor.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific enlarged right external iliac node measures 1.7 x 1.0 cm (series 101, image 65).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No specific signs of residual or recurrent tumor in the vaginal cuff. 2.Nonspecific mildly enlarged right pelvic lymph node."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question : brain lesion. Signs and symptoms : Same Nonenhanced head CT :Examination demonstrate large area of vasogenic edema in the left cerebellum measuring 28.5 x 36.2-mm in size. There is subtle mass effect on the fourth ventricle.Additional large focus of vasogenic edema in the right inferior frontal lobe measuring 32.6 x 33-mm with evidence of focal mass effect. The findings are highly suspected for peritumoral edema of metastatic lesions and recommend further follow-up with a dedicated pre-and post infused brain MRI.This examination is otherwise unremarkable.Calvarium is intact. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.", "output": "1.Two foci of vasogenic edema one in the left cerebellum and a second one in the right inferior frontal lobe concerning for metastatic disease. Recommend further follow-up with pre-and post enhanced brain MRI for better characterization.2.Negative examination otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Transient alteration of awareness. Aphasia Transient alteration of awareness AphasiaClinical question: Evaluate for ischemia, or etiology of seizuresSigns and Symptoms: AMS, possible stroke, seizure No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally there are patchy and punctate T2 and FLAIR signal hyperintense lesions present in the brainstem, thalami and internal capsules as well as the right cerebellar hemisphere.A punctate focus of susceptibility effect is present along the left thalamus. Another similar lesion is present in the lower pons and upper midbrain, another is located in the right cerebellar hemisphere and one more is located in the left hippocampus.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.", "output": "There is no evidence for intracranial mass lesion.1.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 2.Punctate lesions in the brainstem, thalami, internal capsules and right cerebellar hemisphere are also likely vascular related.3.There is no evidence for acute ischemic cerebral infarction.4.Multiple microhemorrhages are identified in the brainstem, cerebellum, left thalamus and hippocampus. This pattern suggests hypertension."}
{"instruction": "Generate impression based on findings.", "input": "24 year-old male. Pelvic pain. Needs to be evaluated for pelvic fistulas. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval resolution of the left ischioanal abscess with mild residual inflammatory enhancement and edema. Placement of setons into the transsphincteric fistula tract on the left originating at the 3 o'clock position of the anus and bifurcating into two tracts that extend down into the left gluteal cleft. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free pelvic fluid.", "output": "Interval resolution of left ischioanal abscess. Seton placement into a 3 o'clock position perianal transsphincteric fistula tract, see above."}
{"instruction": "Generate impression based on findings.", "input": "60 year old male patient with back pain. Evaluate for nerve compression. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. The conus medullaris is normal in position. There is mild prominence of the dorsal epidural fat.There is spondylolysis of L5 with grade 1-2 spondylolisthesis of L5 on S1. There is trace retrolisthesis of L1 on L2 and L2 on L3. There are anterior osteophytes throughout the lumbar spine with disc dessication at all levels, which is most severe at L5/S1. There is mild endplate irregularity of lower lumbar spine with a small focus of enhancement within the superior endplate of L3 which is likely degenerative in etiology. Furthermore, there is enhancement within the epidural space at L5/S1 as well as the facet joints, likely on a degenerative basis. Additional multilevel degenerative changes are as described below:L1-L2: Mild posterior disc bulge without significant spinal canal or neural foraminal stenosis. L2-L3: Minimal posterior disc bulge without significant spinal canal stenosis. Ligamentum flavum thickening and facet hypertrophy contribute to minimal right neural foraminal stenosis.L3-L4: Minimal posterior disc bulge eccentric to the right, ligamentum flavum thickening, and facet hypertrophy without significant spinal canal and minimal right neural foraminal stenosis.L4-L5: Mild posterior disc bulge, ligamentum flavum thickening, and moderate facet hypertrophy contribute to mild spinal canal stenosis, particularly involving the lateral aspect of the thecal sac, moderate to severe left neural foraminal stenosis, and mild to moderate right neural foraminal stenosis. L5-S1: Grade 1-2 spondylolisthesis of L5 on S1 with disc uncovering, ligamentum flavum thickening, and moderate facet arthropathy cause severe left and mild to moderate right neural foraminal stenosis. No significant spinal canal stenosis.Paraspinous soft tissues are within normal limits.", "output": "Multilevel degenerative changes of the lumbar spine, worst at the L4-L5 and L5-S1 levels. There is grade 1-2 spondylolisthesis of L5 on S1 with bilateral pars defects of L5. There is significant neural foraminal stenosis at L4-L5 and L5-S1, worse on the left than the right. Please see additional details above."}
{"instruction": "Generate impression based on findings.", "input": "Evaluation for metastatic disease for squamous cell carcinoma of the lung. There is mild nonspecific scattered cerebral white matter T2 hyperintensity. There is diffuse mineralization in the bilateral basal ganglia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse 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 is mild right maxillary sinus mucosal thickening.", "output": "No evidence of intracranial metastases. "}
{"instruction": "Generate impression based on findings.", "input": "Nasal mucosal melanoma compare to outside MRI post 4 cycles of pembrolizumab . There is an apparent intermediate T2, enhancing mass in the inferior right nasal cavity, which appears to involve the right inferior turbinate. The abnormality is ill-defined and measures approximately 45 mm AP x 15 mm RL x 15 mm SI. There may be extension of abnormality into the right medial maxillary sinus and/or focal adjacent mucosal thickening. The rest of the paranasal sinuses are unremarkable. There is associated narrowing of the inferior portion of the right nasolacrimal duct, while the upper right nasolacrimal duct and sac are distended. There appears to be layering debris with in the lacrimal sac. The orbital contents are otherwise unremarkable bilaterally. There is nasopharynx and left nasal cavity are intact. The imaged intracranial structures are unremarkable.", "output": "An apparent mass in the inferior right nasal cavity may represent recurrent nasal mucosal melanoma, with associated obstruction of the right nasolacrimal duct."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Abnormal findings on diagnostic imaging of skull and head, not elsewhere classifiedClinical question: Eval for change in L CVA and eval for change in R meningioma.Signs and Symptoms: meningioma. The CSF spaces are appropriate for the patient's stated age with no midline shift.There is sulcal and gyral signal hypointensity on SWI present along the medial high convexities of the frontal lobes , right parietal lobe and adjacent right occipital lobe. A focus of susceptibility effect is present in the left frontal lobe subcortical white matter and gray matter at the level of the superior frontal sulcus associated with loss of volume indicative of encephalomalaciaThere is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.", "output": "1.Since the prior exam is no significant interval change. 2.There is redemonstration of a focus of encephalomalacia in the left frontal lobe . This is most likely related to prior infarction3.There is siderosis along the medial aspects of the frontal lobes and along the right parietal and occipital lobes.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.There is no evidence for acute ischemic cerebral infarction.6.There is no evidence for intracranial mass lesion. There is no evidence for meningioma."}
{"instruction": "Generate impression based on findings.", "input": " Brain: There are postoperative findings related to the Chiari decompression with interval resolution of the pseudomeningocele. Protrusion of the right cerebellar tonsil through the neo-foramen magnum to the lower margin of the anterior arch of C1 appears unchanged. There also appears to be mild patchy T2 hyperintensity in the inferior right cerebellar hemisphere and fine linear bands that extend from the posterior surface of the inferior right cerebellar hemisphere to the overlying dural patch. CSF flow is present across the anterior and posterior aspects of the neo-foramen magnum, although the anterior flow column remains slightly constricted due to the retroflexed dens. The third and lateral ventricles are mildly prominent. The basal cisterns remain patent. There is no midline shift or mass effect. There is no evidence of acute infarct or hemorrhage. Cervical Spine: The cervicothoracic syrinx has decreased in size and cranial extent, but is incompletely imaged inferiorly. The syrinx now extends from the inferior aspect of the C6 vertebral body and has a maximal width of 4 mm at the level of T4, previously 8 mm. 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.", "output": "1.Postoperative findings related to Chiari I decompression with interval resolution of suboccipital pseudomeningocele, but fine linear bands that extend from the posterior surface of the inferior right cerebellar hemisphere to the overlying dural patch may represent adhesion formation.2.Decrease in size and cranial extent of syrinx.3. The third and lateral ventricles are dilated.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 onset seizures: starring spells. There is no evidence of intracranial hemorrhage, mass, heterotopia, or infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.", "output": "No gross evidence of potential seizure foci. "}
{"instruction": "Generate impression based on findings.", "input": " No worrisome focal marrow signal abnormality is appreciated in the cervical spine to suggest metastatic disease within the limitations of a noncontrast exam. There is minimal retrolisthesis of C3 on C4, and minimal anterolisthesis of C6 on C7 and C7 on T1. The vertebral body and disk heights are well-maintained. The spinal cord is of normal caliber and signal. Lesions of the right clivus/basiocciput, and left occipital condyle are partially imaged and better evaluated on recent contrast enhanced brain MRI. There is STIR hyperintense lesions involving the T2 vertebral body as well as the partially imaged T3 vertebral body extending into the left pedicle which have progressed since 4/15/2016.At C2-C3, there is moderate right facet arthropathy. There is no significant spinal canal or neuroforaminal stenosis.At C3-C4, there is moderate posterior disc osteophyte complex, uncovertebral hypertrophy, right greater than left, and facet arthropathy. There is mild central canal stenosis. There is moderate right and mild left neuroforaminal stenosis.At C4-C5, there is mild posterior disc osteophyte complex and uncovertebral hypertrophy as well as mild facet arthropathy. There is no significant spinal canal or neuroforaminal stenosis.At C5-C6, there is right greater than left uncovertebral hypertrophy and posterior disc osteophyte complex and mild facet arthropathy. There is effacement of the right lateral recess but no overall significant spinal canal stenosis. There is moderate to severe right and no significant left neuroforaminal stenosis.At C6-C7, there is mild posterior disc osteophyte complex and mild facet arthropathy, left greater than right. There is no significant spinal canal or neuroforaminal stenosis.At C7-T1, there is mild left uncovertebral hypertrophy and moderate bilateral facet arthropathy. There is no significant spinal canal or neuroforaminal stenosis.", "output": "1.Skull base metastases are partially imaged and better evaluated on recent contrast-enhanced brain MRI.2.No definite evidence of metastatic disease in the cervical spine within the limitations of a noncontrast exam. There are however new lesions at the T2 and T3 levels compared to 4/15/2016 which are partially imaged. T3 lesion extends into the left pedicle. These lesions are present on recent CT chest abdomen pelvis from 7/24/2016.3.Multilevel cervical degenerative changes, as above, with facet arthropathy relatively worse at the right C2-3 and bilateral C7-T1 levels and multilevel neuroforaminal stenoses, most prominent at the right C3-C4 and right C5-6 levels."}
{"instruction": "Generate impression based on findings.", "input": "Male, 50 years old, status post lung transplant with distal arm sensory loss, altered sensorium with drowsiness, intermittent confusion and memory loss, word finding difficulty, dropping items. Brain:No evidence of restricted diffusion is seen. No edema or mass effect is detected. Numerous scattered foci of FLAIR hyperintensity are seen within the cerebral hemispheres, largely in a subcortical distribution. The pons is also affected by ill-defined FLAIR hyperintensity.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. The right cerebellar tonsil descends below the level of the foramen magnum by 5 6-mm. However, the foramen magnum does not appear to be particularly crowded.Cervical spine:Alignment is anatomic. Vertebral body heights are preserved. Degenerative endplate signal changes are seen, but there are no areas of concerning marrow replacement.Spinal cord morphology is altered by disc osteophytes at multiple levels as discussed below. However, no clear focal signal abnormality is detected within the cord. No epidural abnormalities are seen.C2-3: Facet arthropathy. Mild posterior disc-osteophyte complex formation which may just contact the ventral cord. No significant spinal canal or foraminal stenosis. C3-4: Facet arthropathy. Mild posterior disc-osteophyte complex formation which may just contact the ventral cord. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation which indents and deforms the ventral cord. Moderate generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation which indents and deforms the ventral cord. Moderate to severe spinal canal stenosis. Moderate right and mild left foraminal narrowing. C6-7: Facet arthropathy. Posterior disc-osteophyte complex formation which indents and deforms the ventral cord. Moderate spinal canal stenosis. Moderate bilateral foraminal narrowing. C7-T1: Facet arthropathy. No significant spinal canal or foraminal stenosis.", "output": "1.No acute intracranial abnormality is seen. 2.There are numerous scattered foci of nonspecific FLAIR hyperintensity within the cerebral hemispheres and the pons. This could reflect chronic small vessel ischemic disease, vasculitis, sequelae of prior demyelination, or sequelae of some other inflammatory process. 3.Incidentally noted is a low-lying right cerebellar tonsil which does meet imaging criteria for a Chiari I malformation. However, the foramen magnum does not appear to be crowded.4.Multilevel disc osteophyte formation and posterior element degeneration is seen in the cervical spine. Significant spinal canal stenosis is evident at C4-5, C5-6 and C6-7 with some degree of cord impingement. No evidence of spinal cord edema is seen."}
{"instruction": "Generate impression based on findings.", "input": "Female, 16 years old. Ankle pain, injury TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Increased T2 signal in the talar neck and along the anterior aspect of the tibial metaphysis and diaphysis. No discrete associated T1 signal abnormality, suggesting that these findings are related to bone marrow edema without fracture.ADDITIONAL", "output": "Bone marrow edema involving the talar neck and anterior distal tibia, compatible with bone contusion, without fracture identified. "}
{"instruction": "Generate impression based on findings.", "input": "50 years Female (DOB:1/14/1966)Reason: Stroke workup History: R arm and leg weakness, L face weakness, R hemisensory lossPROVIDER/ATTENDING NAME: DAVID G BEISER FERNANDO D. GOLDENBERG The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Opacity in the left sigmoid sinus transverse sinus junction most likely represents an arachnoid granulation.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 36 years old, with headache and left eye pain. A punctate focus of restricted diffusion is seen within the left superior parietal lobule. No other definite restricted diffusion is seen. However, there are numerous scattered punctate foci of white matter T2 hyperintensity, none of which is associated with significant edema or mass effect.Brain parenchymal morphology is otherwise unremarkable. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. No pathologic parenchymal or extra-axial enhancement is observed. The ventricles are normal in size and morphology. The pituitary region is unremarkable. Asymmetric prominence of the left basal vein of Rosenthal and deep middle cerebral vein is noted.Assessment of the orbits is somewhat compromised by motion artifact and poor fat saturation. Within this limitation, no definite evidence of any optic nerve or extraocular muscle abnormality is seen. The globes are round and symmetric. The superior ophthalmic veins are not dilated.The left petrous apex is fluid-filled and shows mild streaky enhancement as well. There may be slight thickening of the adjacent middle cranial fossa dura, but this is equivocal. No definite abnormalities of the cavernous sinus are noted. The mastoid air cells and middle ear cavities as visualized on this examination are unremarkable.", "output": "1.A punctate focus of restricted diffusion is seen within the left superior parietal lobule. In addition, there are numerous scattered punctate foci of T2 hyperintensity throughout the cerebral hemisphere. These findings could represent lesions related to migraine headache or some other vasculitic process with the lesion in the left parietal lobe being relatively more acute.2.Asymmetric prominence of the left basal vein of Rosenthal and deep middle cerebral vein are of uncertain significance and may simply represent normal anatomic variation. No other findings to suggest a vascular shunting lesion are seen.3.Given reduced image quality as above, no definite intraorbital abnormalities are appreciated. However, the left petrous apex is fluid-filled and demonstrates mild streaky enhancement. This could represent mild or resolving petrous apicitis, a diagnosis which could account for the patient's left eye pain."}
{"instruction": "Generate impression based on findings.", "input": "Female 42 years old with known left breast DCIS with right-sided retroareolar abnormality on MRI and palpable right axillary lymph node. A targeted right ultrasound was performed in the right areolar region for the MRI area of concern and the right axilla for the palpable area of concern. There is no solid or cystic mass identified in the right areolar region.There is a mildly prominent lymph node in the right axilla measuring 1.3 cm. No additional solid or cystic masses identified.", "output": "No sonographic evidence for malignancy. The MRI finding likely represents the nipple.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Dysphagia and brisk jaw reflex. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are minimal scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are non-specific. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. No abnormal parenchymal or meningeal enhancement. The skull and extracranial soft tissues are unremarkable.", "output": "1. MRI examination is within normal limits for age. No evidence of acute infarct, hemorrhage, intracranial mass or mass effect.2. Minimal scattered punctate foci of white matter T2/FLAIR hyperintensity, which are non-specific, but compatible with mild age-related white matter changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female with sciatica not improving. There is slight straightening of the normal lumbar lordosis. The vertebral body heights are preserved. There is mild narrowing of the disks involving the lower lumbar levels. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology and terminates at the L1-L2 level. Degenerative changes are seen in the lumbar spine as described below:T12-L1: There is a shallow central disc protrusion but no significant compromise to spinal canal or neural foramina.L1-L2: There is a minimal disc bulge, mild facet hypertrophy and ligamentum flavum thickening but no significant compromise to spinal canal or neural foramina.L2-L3: There is a right paracentral to foraminal disc protrusion and a left foraminal disc protrusion which along with mild facet hypertrophy and ligamentum flavum thickening causes mild bilateral neural foraminal stenosis. No significant compromise to spinal canal is visualized.L3-L4: There is a trace disc bulge with left greater than right foraminal prominence as well as mild to moderate facet hypertrophy and ligamentum flavum thickening which causes minimal to mild right and moderate to severe left neuroforaminal stenosis. No significant compromise to spinal canal is visualized.L4-L5: There is a mild to moderate disc bulge with right foraminal prominence as well as moderate facet hypertrophy and ligamentum flavum thickening which causes moderate to severe right and moderate left neural foraminal stenosis. The right foraminal disc may abut the right L4 exiting nerve root. No significant compromise to spinal canal is visualized.L5-S1: There is a mild disc bulge and a large right far lateral disc osteophyte as well as mild facet hypertrophy and ligamentum flavum thickening which causes mild right neural foraminal stenosis but no left foraminal or central canal stenosis. The paravertebral soft tissues are unremarkable. Bilateral small T2 hyperintense lesions within the kidneys are nonspecific, but statistically most likely represent benign renal cysts.", "output": "Overall mild to moderate spondylotic changes involving the lower lumbar spine without significant central canal stenosis but with up to moderate to severe neuroforaminal stenosis at the left L3-4 and right L4-5 levels."}
{"instruction": "Generate impression based on findings.", "input": "63 years, Female, metastatic ovarian cancer status post resection and radiation therapy. Compared to 6/24/2015, there is evidence of treatment response with decrease in size of multiple enhancing lesions. For example left frontal lesion previously 10 x 10 mm now measures 6 x 6 mm. Right parietal 11 x 7 mm lesion measures 7 x 5 mm. 4 mm right cerebellar lesion now measures less than 2 mm. There is interval decrease in FLAIR hyperintensity associated with the left frontal and right parietal lesions. Additional areas of FLAIR hyperintensity in the periventricular and subcortical white matter are not significantly changed. Unchanged appearance of the right frontal resection cavity with surrounding FLAIR hyperintensity which may represent gliosis. Unchanged restricted diffusion involving the posterior aspect of the right frontal resection cavity likely related to chronic blood products. No new enhancing lesion or new mass effect is appreciated. Unchanged ventricular size and periventricular FLAIR abnormality. No midline shift or herniation. Major flow-voids are preserved. Paranasal sinuses and mastoid air cells are clear. No suspicious osseous lesions.", "output": "Compared to 6/24/2015 there is evidence of treatment response with decrease in size of multiple previously seen enhancing lesions. No new lesions."}
{"instruction": "Generate impression based on findings.", "input": "Nontoxic single thyroid nodule RIGHT LOBE MEASUREMENTS: 5.1 x 2.6 x 3.0 cmLEFT LOBE MEASUREMENTS: 5.4 x 2.4 x 2.6 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Innumerable nodules the largest is located near the isthmus and measures 2.4 x 2.2 x 1.7 cm it appears complex but mostly cystic with small microcalcifications.LEFT LOBE: Innumerable nodules with the largest measuring 2.4 x 2.0 x 1.4 cm. Similar to the nodules in the right lobe, these are mostly cystic with areas of complexity and small microcalcifications. ISTHMUS: 11 mm nodule with similar characteristics as the ones noted above PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Innumerable bilateral complex appearing thyroid nodules as described above; most have a appearance consistent with colloid cysts."}
{"instruction": "Generate impression based on findings.", "input": "Male, 23 years old, with unprovoked first time generalized tonic-clonic seizure. 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 seen.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 medial temporal lobe structures are symmetric and free of pathologic signal 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 to account for the patient's seizure."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Left tibia pain x 4 months, no specific injury, xrays taken in January and April with Continued abnormality of the medial cortex of the proximal tibia, evaluate for possible lesion History: Left tibia pain. There is minimal prominence of the medial aspect of the proximal tibial diaphysis associated with a tiny defect in the cortex, perhaps representing a healed fibrous cortical defect. No underlying edema or enhancement. The bone marrow signal intensity of the tibia and fibula appears normal. The musculature of the leg appears normal. Please note, this study was not protocoled for evaluation of the intrinsic structures of the knee.", "output": "Possible small healed fibrous cortical defect, but no finding to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Female, 31 years old, with metastatic breast cancer, assess for brain metastases. No evidence of mass, mass effect or parenchymal edema is seen. A single 3 mm focus of T2 hyperintensity within the left subinsular white matter is nonspecific. No restricted diffusion is evident.There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricular system is normal in size and morphology. Marrow signal characteristics of the calvarium are unremarkable.", "output": "1.A single small focus of signal abnormality within the left subinsular white matter is nonspecific.2.No definite evidence of intracranial metastases is seen without the benefit of IV contrast."}
{"instruction": "Generate impression based on findings.", "input": "Child with GH deficiency and short stature. The pituitary gland is not enlarged and enhances homogeneously. The posterior pituitary bright spot is intact. The infundibulum is also intact. There is no evidence of sellar or suprasellar mass lesions. The cavernous sinuses are unremarkable. There is mucosal thickening within the bilateral sphenoid sinuses. There is a canalis basalis medianus. There is a partially-imaged prominent retrocerebellar cerebrospinal fluid space.", "output": "No evidence of pituitary lesions."}
{"instruction": "Generate impression based on findings.", "input": " For the purposes of this dictation, the last well formed disk space is referred to as L5-S1. There is motion degradation limiting evaluation. Further, due to low GFR, patient was unable to receive IV contrast which further limits evaluation. Given these limitations, there is a 28 x 33 mm expansile heterogeneously T2 hyperintense and T1 hypointense mass in the spinous process, lamina and pedicles of the L1 vertebral body with 5 mm thick posterior epidural tumor extending superiorly up to the mid T12 level. There is diffuse heterogeneous low T1 osseous marrow signal consistent with osseous metastatic disease.The conus appears to terminate at superior aspect of L2, however this is limited by motion artifact. There is ventral displacement of the conus and the cauda equina nerve roots without significant edema within the conus. There is additional T2 hyperintense signal abnormality in the L4 spinous process as well. There are numerous scattered low T1 and high T2 signal lesions in the sacrum and bilateral iliac bones, again consistent with osseous metastases.There is mild grade 1 retrolisthesis L2 on L3, mild anterolisthesis of L4 on L5 and L5 on S1. There is disk desiccation at all levels in the lumbar spine with severe loss of disk height at L2-3. There is mild diffuse posterior epidural lipomatosis which contributes to minimal narrowing of the spinal canal diffusely.T12-L1: Diffuse disk bulge with no significant spinal stenosis.L1-2: Diffuse disk bulge and left far lateral disk protrusion with posterior epidural tumor causing mild spinal canal stenosis. There is mild bilateral neural foraminal stenosis secondary to expansile tumor in the pedicles of L1.L2-3: Diffuse disk bulge, bilateral facet arthropathy and ligamenta flava thickening causing no significant spinal canal stenosis and moderate bilateral neural foraminal stenosis.L3-4: Diffuse disk bulge and moderate bilateral facet arthropathy with ligament flava thickening causing mild right and moderate left neural foraminal stenosis with no significant spinal canal stenosis.L4-5: Diffuse disk bulge asymmetric to the right, and severe bilateral facet arthropathy with ligament flava thickening causing moderate right and mild left neural foraminal stenosis with no significant spinal canal stenosis.L5-S1: Diffuse disk bulge asymmetric to the right with bilateral facet arthrosis and ligament flava thickening causing severe right and mild to moderate left neural foraminal stenosis. Disk material encroaches upon the bilateral subarticular zones (right greater the left) without significant subarticular zone stenosis.", "output": "1.Diffuse osseous metastatic disease, with prominent expansile tumor in the L1 posterior elements extending into the posterior epidural space causing mild spinal canal stenosis at this level.2.Lumbar spondylosis as described above.3.Findings were discussed with the clinical service by the radiology on call resident at time of initial interpretation."}
{"instruction": "Generate impression based on findings.", "input": "Female 73 years old Reason: rectal adenocarcinoma staging History: as above Overall image quality: GoodPELVIS:UTERUS, ADNEXA: Uterus is surgically removed or atrophic.BLADDER: No significant abnormality noted. LYMPH NODES: At least 5 scattered mesorectal fascial lymph nodes, largest measuring up to 6 mm.BOWEL, MESENTERY: Rectal Tumor:Circumferential involvement of an approximately 7.1 cm (image 30/series 1001) segment of rectosigmoid colon. This tumor signal likely extends at least to the muscularis layer with possible minimal extension into the mesorectal fat, T3.Tumor appearance on T2-weighted images: Grey, circumferentialTumor location: Begins at the upper anal sphincter about 2.7 cm from the anal verge.Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): In the same image described immediately below where it extends to the anterior where the tumor extends to the anterior mesorectal fascia, the posterior vaginal wall is also adjacent to the signal abnormality, but has a relatively preserved plane. Some gray signal extending into the wall may be desmoplastic reaction, but underlying tumor is not excluded.Tumor Distance to Mesorectal Fascia: Extending directly to the anterior mesorectal fascia (axial oblique series 801:37)BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Few nonspecific prominent bilateral inguinal lymph nodes. A couple nonspecific right external iliac subcentimeter lymph nodes. The aortic bifurcation is not imaged but there are no common iliac lymph nodes.", "output": "1.Approximately 7 cm long rectosigmoid T3 tumor with several associated mesorectal lymph nodes (>5) and less than 1 mm mesorectal fascial margin as described above. Minimal involvement of the posterior vaginal wall cannot entirely be excluded as above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 11 years old, with history of pilocytic astrocytoma with VP shunt. Yearly follow-up exam. Heterogeneous T2 hyperintense, partially cystic signal characteristics are evident within the right basal ganglia and thalamus, right hypothalamus, and to a lesser degree the left hypothalamus. Pathologic signal extends inferiorly to involve the medial right temporal lobe structures, and in particular, the right amygdala is T2 hyperintense and perhaps mildly thickened relative to the left.The region of abnormal parenchyma involving the right basal ganglia and thalamus is surrounded by patchy intrinsic T1 hyperintensity. A focus of intrinsic T1 hyperintensity is also seen within the right cerebral peduncle. No clear evidence of any true enhancement is seen above and beyond this intrinsic T1 signal.A right parietal approach ventricular catheter is in place and appears to terminate within the body of the right lateral ventricle. The right lateral ventricle is of normal caliber while the left is collapsed. No evidence of any ventricular dilatation is seen.There is no evidence of any significant parenchymal edema or mass effect. The abnormal right basal ganglia/thalamic tissue shows patchy susceptibility effect likely representing chronic blood product. No acute intracranial hemorrhage or other abnormal collections are suspected. A cystic pineal lesion which measures approximately 1 cm in diameter is likely benign and incidental.", "output": "Patchy abnormal signal with evidence of hemosiderin staining and cystic tissue is seen involving predominantly the right basal ganglia and thalamus. Signal abnormality, however, does extend inferiorly into the medial temporal lobe. Without prior examinations for comparison, interpretation of these findings is somewhat limited though they may very well represent the sequelae of a treated or involuted pilocytic astrocytoma as indicated in the clinical history.If prior examinations can be made available, we will be happy to perform a comparison and addend this report."}
{"instruction": "Generate impression based on findings.", "input": "CNS lymphoma, evaluate for recurrence: fatigue. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. There is a cystic cavity in the surrounding right frontal lobe parenchyma that measures up to 31 mm. The ventricles and basal cisterns are unchanged in size and configuration, with mild diffuse cerebral volume loss. There is mild diffuse periventricular white matter T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. There is persistent high T2 signal and enhancement in the clivus, with prominent trabeculae. There is mild left maxillary sinus mucosal thickening.Orbits: There is persistent mild diffuse enhancement along the bilateral optic nerve sheaths, but otherwise no evidence of intraorbital mass lesions. There are bilateral staphylomatous globe deformities and a left lens implant. Spine: There is persistent mild enhancement along multiple cauda equina nerves roots diffusely and along the surface of portions of the thoracic spinal cord. The spinal cord otherwise displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is degenerative spondylosis involving multiple levels of the lower lumbar spine with inflammatory changes in multiple facet joints, but no significant spinal canal or neural foraminal stenosis. Aside from degenerative signal alterations, the vertebral bone marrow signal is unremarkable. However, there is persistent signal abnormality in the bilateral iliac bones. The paravertebral soft tissues are unremarkable.", "output": "1. No evidence of intracranial tumors.2. Cavitation surrounding the right transfrontal Ommaya catheter may represent sequela of necrosis.3. The ventricles are unchanged in size. 4. Persistent mild diffuse enhancement along the bilateral optic nerve sheaths, which may be related to lymphoma or represent perineuritis, but otherwise no evidence of intraorbital mass lesions.5. Persistent mild enhancement along multiple cauda equina nerves roots diffusely and along the surface of portions of the thoracic spinal cord likely related to lymphoma.6. Nonspecific persistent abnormality in the clivus and iliac bones.7. Multilevel degenerative spondylosis in the lower lumbar spine, with inflammatory facet arthropathy."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male patient with history of IPMN. Follow-up imaging. ABDOMEN:LIVER, BILIARY TRACT: Again seen is a septated cystic lesion in the uncinate process of the pancreas that measures 1.4 x 1.0 cm (series 3 image 43), previously 1.7 x 0.8 cm. A similar tubular cystic lesion in the pancreatic head measures 1.0 cm (series 3 image 53), unchanged. There are a few smaller cystic projections seen in the body and tail, which also appears similar compared to prior examination and are all less than 1 cm in size. These smaller cystic projections appear to communicate with the pancreatic duct, likely representing side branch IPMNs.Incomplete pancreatic divisum.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Similar size of probable IPMNs in the uncinate process and pancreatic tail as well as punctate probable side branch IPMNs. No suspicious enhancement."}
{"instruction": "Generate impression based on findings.", "input": "History of elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.5 x 4.7 x 4.2 cmPeripheral Zone: No discrete suspicious lesion is seen within the peripheral zone.Central Gland: In the transition zone at the apex there is a ill-defined T2 hypointense focus measuring 1.2 x 1.2 cm (series 701/10) with associated restricted diffusion (series 1103/36) suspicious for prostatic adenocarcinoma.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Approximately 1.2 cm lesion in the transition zone of the apex is suspicious for prostatic adenocarcinoma and is amenable to MRI/Ultrasound fusion biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Backache, numbness in right leg and left shoulder pain. Signs and symptoms: As above. Nonenhanced lumbar MRI:There is normal anatomical alignment the vertebral column.Normal stimuli thoracic spine and thoracic cord is unremarkable. T11 -- T12 is unremarkable.T12 -- T11 demonstrate mild disk disease and unremarkable otherwise.L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild disk disease and mild bilateral ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.L3 -- 4 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however moderate right neural foraminal compromise is noted.L4 -- 5 demonstrate advanced disk disease with significant loss of disk height, moderate to significant left and moderate right facet and ligamentum flavum hypertrophy is present. Constellation of changes results in mild central spinal stenosis and moderate bilateral (left greater than right) neural foraminal compromise.L5 -- S1 demonstrate mild degenerative changes and unremarkable otherwise.", "output": "1.Degenerative changes of disk and the posterior elements at L4 -- L5 with mild central spinal stenosis and moderate (L>R) neural foraminal compromise as detailed.2.Degenerative changes at the L3 -- L4 results in moderate right neural foraminal compromise.3.Minimal degenerative changes at other levels however without spinal stenosis or neural foraminal compromise."}
{"instruction": "Generate impression based on findings.", "input": "Other specified disorders of bladder [N32.89] / Unspecified urinary incontinence [R32], Reason for Study: ^Reason: Evaluate for tethered cord History: day time and night time enuresis Redemonstration of right frontal parietal craniotomy with right frontal tissue loss especially anterior aspect of right inferior frontal lobe, lateral orbital gyrus as well as encephalomalacia of right medial orbital gyrus and the right rectus gyrus indicating postoperative changes, unchanged since prior scan.There is about 2.8mm sized nodular enhancing lesion on the superior aspect of resection margin just inferior lateral aspect of the right lateral ventricle frontal horn.This lesions were not seen on prior scan. Thus could represent small focal recurrence of tumor.There is another small enhancing lesion on inferolateral aspect of the right middle frontal gyrus and associated with adjacent dural enhancement. The lesion appears to be slightly smaller than prior especially brain MRI performed on Jul 9 2014, thus indicating postoperative reactive changes. Diffuse dural enhancement is still seen which has not been changed since prior scan. Thickening of anterior cranial fossa especially right side lesser wing of sphenoid is again seen, unchanged.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.", "output": "1. Focal nodular enhancing lesion on the resection margin of the original tumor, at the inferolateral aspect of the right lateral ventricle frontal horn. Diagnostic possibility includes recurrent tumor. Follow up imaging is recommended.2. Otherwise stable postresection status of large right subfrontal meningioma since prior scan."}
{"instruction": "Generate impression based on findings.", "input": "Female, 50 years old. Left tibial pain The left tibia and fibula appear normal. The soft tissues of the leg appear normal. We see no findings to account for the patient's tibial pain.Abnormal signal intensity in the right tibial plateau as seen on the large field-of-view images is presumably degenerative in etiology.", "output": "Normal-appearing left tibia without findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis status post OLT in 1994, evaluate for lesions and hepatic vessel patency The exam is limited secondary to respiratory motion.ABDOMEN:LIVER, BILIARY TRACT: The liver has a cirrhotic morphology. There are no suspicious hepatic lesions. The portal and hepatic veins are patent. The hepatic artery is suboptimally evaluated on this limited study but appears patent.SPLEEN: No significant abnormality noted.PANCREAS: 1 cm cystic lesion along the anterior aspect of the pancreatic body has increased in size the prior exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "1.Cirrhosis without evidence of suspicious hepatic lesions on this limited exam. 2.Hepatic and portal veins are patent. The hepatic artery is suboptimally evaluated on this limited study, but appears patent.3.Cystic lesion along the anterior aspect of the pancreatic body is slightly larger compared to prior."}
{"instruction": "Generate impression based on findings.", "input": "Blurry vision and numbness/tingling, rule out demyelinating diease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.", "output": "No evidence of demyelinating lesions, acute intracranial hemorrhage, mass, or acute infarction."}
{"instruction": "Generate impression based on findings.", "input": "Stated history of liver cysts. ABDOMEN:LIVER, BILIARY TRACT: Several T2 hyperintense nonenhancing foci in the liver compatible with simple hepatic cysts. No suspicious liver lesion biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum. No stigmata of acute or chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right breast implant with intracapsular rupture.OTHER: No significant abnormality noted.", "output": "Hepatic cysts. No suspicious liver lesion. Pancreas divisum"}
{"instruction": "Generate impression based on findings.", "input": "Female, 58 years old. History of fracture with recent MRI indicated non-union of a small 3mm fragment at radial base. Pain at base of 5th MC. There is deformity of the base of the fifth metacarpal indicating a healing fracture. There is scalloping of the anterior surface of the base of the fifth metacarpal that we presume represents chronic mechanical erosion as suggested on the recent MRI study. A 2 mm density adjacent to the medial aspect of the base of the fourth metacarpal may represent the small ununited fracture fragment suggested on MRI, but this is equivocal. Mild osteoarthritis affects the basilar joint and IP joints, and additional small cysts are seen in multiple carpal bones. There is slight widening of the scapholunate interval. A tiny ossicle adjacent to the ulnar styloid is unchanged.", "output": "Posttraumatic deformity of the base of the fifth metacarpal representing a healing fracture with other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Right ethmoid/nasal mass with possible bony erosion: epistaxis. There is a heterogeneously enhancing mass in the posterior right nasal cavity and ethmoid sinuses, which measures up to 5 cm. The tumor extends to the right medial cribriform plate, where there is a dehiscence demonstrated on CT. Otherwise, there is no discernible intracranial extension of tumor. There are trapped secretions and/or hemorrhage in the right sphenoid, ethmoid, and bilateral maxillary sinuses and surrounding recesses, with mild underlying mucosal thickening. There is sclerosis in the bone marrow surrounding the right sphenoid sinus. The orbits are unremarkable.", "output": "A mass in the posterior right nasal cavity and ethmoid sinuses that measures up to 5 cm likely represents an neoplasm, such as an inverted papilloma, melanoma, or carcinoma, for example. The tumor extends to the right medial cribriform plate, where there is a dehiscence demonstrated on CT. Otherwise, there is no discernible intracranial or intraorbital extension of tumor. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Blunt trauma. Signs and symptoms: Loss of consciousness. 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 is within normal limits. Very small focus of low-attenuation in the periventricular white matter is believed to represent a small was ischemic disease as was noted on prior MRI examcalvarium is intact. No evidence of hemorrhage or swelling of the scalp is detected.Mastoid air cells and middle ear cavities are pneumatized and unremarkable.Visualized paranasal sinuses are unremarkable.Limited images through the orbits are unremarkable.", "output": "With the exception of minimal small vessel ischemic disease of indeterminate age this study is within normal limits."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with left knee pain, medial sided. MENISCI: There is fragmentation and maceration of the posterior horn, body and anterior horn of the lateral meniscus. There are associated subcentimeter foci of fluid signal abnormality along the posterior aspect of the meniscus consistent with parameniscal cyst formation.There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. Some of the signal extends to the tibial and femoral articular surface consistent with degenerative tearing/fraying which extends to the body of the meniscus. There is a linear focus of signal abnormality within the posterior horn of the medial meniscus which extends to the femoral articular surface consistent with a complex tear with a horizontal component.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the lateral facet of the patella with large areas completely devoid of articular cartilage. There is degenerative underlying subchondral signal abnormality. There is near full-thickness to full-thickness articular cartilage degeneration of the articular cartilage along the lateral facet of the femoral trochlea with underlying degenerative subchondral signal abnormality. There is near full-thickness articular cartilage degeneration along the lateral tibiofemoral compartment particularly affecting the posterior aspect of the lateral tibial plateau. The medial tibiofemoral compartment appears relatively spared.LIGAMENTS: The PCL appears intact. The ACL is indistinct with associated foci of lobulated fluid signal abnormality. These findings likely represent a combination of chronic tearing as well as mucoid degeneration. There is thickening of the proximal fibers of the superficial band of the MCL which may reflect prior injury or sprain. The MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Degenerative tearing of the medial and lateral meniscus with parameniscal cyst formation as described above.2. Findings consistent with disruption of the ACL.3. 14 mm loose body within the joint as described above.4. Full-thickness articular cartilage degeneration most pronounced along the patellofemoral and lateral tibiofemoral compartments.5. Nonspecific subcutaneous edema along the anterior medial aspect of the knee."}
{"instruction": "Generate impression based on findings.", "input": "Male, 60 years old. Evaluate for source of knee pain following fall and twisting. Five views of the right knee demonstrate swelling along the anterior aspect of the knee which could represent a hematoma. Soft tissue swelling limits evaluation of the extensor mechanism. There are small ossicles in the distal quadriceps tendon which suggest chronic tendinosis. If there is clinical concern for an acute quadriceps tendon rupture, MRI can be considered. We see no fracture.", "output": "Soft tissue swelling anterior to the patella which may represent a hematoma. This limits evaluation of the extensor mechanism. If there is clinical concern for a quadriceps tendon tear, then MRI can be considered.Findings were discussed by telephone with Dr. DiMaggio at 2:30 PM on 3/28/2016"}
{"instruction": "Generate impression based on findings.", "input": "20-year-old male with instability. Evaluate for labral tear. ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: No significant fluid is identified within the subacromial subdeltoid bursa. No intra-articular gadolinium extends into the bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is linear increased signal abnormality traversing the posterior superior labrum indicating a tear. The glenohumeral joint alignment is anatomic. No full-thickness articular cartilage defects are identified.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL", "output": "Posterior glenoid labral tear as described above. "}
{"instruction": "Generate impression based on findings.", "input": "Obsessive-compulsive disorders. Preoperative planning for laser ablation. There is no evidence of intracranial hemorrhage or mass. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There is a subcentimeter left maxillary sinus retention cyst. There are retained nasopharyngeal secretions.", "output": "Unremarkable preoperative planning MRI."}
{"instruction": "Generate impression based on findings.", "input": " This exam is degraded by motion artifact. There is a mass that measures up to 5 cm centered within the left aspect of the frontal bone that erodes through the inner table and results in mass effect upon the left frontal lobe without significant edema. There is also another subcentimeter lesion in the left squamous temporal bone. There are multiple lesions with associated vasogenic edema at the grey-white matter junctions in the bilateral cerebral hemispheres, the largest of which is in the right superior frontal gyrus, measuring up to 15 mm. There are multiple additional small patchy foci of T2 hyperintensity throughout the deep cerebral white matter that are nonspecific. There is a punctate focus of susceptibility effect within the left thalamus compatible with a chronic micro hemorrhage. There is a subcentimeter defect in the right pons, which may represent a chronic lacunar infarct. However, there is no evidence of acute cerebral infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mucosal thickening within the right ethmoid and bilateral maxillary sinuses, right greater than left. There is heterogeneous signal within the C3 vertebral body.", "output": "1.A left frontal bone mass with erosion through the inner calvarial table and mild mass effect on the left frontal lobe likely represents a metastasis. Another subcentimeter left squamous temporal bone lesion also likely represents a metastasis. 2.Several bilateral cerebral hemispheric lesions likely represent metastases, although these are incompletely characterized. However, there is no evidence of associated midline shift or hemorrhage.3.An apparent lesion within the C3 vertebral body may also represent a metastasis, although incompletely characterized. 4.Numerous patchy foci of T2 hyperintensity within the supratentorial white matter are nonspecific without contrast, although many have the appearance of chronic small vessel ischemic disease.5.A small chronic microhemorrhage within the left thalamus is likely hypertensive in etiology.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " This exam is degraded by motion artifact. There is no evidence of mass or acute infarct. There are multiple patchy foci of T2 hyperintensity within the periventricular and infratentorial white matter with some involvement of the corpus callosum. Many of these lesions demonstrate T1 hypointensity. There is also mild global volume loss greater than expected for the patient's stated age.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is disconjugate gaze and minimal paranasal sinus mucosal thickening. There is mild fluid within the mastoid air cells bilaterally.", "output": "Multiple nonspecific supratentorial and infratentorial white matter lesions and mild global volume loss may represent demyelinating process especially given callosal involvement or advanced chronic small vessel ischemic disease. Please correlate clinically."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with previous stroke for evaluation of acute worsening left leg weakness. Multiple areas of ischemia of different ages are noted in the pons. A focus of diffusion restriction with increased T2/FLAIR signal is now noted in the right aspect of the pons, compatible with. There has been interval small chronic infarct in the ventral left aspect of the pons. There has been interval evolution of a now chronic focus infarct involving the mesial dorsal pons. Scattered foci of T2 hyperintensity in the periventricular and subcortical white matter compatible with chronic small vessel ischemic changes. There are also small chronic bilateral thalamic and basal ganglia lacunar infarcts. Note is made of a prominent perivascular space in the left insula. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. Note is again made of a 13 mm sebaceous cyst overlying the left zygoma.MRA head:There is approximately 70% narrowing of the mid to distal M1 segment of the right middle cerebral artery proximal to its bifurcation. The anterior and middle cerebral arteries do not otherwise demonstrated areas of significant stenoses. The posterior communicating arteries are diminutive bilaterally. The V4 segment of the right vertebral artery is mildly narrowed with loss of flow related enhancement. The left vertebral artery is dominant. The basilar artery and posterior cerebral arteries are normal in caliber. No significant intracranial aneurysm. MRA neck:The left common carotid artery originates off of the innominate artery. The carotid arteries are widely patent with normal contour and caliber throughout. The left vertebral artery is normal caliber and contour for the remainder of its course. The origin of the right vertebral artery remains stenotic. Mild stenosis of the distal vertebral artery is again noted as it pierces the dura. This is compatible with a dissection of indeterminate age. There is a subcutaneous lipoma incidentally noted in the right posterior paraspinal soft tissues.", "output": "1. Acute to subacute lacunar infarct in the right aspect of the pons. Remote lacunar infarcts involving the mesial dorsal and ventral left aspects of the pons. 2. Unchanged stenoses of the right vertebral artery origin and distally as it enters the dura with associated findings suggesting slow flow.3. Right middle cerebral artery stenosis, as on the prior examination. No evidence of new flow-limiting stenosis, occlusion, or aneurysm in the major intracerebral arteries.4. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5. chronic lacunar infarcts in the bilateral basal ganglia and thalami."}
{"instruction": "Generate impression based on findings.", "input": "Female 20 years old Reason: evaluate for SB inflammation or masses History: patient with NF1, chronic diarrhea ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense lesion in the left lateral segment of the liver measures 1.5 x 1.6 cm on image 10/series 4. The lesion has peripheral nodular enhancement and progressive fill and is most compatible with a hemangioma.Hepatic and portal veins are patent. No suspicious hepatic lesions.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: Small bowel is normal in caliber and course. The terminal ileum is normal in caliber. No focal enhancement or mural thickening.There are small retroperitoneal and mesenteric lymph nodes.BONES, SOFT TISSUES: Multiple small cutaneous T2 hyperintense foci likely represent small neurofibromas.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Probable arcuate uterus, suboptimally evaluated as the study was not tailored to evaluate the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: Small cutaneous neurofibromas. OTHER: No significant abnormality noted.", "output": "1.Unremarkable examination of the small bowel without focal areas of inflammation or obstruction.2.Left hepatic lobe hemangioma.3.Possible arcuate uterus."}
{"instruction": "Generate impression based on findings.", "input": "Male, 61 years old, with weakness in the left quadriceps muscle, evaluate lumbar spondylosis, specifically the left L3 nerve root. Trace retrolisthesis of L4 relative to L5 is unchanged. Spinal alignment is otherwise unremarkable.Mild anterior wedging of the T11 and T12 vertebral body is unchanged. Vertebral body heights are otherwise preserved. Marrow signal characteristics are slightly heterogeneous which in part represents endplate degenerative signal abnormality. No focal worrisome marrow replacement or marrow edema is seen.Mild focal myomalacia of the spinal cord at the T11-12 level is unchanged. Elsewhere, the visualized distal spinal cord, conus and nerve roots of the cauda equina are normal in signal characteristics.Diffuse loss of disc height is seen with the exception of L5-S1 which demonstrates relatively preserved disc height. The discs show uniformly T2 signal. Additional level specific findings are as follows:T11-12: Evidence of prior posterior element surgery. Left facet arthropathy. Disc bulging with a small left foraminal protrusion. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes. T12-L1: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulge. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.L1-2: Facet arthropathy. Ligamentum flavum thickening. Moderate generalized spinal canal stenosis with some crowding of the cauda equina. Mild bilateral foraminal narrowing.L2-3: Facet arthropathy. Ligamentum flavum thickening. Disc bulging. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes. L3-4: Facet arthropathy, left worse than right. Minimal disc bulging. Mild generalized spinal canal stenosis. Severe left and moderate right foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Ligamentum flavum thickening. Bulging disc with a small right paracentral protrusion. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Ligamentum flavum thickening. Bulging disc with a small central protrusion. Mild generalized spinal canal stenosis. Severe left and mild right foraminal narrowing. No interval changes.", "output": "Multilevel degenerative disease of the discs and posterior elements is redemonstrated without significant interval change. As on the prior examination, severe foraminal narrowing is demonstrated on the left at L3-4 and on the left at L5-S1. Moderate spinal canal stenosis is seen at L1-2 with some crowding of the cauda equina. Mild spinal canal narrowing is also evident at additional levels as above."}
{"instruction": "Generate impression based on findings.", "input": "Biliary obstruction. Abdominal pain. History of ovarian/fallopian cancer. ABDOMEN:LIVER, BILIARY TRACT: Fatty liver. Numerous bilobar mildly and very hyperintense subcentimeter lesions in the liver. The number, distribution and enhancement characteristics suggest that this is primarily biliary hamartomas. No extra hepatic biliary ductal dilatation. There is moderate bilobar intrahepatic ductal dilatation with abrupt narrowing of the common hepatic duct (series 401/24) at the level of the patient's porta hepatis lymphadenopathy.Mild narrowing of the extrahepatic portal vein. Moderate to severe narrowing of the left portal vein.SPLEEN: The spleen measures 13.8 cm in craniocaudal length with a small non-specific hypoenhancing focus.PANCREAS: Pancreas divisum without pancreatic ductal dilatation or focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate bilateral T2-weighted hyperintensities, probable cysts.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal lymphadenopathy. Porta hepatis lymphadenopathy. Extensive peripherally enhancing serosal implants along the falciform ligament, of the left lobe of the liver and posterior aspect of the antrum. Portocaval lymphadenopathy.BOWEL, MESENTERY: There is moderate volume of loculated ascites with thin septations suspicious for peritoneal carcinomatosis. Nodular implants along the greater curvature of the stomach, better evaluated on recent CT.BONES, SOFT TISSUES: Metastatic pulmonary nodules are partially imaged. Small right anterior abdominal hernia containing a short-segment or wall of small bowel, unchanged.OTHER: No significant abnormality noted.", "output": "Intrahepatic biliary ductal dilatation to the level of the common hepatic duct where there is porta hepatis lymphadenopathy as well as tumoral implants. Numerous punctate liver lesions likely represent multiple biliary hamartomas. Mild narrowing of the extrahepatic portal vein. Moderate to severe narrowing of the left portal vein.Peritoneal carcinomatosis including moderate volume of loculated ascites and serosal implants along the stomach and liver. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Intracranial hemorrhage, fracture. Signs and symptoms: Head trauma. Nonenhanced CT brain:Diffuse area of encephalomalacia in the left frontal, temporal, parietal lobes with ex vacuo dilatation of the left lateral ventricle is consistent with an old stroke. This examination is otherwise unremarkable and in particular no evidence of acute intracranial process is detected.There is a slight widening of calvarium on the left side believed to be secondary to underlying parenchymal volume loss. Area of sclerotic change of the squamosal portion of left temporal bone may also be result of intracranial process however possibility of fibrous dysplasia should be considered. Visualized paranasal sinuses and mastoid air cells are unremarkable. There is no definitive abnormality of soft tissues of the scalp.Nonenhanced CT of cervical spine:The alignment of cervical spine remains within normal limits.There is no definitive evidence of fracture or malalignment. Advanced degenerative disk disease with large anteriorly projecting osteophytes at C3 -- C4 through C6 -- C7 levels are present. At C5 -- C6 within the anteriorly projecting osteophytes and lucent line is identified. Remote possibility of fracture of this osteophyte cannot be ruled out. There is no detectable soft tissue abnormality associated with this finding. Correlated with physical exam and direct palpation and if clinical concern persists a follow-up with an MRI is recommended.", "output": "1.No evidence of acute intracranial or calvarial pathology.2.Large area of encephalomalacia in the left frontal, temporal and parietal lobes with resultant ex vacuo dilation of left lateral ventricle.3.Calvarial changes secondary to significant left hemispheric parenchymal volume loss is evident by thickening of calvarium on the left. Focal area of fibrous dysplasia of the squamosal portion of the left temporal bone.4.No definitive evidence of fracture of the cervical spine. Lucent line traversing the anterior osteophyte at C5 -- C6 likely not a fracture. Please correlate with history and if clinical concern persists follow-up with an MRI is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Hx of right breast cancer in 2008 (ER+, node+). Left breast cancer that was HER2+, node+ left breast cancer, s/p neoadjuvant therapy and lumpectomy/SLNBx \\T\\ XRT. Currently on exemestane History: new rib pain, now with vertebral body sclerosis at C4 concerning for metastasis Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is 5 mm anterolisthesis C7 on T1. There is some loss of normal lordosis with mild reversal involving the upper cervical spine. No destructive osseous lesions or abnormal enhancement involving the vertebral bodies to suggest metastatic disease is appreciated. No suspicious enhancement within the spinal canal is definitively appreciated. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below, advanced at the C7-T1 level:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and bilateral uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is moderate right worse than left neural foraminal stenosis. C4-5: Bilateral uncovertebral hypertrophy with moderate right and mild left neural foraminal stenosis. No significant spinal canal stenosis.C5-6: Bilateral uncovertebral hypertrophy with mild to moderate bilateral neural foraminal stenosis. No significant spinal canal stenosis.C6-7: Bilateral uncovertebral hypertrophy and small disc osteophyte complex. There is moderate to severe left and mild right neural foraminal stenosis. There is mild to moderate spinal canal stenosis.C7-T1: Advanced degenerative changes with anterolisthesis with disc uncovering and extrusion. There is moderate spinal canal stenosis at this level including mild impression on the cord without cord signal abnormality. Advanced facet arthropathy is noted bilaterally. There is abnormal enhancement surrounding the facet joints, extending into the neural foramen bilaterally, as well as the epidural space, all favored to be on a degenerative basis. There is minimal right and moderate left neural foraminal stenosis.", "output": "1. No convincing evidence of metastatic disease in the cervical spine. No suspicious lesion is seen corresponding to the C4 sclerosis seen on recent cervical radiographs and was most likely on a degenerative basis.2. Advanced degenerative changes at the C7-T1 level with grade 1 to grade 2 anterolisthesis and advanced bilateral facet arthropathy. There is abnormal paraspinous soft tissue enhancement at this level extending into the epidural space which is likely on a degenerative basis. There is moderate spinal canal stenosis at this level with mild impression on the cord, without cord signal abnormality. Additional levels as above."}
{"instruction": "Generate impression based on findings.", "input": "19 year-old female history of hip pain. ACETABULAR LABRUM: We see no gadolinium entering the labrum, nor do we see of a full thickness tear; however there is globular increased signal abnormality within the superior labrum compatible with degeneration. This globular signal abnormality disrupts the undersurface of the labrum at the one o'clock position (posterior/superior) suggestive of undersurface fraying (image 6 of series 1501). Furthermore, there is blunting of the anterior/superior labrum at the one to two o'clock position with mild surface irregularity and intrasubstance signal suggestive of partial thickness tearing superimposed on chronic attritional degeneration. We see no displaced labral fragments.ARTICULAR CARTILAGE AND BONE: We see no focal articular cartilage defects. There is mild prominence of the anterior aspect of the femoral head/neck junction at the 3 o'clock position with an alpha angle of approximately 65 degrees. Bone marrow signal intensity is unremarkable.SOFT TISSUES: The ligamentum teres is intact. There is mild edema of the tensor fasciae latae muscle presumably related to injection. The musculature of the left hip is otherwise unremarkable.ADDITIONAL", "output": "1.Labral abnormalities as described above likely representing a combination of degenerative undersurface fraying and partial thickness tearing; however we see no displaced labral fragment.2.Mild CAM deformity and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": " Redemonstrated is an approximately 6 mm craniocaudal x 3 mm AP dimension T1 hypointense, T2 hyperintense, nonenhancing focus involving the posterior aspect of the pituitary. The posterior pituitary lobe appears to be flattened posteroinferiorly. The pituitary gland anteriorly is normal in size and shape without other discrete mass lesion. There is no macroadenoma. The pituitary infundibulum inserts on the midline of the gland. There are no suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally. Limited views of the other intracranial structures are unremarkable. A 7 mm enhancing excrescence is noted of the skin just superior and anterior to the ear.", "output": "1.Redemonstrated is an approximately 6 mm craniocaudal x 3 mm AP dimension T1 hypointense, T2 hyperintense, nonenhancing focus involving the posterior aspect of the pituitary. The posterior pituitary lobe appears to be flattened posteroinferiorly. This constellation of findings is most suggestive of a Rathke's cleft cyst.2.A 7 mm enhancing excrescence is noted of the skin just superior and anterior to the ear."}
{"instruction": "Generate impression based on findings.", "input": "8-year-old male with macrocephaly and a left arachnoid cyst. Evaluate progression of the cyst. Left middle intracranial fossa cyst without significant change in size given the differences in technique. No evidence of hydrocephalus or midline shift. No evidence of intracranial hemorrhage, edema or solid mass. The ventricles and basal cisterns are unremarkable in size and configuration.Intracranial mild scalloping and thinning of the calvarial bone is nonspecific and may be secondary to a history of chronic increased intracranial pressure or a normal variant. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Grossly stable left middle cranial fossa arachnoid cyst."}
{"instruction": "Generate impression based on findings.", "input": "Male, 89 years old, with history of L2 deformity, history of kyphoplasty, eval for discitis. A chronic compression deformity of the L2 vertebral body, with evidence of prior kyphoplasty, is unchaged. There is no significant marrow edema at this level.A compression deformity of the L3 vertebral body has mildly progressed in severity with a slightly greater degree of retropulsion and thecal sac effacement. Marrow edema has, however, improved from the prior exam.Interval loss of disc height at L2-L3 is seen with only trace residual fluid signal present in the disc space. Stable loss of disc height is seen at L1-2, L3-4 posteriorly, and L4-5. No edema is seen in any of these discs.Post contrast images show relatively diffuse enhancement of the marrow of the compressed L2 and L3 vertebral bodies. No enhancement is seen in the L2-3 disc space, or any of the adjacent disc spaces. The dura at L2 and L3 is circumferentially enhancing, but no fluid collections are seen. The right psoas muscle is enhancing at L3, but again, no fluid collections are seen. Spinal alignment is grossly anatomic and unchanged. No other marrow space lesions are seen. The distal spinal cord and conus are within normal limits. No pathologic intrathecal enhancement is seen. L1-2: Facet arthropathy, ligamentum flavum thickening, disc bulge and slight vertebral body retropulsion contribute to a moderate spinal canal stenosis, moderate left and mild-moderate right foraminal narrowing. No interval changes. L2-3: Facet arthropathy and ligamentum flavum thickening are unchanged. Disc bulge and vertebral body retropulsion have progressed with a worsened, severe spinal canal stenosis with effacement of CSF and crowding of the cauda equina. A prior right paracentral extrusion has, however, improved. Severe right and moderate left foraminal narrowing have not changed.L3-4: Facet arthropathy, ligamentum flavum thickening, and disc bulge contribute to moderate spinal canal stenosis and moderate left foraminal narrowing. No interval changes. L4-5: Facet arthropathy, ligamentum flavum thickening, and disc bulge contribute to moderate left and mild right foraminal narrowing, unchanged. L5-S1: Facet arthropathy and disc bulging are unchanged with no significant spinal canal or foraminal stenosis.", "output": "1.No change in the L2 vertebral body compression deformity with evidence of prior kyphoplasty.2.Progressive compression of the L3 vertebral body when compared to the prior exam. However, the degree of marrow edema has improved.3.Progressive loss of height of the L2-3 disc is seen, with only trace residual fluid signal in the disc space. 4.Enhancement of the L2 and L3 marrow, the adjacent dura, and the right psoas muscle is seen. Although infection cannot be excluded with certainly on the basis of imaging alone, all these findings could potentially be reactive to the severe compressions and disc degeneration. Lack of fluid collections, and resolving L3 edema argue against infection."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female patient with knee pain. Question of meniscus tear. Due to the patient's body habitus, a high-resolution knee coil could not be used. Alternative coils were instead used which result in suboptimal image quality. Furthermore, several sequences are rendered suboptimal due to motion artifact.MENISCI: Evaluation of the menisci is limited, however, there is blunting of the posterior horn and body of the medial meniscus with low signal intensity in the medial gutter below the peripheral fibers of the body of the medial meniscus likely representing a displaced flap of meniscal tissue. The lateral meniscus is grossly intact.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is limited. We see no full-thickness fluid intensity cartilaginous defects. Bone marrow signal intensity is unremarkable.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. Mild edema along the patellar tendon and medial retinaculum is nonspecific.ADDITIONAL", "output": "Extremely limited study showing findings compatible with a displaced flap tear of the medial meniscus."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status, unspecified [R41.82] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke History: aphasia Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.There are, however, multifocal chronic ischemic lesions with encephalomalacia on bilateral cerebellar hemisphere, left parietal lobe inferior parietal lobule (series 5, image 20/32) bilateral occipital lobes and left temporal lobe posterior aspect of the middle and inferior temporal gyri. In particular, left temporal lobe, bilateral parietal lobes especially inferior parietal lobules and bilateral occipital lobe lesions show susceptibility artifacts especially on the superficial cortex on gradient echo images which indicate possible prior petechial hemorrhage of the ischemic area.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral posterior communicating arteries are patent as well as a common artery.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. Multifocal chronic ischemic lesions with encephalomalacia as well as focal hemorrhagic lesions involving bilateral cerebellar and superior, bilateral occipital lobes and the right temporal lobe as described above. 3. Normal brain MR angiogram."}
{"instruction": "Generate impression based on findings.", "input": "23 year old male with a history of Crohn's disease with prior perforation last 2/2014. Presents with abdominal pain. 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: There are multiple scattered mesenteric lymph nodes. BOWEL, MESENTERY: Note is made of wall thickening and increased signal abnormality with associated enhancement affecting a long segment of the terminal ileum measuring approximately 10 cm in length. No evidence of fistula formation. There is no focal fluid collection to suggest abscess formation. The appendix is normal in size and appearance. 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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Findings consistent with acute on chronic inflammatory bowel disease affecting a long segment of the terminal ileum. No evidence of abscess formation or fistula, as clinically questioned. "}
{"instruction": "Generate impression based on findings.", "input": "History of pineal cyst: vision loss both eyes. Brain: There is no evidence of acute intracranial hemorrhage or acute infarct. There is a small amount of encephalomalacia in the right cerebellar hemisphere and bilateral basal ganglia. There is also a mild degree of cerebral white matter T2 hyperintensity. There is an unchanged 7 mm diameter pineal gland cyst. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull appears to be grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is enhancement surrounding the root of tooth number 7. There is focal thinning of the parietal scalp, which may be due to atrophy or prior surgery. There is a nonspecific small right nasolabial fold skin excrescence.Orbits: There is a right lens implant. The bilateral globes and ocular adnexa are otherwise unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.", "output": "1. Chronic lacunar infarcts in the right cerebellar hemisphere and bilateral basal ganglia, but no evidence of acute infarct.2. Unchanged subcentimeter pineal gland cyst.3. Right lens implant. Otherwise, no evidence of gross orbital lesions.4. Periodontal disease associated with tooth number 7."}
{"instruction": "Generate impression based on findings.", "input": "Left optic nerve pallor. Orbits: There is diffuse volume loss of the left optic nerve and chiasm without evidence of signal abnormality. There are no compressive mass lesions. There is no evidence of abnormal enhancement. The globes and ocular adnexa are unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. Punctate foci of susceptibility effect along the bilateral hippocampi correspond to calcifications. The major cerebral flow voids are intact. There is a 5 mm wide left frontal scalp lipoma. There is mild mucosal thickening in the maxillary sinuses.", "output": "1. Diffuse left optic nerve atrophy without evidence of inflammatory neuritis or compressive neuropathy.2. Chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or cerebral edema."}
{"instruction": "Generate impression based on findings.", "input": "History of left breast mammographic architectural distortion with sonographic correlate. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are adjacent foci of enhancement near the left breast at 10:00 in the mid to posterior depth which together measure 6 x 6 x 8 mm. These have mixed kinetics including areas of washout. This finding correlates positionally to the mammographic and sonographic finding. Elsewhere scattered non-suspicious foci are seen. No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.Hepatic cysts are noted.", "output": "Enhancing adjacent left breast foci that correlate positionally to the mammographic and sonographic finding. No additional suspicious enhancing lesion. No enlarged axillary lymph node. Subsequent to this exam, the patient underwent an ultrasound guided biopsy. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Gait disorder with right upgoing toe and left leg paresthesia. There is appears to be patchy T2 hyperintensity and mild volume loss at the T6-7 level. There is also apparent T2 hyperintensity in the spinal cord at the T1-2 and T4 levels. There are small posterior disc-osteophytes in the mid thoracic spine, but the spinal canal is not significantly narrowed. There are subcentimeter neural foraminal perineural cysts at multiple levels. 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 evidence of mass lesions or abnormal enhancement in the thoracic spine. The paravertebral soft tissues are unremarkable.", "output": "Apparent myelomalacia at multiple levels of the thoracic spinal cord. These may be secondary to a prior demyelinating or infectious process, for example."}
{"instruction": "Generate impression based on findings.", "input": "History of prostate cancer now with weakness and known lumbar lesions of metastatic disease. Rule out cord compression. Diffuse bone marrow changes are present compatible with the patient's known diffuse osseous metastases. There are degenerative changes in the cervical spine, including disc-osteophyte complexes and ligamentum flavum thickening at multiple levels with chronic spinal canal narrowing but there is no evidence of cord signal abnormality or acute cord compression. Similarly in the thoracic spine no cord signal abnormality or cord compression is demonstrated. Degenerative changes and osseous metastases are present in the lower lumbar spine, especially involving the L3-4 and L4-5 levels. The exam in the lumbar spine is degraded by motion artifact. Given this, and the absence of contrast, mild epidural spread of metastatic disease cannot be excluded, though a high-grade canal stenosis is not highly suspected .", "output": "This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Diffuse osseous metastatic disease and degenerative changes but no distinct evidence of cord compression is identified. The exam in the lumbar spine is degraded by motion and artifact and in the absence of contrast, mild epidural spread of metastatic disease cannot be excluded. However, no high-grade acute canal stenosis is suspected."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate sagittal balance, evaluate effusion. Back and right leg pain. History of lumbar fusion. Mild multilevel degenerative disc disease and anterior osteophytes are noted in the thoracolumbar spine. Posterior stabilization rods and pedicular screws entering the L4 and L5 vertebral bodies are noted, with intervertebral bone graft at L4-5. There remains approximately 7 mm in anterolisthesis of L4 on L5.There is approximately 11 degrees levoscoliosis of the thoracolumbar spine, as measured from the superior endplate of T3 to the inferior endplate of L1.Coronal balance is within normal limits. There is approximately 3.5 cm positive sagittal balance.", "output": "Multilevel degenerative disc disease.Levoscoliosis and positive sagittal balance of the spine, as above."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old male with metastatic prostate cancer and history of lung cancer. CHEST:LUNGS AND PLEURA: Postsurgical changes with volume loss from prior right lower lobectomy noted.No new infiltrates, nodules, masses or effusions seen. Elevation of the right hemidiaphragm persists.MEDIASTINUM AND HILA: Calcifications from prior granulomatous disease again noted. No enlarged lymph nodes identified. No other abnormalities.CHEST WALL: Again noted are diffuse sclerotic skeletal metastases there sclerotic in nature. Previous lesions identified have increased in size and there are scattered newer foci.ABDOMEN:LIVER, BILIARY TRACT: Diffuse low-attenuation liver is present indicative of diffuse fatty infiltration. This obscures metastatic lesions on CT and if concern over metastases to liver exists, ultrasound or MRI would be recommended. No such lesions are identified. Patient is status post cholecystectomy. No intrahepatic or extrahepatic bile duct dilatation is seen.SPLEEN: No significant abnormality notedPANCREAS: Resection of the pancreatic head mass noted on 2005 CT is present. The pancreatic duct has returned to near normal diameter compared to the marked dilatation previously. No evidence of recurrent tumor is seen in surgical bed. No other abnormalities are noted.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged retroperitoneal lymph node posterior to the aorta seen inferiorly at the abdominal/pelvic junction (series 4, image 127) measuring 1.7 x 1.2 cm. This was not present on the December, 2005 examination.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatectomy. No evidence of tumor recurrence in surgical bed.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse sclerotic metastases seen throughout the bony skeleton. These were not present on 2005 CT examination. New since 2005 examination right inguinal hernia containing small bowel and mesenteric fat/vessels without apparent complication.OTHER: No significant abnormality noted", "output": "1. Prior right lower lobe lung resection. Diffuse thoracic skeletal metastases with slight increase number and size of sclerotic lesions noted previously. 2. Diffuse fatty infiltration of the liver. This obscures the ability to detect liver metastases as described above. 3. New lymphadenopathy in retroperitoneum of the abdomen measured above. 4. Resection of prior noted pancreatic neuroendocrine tumor without evidence of recurrence. 5. Diffuse sclerotic metastases in the abdomen and pelvis. 6. New right inguinal hernia with small bowel without complication evident."}
{"instruction": "Generate impression based on findings.", "input": "Nausea/vomiting. Evaluate pancreatic mass (found on CT A/P w). ABDOMEN:LIVER, BILIARY TRACT: Severe fatty infiltration of the liver. No biliary ductal dilatation. No focal hepatic mass. Patent hepatic vasculature.SPLEEN: Diffusely decreased T2 hypointensity of the spleen with signal loss on in phase images consistent with iron deposition.PANCREAS: The subcentimeter hypoattenuating focus in the distal pancreatic body on prior CT consistent with focal fat, best seen on opposed phase images. No pancreatic mass or IPMN is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "The distal pancreatic body lesion seen on prior CT is consistent with interdigitating fat. No pancreatic mass or IPMN is evident."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for pathology for right lower extremity numbness and tingling. Signs and symptoms: RLE numbness and tingling. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.The marrow signal intensity of the vertebral column is uniformly abnormal with low T1 and low T2 and most likely secondary to long standing chronic kidney disease. No significant degenerative disease of the lumbar spine is identified.Lower most visualized thoracic spine and thoracic cord is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 is unremarkable.L3 -- L4 demonstrate minimal ligamentum flavum hypertrophy and unremarkable otherwise.L4 -- L5 demonstrate mild bilateral symmetrical ligamentum flavum hypertrophy. There is a tiny right paramedian annular fissure at this level which is best appreciated on axial T2 series 7 image 27 and unremarkable exam at this level otherwise.L5 -- S1 is unremarkable.The paraspinal musculature remains within normal size and signal intensity. Incidental note is made symmetrical bilaterally small kidneys which was also noted on prior CT of abdomen from 12 -- 14 -- 13.", "output": "1.Tiny central and rightward annular fissure at L4 -- L5.2.Unremarkable exam otherwise and without spinal stenosis or neural foraminal compromise at any level.3.Incidental note is made of bilaterally symmetrical small kidneys.4.Uniformly abnormal marrow signal of vertebral column secondary to long standing chronic kidney disease."}
{"instruction": "Generate impression based on findings.", "input": "Status post craniotomy with worsening headache. Evaluate for bleed. The patient is status post frontal craniotomy. Pneumocephalus and subcutaneous emphysema are likely postsurgical. In the left frontal high convexity an area of hypodensity with surrounding air represents the surgical bed. Foci of high attenuation likely represent a small amount of blood within the surgical bed. No large intracranial hemorrhage is identified. No midline shift. 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": "Expected postoperative findings of a recent craniotomy. No large intracranial hemorrhage."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with history of EBV lymphoma proliferation in HIV. Follow-up. BRAIN: Limited intracranial images demonstrate no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.NECK SOFT TISSUES:The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The lingual tonsils appear slightly prominent. No frontal masses are noted. There are many cervical lymph nodes at multiple levels.Small intraparotid lymph node is borderline in size measuring 12 x 8 mm (series 4, image 36). Small level 2 lymph node posterior and inferior to the right parotid gland is 11 x 8 mm (series 4, image 41). Small level 2 lymph node anterior to the sternocleidomastoid muscle anterior to the carotid artery measures 17 x 6 mm, (series 4, image 44). Additional multiple small lymph nodes are present throughout the visualized soft tissues not enlarged by CT criteria.Minimal multilevel degenerative change affects the visualized cervical spine without evidence of central canal or neuroforaminal stenosis. Vertebral body hypertrophy with posterior bridging osteophyte present at T1-T2 which is causing posterior indentation into the visualized cervical central canal. Due to CT technique and artifact in the spinal cord cannot be evaluated. There is clinical concern for cord compromise an MRI may be considered. The osseous structures are otherwise unremarkable.LUNG APICES:Lung apices are clear bilaterally.", "output": "1. Multiple lymph nodes some of which are borderline many of which are not pathologically enlarged by CT criteria, none of which demonstrate pathologic enhancement. No additional masses identified.2. Slight prominence of the lingual tonsils of uncertain etiology.3. Vertebral body hypertrophy with posterior bridging osteophyte present at T1-T2 which is causing posterior indentation into the visualized cervical central canal. Due to CT technique and artifact in the spinal cord cannot be evaluated. There is clinical concern for cord compromise an MRI may be considered. "}
{"instruction": "Generate impression based on findings.", "input": " There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Osteophyte disc complex and bilateral uncinate hypertrophy. There is mild anterior cord flattening without intrinsic cord signal abnormality. There is mild central and moderate bilateral neural foraminal stenosis.C4/5: Osteophyte disc complex somewhat asymmetric to the right and bilateral uncinate hypertrophy. There is mild anterior cord flattening, right greater than left, without intrinsic cord signal abnormality. There is mild central and mild bilateral neural foraminal stenosis.C5/6: Osteophyte disc complex and bilateral uncinate hypertrophy. There is mild anterior cord flattening without intrinsic cord signal abnormality. There is mild central, severe left neural foraminal, and mild right neural foraminal stenosis.C6/7: Osteophyte disc complex and left-sided uncinate hypertrophy. There is moderate left neural foraminal stenosis.C7/T1: UnremarkableLeft sided facet hypertrophy encroach the left neural foramen at T1/T2 and T2/3", "output": "1.C3/4: Mild central and moderate bilateral neural foraminal stenosis.2.C4/5: Mild central and mild bilateral neural foraminal stenosis.3.C5/6: Mild central, severe left neural foraminal, and mild right neural foraminal stenosis.4.C6/7: Moderate left neural foraminal stenosis.5.Left sided facet hypertrophy encroach the left neural foramen at T1/T2 and T2/3"}
{"instruction": "Generate impression based on findings.", "input": "Please obtain high res (1mm thickness) MRI T1-weighted to further characterize lesions. Differential: myeloma vs other neoplasm, inflammation, infection. History: left inferior nasal field vision blurring, 4y h/o myeloma, pt got MRI at OSH (uploaded in system) showing enhancing lesions in Lt optic n., left frontal leptomeninges, and 2 nodules in left cerebellum. There is no evidence of intracranial hemorrhage, large mass, or acute infarct. There is decreased subcortical T2 hyperintensity in the left frontal lobe. The cerebellum appears to be grossly 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is mild thickening diffusely along the left optic nerve sheath.", "output": "No evidence of intracranial hemorrhage, large mass, or acute infarct. However, characterization of the previously demonstrated lesions is limited due to the lack of contrast. Likewise, the left optic nerve sheath abnormality is not well-characterized without intravenous contrast. Otherwise, there is decreased nonspecific subcortical T2 hyperintensity in the left frontal lobe. "}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with hyperprolactinemia and amenorrhea. Evaluate for pituitary adenoma. The pituitary gland is within normal limits in size, signal intensity and enhancement. The pituitary stalk is located at midline without deviation, and is normal in caliber, signal intensity and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. The orbits and contents are unremarkable.  Limited images of the brain demonstrate no midline shift or mass effect. There are no areas of abnormal signal or pathologic enhancement. The ventricles and sulci are within normal limits. The midline structures and craniocervical junction are within normal limits.", "output": "Unremarkable examination with no focal lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male. BMT patient on long-term steroid. Severe right hip pain. Evaluate for avascular necrosis R hip. History of metastatic melanoma and myelofibrosis. Slightly mottled appearance to the bone marrow compatible with history of myelofibrosis. We see no specific imaging features of osteonecrosis. Tubular foci of low signal within the iliac wings and right sacrum represent biopsy tracts. Mild osteoarthritis affects both hip joints. Sacroiliac joints are unremarkable. Degenerative disk disease of the lower lumbar spine with spinal canal narrowing, which can be better evaluated with dedicated MRI lumber spine if clinically warranted.Mild edema and enhancement of the lateral insertional fibers of the right gluteus minimus/medius. There is also mild edema and enhancement of the far lateral fibers of the gluteus maximus muscle at the level of the greater trochanter. The right gluteus minimus tendon is slightly thickened but otherwise intact. Mild fatty atrophy of the left inferior erector spinae muscle.Tiny subcentimeter focus of fluid signal intensity adjacent to the anterior rim of the right acetabulum. This could represent a small paralabral cyst. We see no enhancement within either hip joint to indicate synovitis.", "output": "1. Bone marrow changes may be related to patient's known history of myelofibrosis. No findings to suggest osteonecrosis.2. Mild nonspecific right peritrochanteric inflammatory changes, as described above.3. Small lobulated fluid signal collection anterior to the right acetabulum, may represent a paralabral cyst. If there is clinical concern for a labral tear, MR arthrography can be considered."}
{"instruction": "Generate impression based on findings.", "input": "Female, 6 months old, with incidental finding of hypomyelination on previous MRI. Evaluate for interval changes. The pattern of white matter myelination has progressed from the prior examination and falls in the 4 to 5-month-old range. Parenchymal morphology is otherwise unremarkable. The degree of sulcation and gyral development is appropriate. No areas of focal signal abnormality or diffusion restriction are seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. The ventricles are normal in size and morphology.", "output": "Since the prior examination, white matter myelination has progressed and is appropriate for the patient's corrected gestational age. Evaluation of the brain is otherwise unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Status post blunt head trauma.? Intracranial hemorrhage. Signs and symptoms: Fell from bed with blunt head trauma and 4 episodes of nausea and vomiting 7 hours later. Non-enhanced CT brain: There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, CSF cisterns and ventricular system are essentially unremarkable. Sagittal reformatted images demonstrate minimal ectopia of the cerebellar tonsils. Follow-up with an MRI is recommended.Limited images of orbits are negative. Calvarium is intact. No definitive abnormality of the scalp is detected. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.", "output": "1.No evidence of acute intracranial process.2.Minimally ectopic cerebellar tonsils. Followed with an MRI is recommended.3.Calvarium is intact."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for NMO or demyelinating disease. Signs and symptoms: BUE weakness. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2 -- C3 demonstrate moderate disk disease and loss of disk height and mild facet and moderate ligamentum flavum hypertrophy changes. Constellation of changes results in moderate to severe central spinal stenosis and no neural foraminal compromise.C3 -- C4 demonstrate moderate advanced disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is resultant significant central spinal and bilateral neural foraminal compromise.C4 -- C5 demonstrate advanced disk disease and loss of disk height, mild ligamentum flavum and moderate facet hypertrophic changes are present at this level. Constellation of changes results in moderate central spinal stenosis, significant left and moderate right neural foraminal compromise.C5 -- C6 demonstrate moderate disk disease and loss of disk height, mild facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.C6 -- C7 demonstrate moderate disk disease and mild facet and ligamentum flavum degenerative changes without spinal stenosis. Mild right neural foraminal compromise is present.C7 -- T1 demonstrate mild disk disease and moderate left facet and ligamentum flavum hypertrophy. There is resultant mild to moderate left neural foramina compromise and patent right and without spinal stenosis.The signal intensity and caliber of the cervical cord and uppermost visualized thoracic cord is within normal.Pre-and post-enhanced brain MRI:Examination demonstrates few nonspecific and non-enhancing foci of flair hyperintensity only in the subcortical white matter of bilateral cerebral hemispheres. Unremarkable signal intensity brain parenchyma otherwise on all acquired MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise. Unremarkable images through posterior fossa.Negative post enhanced images of the brain parenchyma, leptomeninges, calvarium and the orbits.Unremarkable images through the orbits.Normal pneumatization signal pattern of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.", "output": "1.Normal signal intensity of cervical and uppermost visualized thoracic cord. Extensive degenerative changes of cervical spine results in multilevel mild to severe central spinal stenosis at C2 -- C3, C3 -- C4 and C4 -- C5 levels. There are multilevel neural foraminal compromise as detailed per level above.2.Pre-and post enhanced brain MRI demonstrates few nonspecific and nonenhancing small foci of flair hyperintensity only in the subcortical white matter of cerebral hemispheres. Unremarkable exam otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Male 22 years old. Reason: r/o fx, surgical complication. History: right knee swelling, s/p patellar tendon repair. Four non-weightbearing views of the right knee demonstrate thickening of the patella tendon, particularly proximally, more so than seen on prior study. There are calcifications in the soft tissues along the inferior margin of the patella. We see no large joint effusion.", "output": "Patellar tendon thickening and calcifications along the inferior margin of the patella as described above. These findings may reflect chronic tendinopathy and old post operative changes, however, we cannot exclude a superimposed \"acute\" partial thickness tear of the patellar tendon proximally. If further imaging is clinically warranted, MRI may be considered."}
{"instruction": "Generate impression based on findings.", "input": "Male, full-term 7-year-old infant with jerking episodes of bilateral upper extremities. A 4 mm T1 intermediate and T2 hypointense, susceptibility inducing lesion is evident along the body of the left caudate nucleus. This is located at the superior most aspect of the caudothalamic groove. No significant associated edema or mass effect is observed. There may also be a tiny focus of susceptibility overlying the right occipital horn but this is equivocal. Elsewhere, the morphology of the brain is appropriate for gestational age. No areas of edema or mass effect are detected. No large extra-axial fluid collections are observed. The ventricles are normal in size and morphology.The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. The corpus callosum is fully formed and intact. The pattern of white matter myelination is appropriate for age.", "output": "1.A susceptibility inducing lesion is evident along the body of the left caudate nucleus which which could represent a small focus of hemorrhage. The age of this lesion is difficult to ascertain though it is favored to be subacute to chronic.2.A questionable focus of susceptibility overlying the right occipital horn would also support the possibility of a prior hemorrhagic event.3.Evaluation of the brain is otherwise unremarkable.Discussed with Dr. Elios at 12:00 PM on 6/3/16."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old man with history of prostate biopsy in 7/2016 demonstrating Gleason 7 adenocarcinoma in the left apex and the Gleason 6 adenocarcinoma in the left mid gland. PELVIS:PROSTATE:Prostate Size: 45 x 35 mm.Peripheral Zone: The left apical peripheral zone (401/60) there is a 9 x 5 mm area of T2 hypointensity and diffusion abnormality (708/164). This region abuts the prostatic capsule with overlying indistinctness and subtle disruption of the capsule suggested. Scattered postbiopsy change with increased T1 signal seen in the peripheral zone.Central Gland: Nodular and enlarged.Seminal Vesicles: Normal in appearance.Extracapsular Extension: Irregularity of the left posterolateral prostatic capsule suggests invasion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Left apical focus of signal abnormality suspicious for adenocarcinoma with suspected focal extracapsular invasion. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 59 years old, with persistent abnormal smells, unilateral leg weakness, lung transplant patient. Concern for onset of temporal lobe seizures. Assess for structural lesions. Diffusion-weighted images are unremarkable. Numerous scattered foci of T2 hyperintensity are demonstrated within the bilateral cerebral white matter, unchanged from the prior exam. A few areas of cortical signal abnormality are also stable, for example involving the left parietal lobe and high right middle frontal gyrus.As on the prior examination, an oval cystic lesion is seen interposed between the substantia nigra and red nucleus on the right of the midbrain. This lesion follows CSF signal on all sequences and has not changed.There are a few scattered punctate foci of susceptibility in the brain which are of doubtful significance and may simply represent chronic microhemorrhage. No acute intracranial hemorrhage is suspected. Ventricles are stable and normal in size.A partially empty sella is unchanged. The marrow signal characteristics are unremarkable.", "output": "1. Sequelae of chronic microvascular and perhaps chronic cortical ischemia. No evidence of acute ischemia or any other acute findings.2. No change in the appearance of the temporal lobes with no specific lesions seen which would account for the patient's symptoms.3. Stable cystic lesion within the right midbrain which may represent a dilated perivascular space."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with slurred speech x 3 days and ataxia x 2 days on Coumadin. Rule-out intracranial hemorrhage, old stroke. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of periventricular and subcortical white matter hypodensities consistent with small vessel disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Sinus disease within the right sphenoid sinus. The remainder of the visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Small vessel disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered."}
{"instruction": "Generate impression based on findings.", "input": "Female 70 years old Reason: evaluate for osteomyelitis History: wound x 3 weeks with increased drainage, increased pain. hx lymphedema. There is skin thickening and reticulation of the subcutaneous fat consistent with stated history of lymphedema. There is replacement of the subcutaneous fat along the posterolateral aspect of the calcaneus with abnormal signal intensity and enhancement, presumably representing inflammation related to the overlying wound. Focal signal abnormality within the underlying calcaneus, specifically within the inferolateral aspect of the posterior tuberosity, that demonstrates slightly decreased signal on T1-weighted images and slightly increased signal on T2 weighted images as well as contrast enhancement and is suspicious for osteomyelitis. We see no additional foci of osteomyelitis.TENDONS: The visualized tendons are intact.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Mild degenerative arthritic changes affect the ankle, hindfoot, and midfoot. Additionally, please refer to 'findings' above.ADDITIONAL", "output": "Signal abnormality within the inferolateral aspect of the posterior tuberosity of the calcaneus suspicious for osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 80 years old. Reason: evaluate for RA, OA History: flexion contractures at PIP's Right hand: The bones appear demineralized. Moderate osteoarthritis affects multiple interphalangeal joints. Severe osteoarthritis affects the first carpometacarpal joint. We see no specific radiographic features of rheumatoid arthritis.Left hand: The bones appear demineralized. Moderate osteoarthritis affects multiple interphalangeal joints. Moderate osteoarthritis also affects the first carpometacarpal joint. We see no specific radiographic features of rheumatoid arthritis.Right knee: Severe osteoarthritis affects the right knee, particularly the lateral and patellofemoral compartments. A cluster of calcifications in the distal femoral metaphysis likely represents a benign enchondroma. The patella appears low lying, which may simply represent artifact related to patient positioning. However, if there is clinical concern for quadriceps tendon injury, MRI can be considered for further evaluation.Left knee: Severe osteoarthritis affects the left knee, particularly the lateral and patellofemoral compartments.", "output": "Osteoarthritis of both hands and both knees; other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Other headache syndrome [G44.89], Reason for Study: ^Reason: R/O venous obstruction, structural abnormality History: headaches Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV2-D and 3D MRV brain noncontrast enhanced with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.", "output": "1. Normal brain MRI.2. No evidence of dural sinus occlusion or stenosis. There is no evidence of venous congestive encephalopathy."}
{"instruction": "Generate impression based on findings.", "input": "Relapsing remitting multiple sclerosis. Not on treatment. Tingling in the hands. Brain:Since the previous examination, there has been progression of the patchy and confluent cerebral white matter (including corpus callosum) T2/FLAIR hyperintense lesions. The lesions are larger and more numerous and the overall burden is now moderate-to-severe. Some of the lesions in the frontal lobes are juxtacortical. There are lesions in the cerebellum, cerebellar peduncles, and the brainstem. Increased parenchymal volume loss is seen manifested by increased size of the sulci and other CSF-containing spaces as well as thinning of the the corpus callosum. The orbits are normal. There is minimal mucosal thickening in the inferior aspect of the left maxillary sinus and in the lateral most aspect of the left mastoid air cells. The paranasal sinuses and mastoid air cells are otherwise clear. There is no skull destructive lesion.Cervical spine:The T2 hyperintense spinal cord lesions at C1-C2 and C4-C5 levels, as well as several smaller scattered lesion, are not significantly changed since the previous examination. The associated very subtle volume loss at C7 and T1 levels is also unchanged. There is no new cervical spinal cord lesion.Mild multilevel cervical spondylosis has minimally progressed since the previous examination at C2-C3 level and is unchanged at the other levels. There is no significant spinal canal narrowing. There is mild to moderate neural foraminal narrowing as described below.The heterogeneously T2 hyperintense right thyroid lobe nodule is still present but is not diagnostically included.C2-C3: There is mild right neural foraminal narrowing by uncovertebral arthropathy which has slightly increased since the previous examination.C3-C4: There is moderate left and mild right neural foraminal narrowing by uncovertebral and facet arthropathy.C4-C5: There is severe right and minimal left neural foraminal narrowing by uncovertebral and facet arthropathy.C5-C6: There is moderate-to-severe right and moderate left neural foraminal narrowing by uncovertebral and facet arthropathy.C6-C7 and C7-T1: There is no significant spinal canal or neural foraminal narrowing.", "output": "1.Since 2012, there has been definite progression in the involvement of the white matter by multiple sclerosis (which is now moderate-to-severe) with more obvious overall volume loss.2.The cervical spinal cord lesions are not significantly changed. 3.The relatively mild multilevel degenerative spondylosis is minimally increased at C2-C3 and is unchanged at other levels."}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval hematoma vs infection of left thigh History: 4d of pain/swelling to left thigh. has liver failure w/ elevated inr... also has lactate... also has crp<3 and afebrile Complex cystic solid mass in the adductor magnus measuring approximately 10.6 x 5.0 x 20.3 cm. There is subtle peripheral enhancement. Imaging features suggestive of liquefying hematoma with or without superimposed infection. Severe compression of the superficial femoral vein anterior to the mass with abnormal signal in the vessel, which may represent DVT versus slow flow. Small joint effusion. There is interfascial and circumferential subcutaneous edema.", "output": "Large complex mass centered in the abductor magnus. Imaging features most consistent with hematoma with or without superimposed infection. Recommend follow-up to resolution."}
{"instruction": "Generate impression based on findings.", "input": "Reason: renal mass History: none ABDOMEN:LIVER, BILIARY TRACT: There are 3 lesions within segments 2, 7 and 8 which are hyperintense on T2-weighted images and demonstrate peripheral nodular enhancement, consistent with hemangiomas. A segment 7 lesion measures 2.3 x 1.6 cm (5/4), previously 2.1 x 1.6 cm. A segment 2 lesion measures 1.7 x 1.2 cm (5/11), previously 1.6 x 1.2 cm. There is a lesion in within the inferior right hepatic lobe which is enhances on arterial phase and is isointense on delayed phases measuring 4.6 x 2.5 cm, unchanged in size. This lesion has previously been shown to exhibit hepatobiliary phase enhancement with central scar, suggesting focal nodular hyperplasia. .SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a lesion in the right midpole which subtly enhances on delayed phases and measures 1.2 x 1.0 cm (13/27), unchanged in size.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.Subtly enhancing lesion in the right midpole is stable in size and suspicious for renal cell carcinoma.2.Multiple hemangiomas are minimally increased in size.3.Lesion in the right inferior hepatic lobe is stable and likely represents focal nodular hyperplasia."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: History of tethered cord repair, x 2 by meningomyelocele, follow up. Signs and symptoms: New symptoms, back pain, and electric shock type pain feeding to lower back. Nonenhanced lumbar MRI:The examination redemonstrates a small lipoma along the dorsal aspect of conus measuring at 19.8 he previous axis and 6.4-mm in AP axis (measured on sagittal series) without interval change since prior study from 2011. Lipoma resolve since subtle flattening and forward displacement of the conus similar to prior exam and without evidence of spinal stenosis. The signal intensity of the cord and conus is otherwise within normal.The lipoma these presented at the level of the superior endplate of L2 and without evidence of any change since prior.Revisualization of stable postoperative changes of prior laminectomy for untethering of the cord and removal of meningomyelocele. There is termination of the cord at upper L2 level which is inseparable from the posterior thecal sac similar to prior exam and suspected for adhesion.Prone sagittal T2 weighted images demonstrate anterior movement of the lower cord however without movement of the tip of the conus which remains inseparable from the posterior wall of the thecal sac and likely representing adhesion. There is apparent worsening of this finding on prone sagittal series by apparent increased point of contact of the lower tip of conus to the posterior wall of thecal sac on sagittal prone T2W series compared to prior prone sagittal T2. This observation can be result of slice positioning and not a true interval change and there are no axial images on prone position for comparison.", "output": "1.Revisualization of a stable small lipoma of the dorsal aspect of conus.2.Prone sagittal T2-weighted images demonstrate anterior movement of the lower cord however without movement of the tip of the conus which remains inseparable from the posterior wall of the thecal sac and is suspected on adhesion. Please see above comments.3.Revisualization of postoperative changes of prior cord untethering and removal of the meningomyelocele."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female with knee pain, evaluate meniscus MENISCI: There is oblique tear of posterior horn of the medial meniscus with extension to the femoral and tibial articular surfaces. There is globular signal abnormality within the body of the lateral meniscus without extension to either articular surface.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage loss along the medial patella undersurface with full-thickness degeneration and fissuring along the median eminence. Full-thickness and near full-thickness articular degeneration along the femoral trochlea with underlying reactive marrow changes. There is near full thickness loss of the articular cartilage along the medial femoral condyle with scattered foci of full-thickness degeneration and underlying reactive changes in the subchondral marrow. Mild diffuse articular cartilage thinning within the lateral tibiofemoral compartment.Tricompartmental osteophytes are noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patella tendons appear normal. There is marked prepatellar tendon soft tissue edema.ADDITIONAL", "output": "1. Severe osteoarthritis with tricompartmental articular cartilage loss as described above.2. Nondisplaced tear of the posterior horn of the medial meniscus as detailed above.3. Diffuse soft tissue swelling and fluid collection along the medial soft tissues which may reflect prior trauma/degloving injury.4. Moderate joint effusion and small Baker's cyst."}
{"instruction": "Generate impression based on findings.", "input": "Hit with baseball bat RIGHT TESTIS: No significant abnormalities noted. Normal testicular echotexture, without evidence of traumatic injury. The right testis measures 1.3 x 0.8 x 1.5 cmLEFT TESTIS: No significant abnormalities noted. Normal testicular echotexture, without evidence of traumatic injury. The left testis measures 1.5 x 0.7 x 1.0 cmRIGHT EPIDIDYMIS: No significant abnormalities noted. The right epididymis measures 0.6 x 0.3 x 0.6 cm.LEFT EPIDIDYMIS: No significant abnormalities noted. The left epididymis measures 0.6 x 0.5 x 0.7 cm.OTHER: No paratesticular collections or masses to suggest hydrocele or hematoma.DOPPLER", "output": "Normal sonographic appearance of the testes and scrotum, without evidence of traumatic injury or torsion."}
{"instruction": "Generate impression based on findings.", "input": "Fall. History of agenesis of the corpus callosum and subdural hemorrhage. There is motion artifact at the convexities, however within this limitation there is stability in size (12 mm coronally) of the evolving left subdural hematoma which was first documented on the MRI performed 8/20/2013. There has been partial resolution of the previously described right parasagittal subdural hematoma. There are stable bilateral prominent CSF attenuating fluid collections. There are no new extra axial fluid collections identified.Previously described findings representing complete agenesis of the corpus callosum are stable. No new intracranial masses, mass effect including midline shift or CT evidence of acute hydrocephalus. Ethmoid air cells are aerated and maxillary sinuses are partially aerated. Sphenoid are opacified, as is appropriate for the patient's age. Mastoid air cells are unremarkable. There are no visualized bony abnormalities.", "output": "1.Stable evolving left subdural hematoma.2.Interval partial resolution of a right parasagittal subdural hematoma.3.Stable findings representing complete agenesis of the corpus callosum.4.Stable CSF attenuating extra-axial fluid collections bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old with history of metastatic renal cell cancer, presurgical for C4 vertebrectomy. Reversal of lordosis of the cervical spine is identified. There is a significant compression fracture at C4, as well multiple metastases seen throughout the posterior elements of the cervical spine as reported on today's MRI. A posterior laminectomy from C3 to C5 is also identified.", "output": "Diffuse posterior element metastases, as well as a significant compression deformity of C4. For better characterization, please see today's dedicated MRI report."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified fall, initial encounter [W19.XXXA] / Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: 79F with multiple falls and RLE weakness, some incontinence too, h/o amyloidosis, ?spinal tumor, ?nerve impingement, For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-2 level.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L1-L2: Disc desiccation, with mild bilateral ligamentum flavum thickening. No neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation, diffuse bulging of disc with mild bilateral ligamentum flavum thickening result minimal spinal canal stenosis. No neuroforaminal narrowing or spinal stenosis. L4-L5: There is grade 1 anterolisthesis of L4 on L5. Associated with bilateral ligamentum flavum thickening, spinal canal at this level shows moderate to severe spinal stenosis. No neuroforaminal narrowing or spinal stenosis. L5-S1: Disc desiccation, diffuse bulging of disc with bilateral ligamentum flavum thickening indicates minimal spinal canal stenosis. No neuroforaminal narrowing or spinal stenosis.", "output": "1. Grade 1 anterolisthesis of L4 on L5 with moderate to severe spinal canal stenosis.2. Degenerative spondylosis of the lumbar spine including various degree of spinal stenosis as described above.3. No evidence of spinal cord compression."}
{"instruction": "Generate impression based on findings.", "input": "Prostate cancer. Evaluate for high risk features. PELVIS:PROSTATE:Prostate Size: 2.9 x 5.6 x 4.2 cmPeripheral Zone: In the left medial apex there is a 1.0 x 0.5 cm lesion with decreased T2/ADC signal (series 1001/11) as well as diffusion restriction (series 1104/1 84).In the right lateral mid gland there is a 9 x 7 mm focus with decreased T2/ADC signal (series 801/68) as well as associated restricted diffusion (series 1104/224).There is atrophy at the right base with ill-defined decreased T2 signal but no associated abnormal signal on ADC/DWI.Central Gland: Mild benign prostatic hyperplasia. No discrete suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small left external iliac lymph nodes are nonspecific. No additional enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Dominant 1.0 cm left medial apex and 0.9 cm right lateral mid gland lesions, suspicious for prostatic adenocarcinoma.2.Indeterminate ill-defined lesion at the right base. 3.No evidence of extracapsular extension or pelvic lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Left-sided sciatica with weakness in dorsiflexion For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Diffuse bulging of disc which abuts thecal sac. No neuroforaminal narrowing or spinal stenosis. L4-L5: Diffuse bulging of disc with associated broad-based disc protrusion towards left side lateral recess which compress left-sided nerve root. Disc desiccation is seen.L5-S1: Diffuse bulging of disc. Disc desiccation is seen. No neuroforaminal narrowing or spinal stenosis.", "output": "Central to left disc herniation at the level of L4-5 as described above.Diffuse bulging of discs at the level of L3-4 and L5-S1."}
{"instruction": "Generate impression based on findings.", "input": " Spine: Again seen are postoperative changes related to tumor resection with T7 and T8 laminectomies. Myelomalacia involving the cord from the T6 to T10 levels with associated cord deformity appears similar. The cord is again somewhat dorsally located within the thecal sac that some of these levels which may relate to adhesions. No new cord signal abnormality. Focal susceptibility at the T11 level dorsally is unchanged and consistent with postsurgical change. There is no new pathological enhancement. Again seen is enhancing nodule at the T8 level which is in the resection bed of resection from 9/2014 but smaller compared to prior pre-recent resection MRI from 7/21/2014. Lesion measures 8 mm in the craniocaudal dimension and 4 mm in the anteroposterior dimension. Axial images are motion degraded. The cervical, thoracic, and lumbar spine are in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis.Brain: The brain parenchyma appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is no abnormal intracranial enhancement.", "output": "1. Postoperative changes of tumor resection in the thoracic spine with extensive myelomalacia from T6 to T10. Again seen is an enhancing nodule at the T8 level which is in the surgical bed of recent resection from 9/2014. Although some of this enhancement may be post-surgical, residual/recurrent tumor is not excluded. Finding is slightly more prominent than prior. Suggest close follow-up.2. No new area of enhancement in the thoracic cord or leptomeningeal disease in the spine.3. MRI of the brain is unremarkable without evidence of intracranial mass or abnormal parenchymal or meningeal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female with pituitary lesion, assess for changes. The pituitary gland is appropriate in overall height and morphology. There is mild heterogeneous enhancement of the pituitary gland, however there are no discrete lesions identified. Dynamic images are slightly degraded by motion. No definite T2 pituitary abnormality is seen. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally. There is no diffusion abnormality.", "output": "Mild heterogeneous enhancement of the pituitary gland with no discrete lesions identified. "}
{"instruction": "Generate impression based on findings.", "input": "Female 44 years old Reason: right knee meniscus tear History: pain and swelling MENISCI: Slight attenuation of the posterior horn of the medial meniscus that may reflect interval partial meniscectomy. A small focus of intermediate signal intensity along the undersurface of the remainder of the posterior horn of the medial meniscus may simply represent residual degenerative signal within the meniscus although we cannot completely exclude a small undersurface tear. More concerning however is replacement of the body of the medial meniscus with increased signal intensity, best seen on the coronal sequences, suggesting a large radial tear. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a new full-thickness defect of the articular cartilage on the weight-bearing surface of the medial femoral condyle measuring between 1.0 and 1.5 cm in greatest dimension. There is extensive edema within the underlying medial femoral condyle. There is also a large full thickness defect of the articular cartilage at the anterior aspect of the medial femoral condyle extending into the trochlea measuring between 1.0 and 1.5 cm in greatest dimension which is new from prior study. There is focal partial thickness degeneration of the articular cartilage of the lateral facet of the patella. The articular cartilage of the lateral joint compartment appears intact.LIGAMENTS: The anterior cruciate ligament now appears thickened and of increased signal intensity in a pattern suggestive of mucoid degeneration with small foci of signal abnormality within the adjacent tibial plateau and intracondylar notch of the femur. The posterior cruciate ligament is intact. There is edema along the superficial fibers of the medial collateral ligament that could represent a sprain in the correct clinical context. The deep fibers of the medial collateral ligament appear abnormally thickened which could represent tearing related to the aforementioned medial meniscus abnormalities. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: There is mild edema along the anterior margin of the patellar tendon but the patellar tendon and quadriceps tendon appear intact.ADDITIONAL", "output": "1. Post operative changes of the medial meniscus as described above with findings suggestive of a new large radial tear through the body of the medial meniscus.2. New full-thickness cartilage defects along the medial femoral condyle as described above with new edema in the medial femoral condyle as well.3. Thickening and increased signal intensity in the anterior cruciate ligament suggesting progression of mucoid degeneration.4. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Status post resection of cerebellar osteosarcoma metastasis referred for post-operative SRS to cavity. There are postoperative findings related to right suboccipital craniotomy with mild susceptibility and presumed linear enhancement along the margins of the right cerebellar hemisphere resection cavity, which measures up to 25 mm. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. A subcentimeter nodular and linear focus of presumed enhancement in the left temporal fossa may represent a vascular or inflammatory lesion versus less likely a metastasis.", "output": "Pre-treatment planning MRI shows recent postoperative findings related to right suboccipital craniotomy."}
{"instruction": "Generate impression based on findings.", "input": "Benign neoplasm of cranial nerves [D33.3], Reason for Study: ^Reason: Brain tumor: Preop planning for resection History: headaches The scan was performed with multiple fiducial markers attached on the scalp.There is a large extra-axial mass on the left petrous apex with inhomogeneous enhancement.The mass is measured about 47.1mm(CC) x 35.7mm(RL) x 51.3mm(AP).The mass is centered at or around mesial skull base and eroding left petrous apex.The mass shows central non enhancing portion without evidence adjacent dural enhancement.The left cavernous sinus appears to be involved or completely pushed toward right side and the left cavernous sinus segment of the left ICA appears to be surrounded by the enhancing mass about 180-200 degree especially at the junction of petrous segment and posterior cavernous sinus segment.There is mass effects against brain stem, left cavernous sinus and left mesial temporal lobe.Differential diagnosis include left trigeminal nerve origin schwannoma or meningioma. There is no evidence of ventriculomegaly.The paranasal sinuses and mastoid air cells are clear.", "output": "Left petrous apex extra axial mass with inhomogenous enhancement as described above.Differential diagnosis include Schwannoma and meningioma."}
{"instruction": "Generate impression based on findings.", "input": "Male 51 years old; Reason: Back pain. There is moderate degenerative disc disease at L4-5 and mild degenerative disease at L2-3 and L3-4. The vertebral body heights are preserved and alignment is anatomic.", "output": "Degenerative disc disease as described above."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with generalized abdominal pain. History of ulcerative colitis. Evaluate for inflammatory bowel disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal mass measures 2 x 3 cm in axial image 30/14 series 3. This is incompletely evaluated on the postcontrast study. Further evaluation with dedicated adrenal CT or MRI examination may be helpful for further characterization, if indicated.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The colon is ahaustral and the descending colon contains small amount of fluid within mucosal enhancement. The appearance is consistent with history of ulcerative colitis. Normal appendix in the right lower quadrant. The terminal ileum appears normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: There is a central pelvic uniloculated fluid density cystic lesion which measures 7 x 8 cm in axial image 120/154 of series 3. This is most likely of adnexal origin. Bilateral adnexal cysts, larger on the left measuring more than 5 cm in diameter. If clinically indicated, transvaginal ultrasound examination may be helpful for further evaluation.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Ahaustral colon compatible with history of ulcerative colitis. No small bowel abnormality was identified. Central pelvic cystic lesion, probably adnexal measures 7 x 8 cm. Additional cystic lesions in the adnexae. Right adrenal mass."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Please perform Dr.Javed's multiple sclerosis protocol on 3T. signs and symptoms: MS progression, please compared with prior. Pre-and post-enhanced cervical MRI:Examination redemonstrates multiple foci of T2 hyperintensity throughout the cervical cord without convincing evidence of interval change since prior study. Limited view of the posterior fossa also demonstrate multiple lesions in the pons and medulla which also appear to have remained stable since prior exam. None of the lesions demonstrate abnormal enhancement. Findings consistent with patient's known emanating disease and medulla suggestion of progression.Multilevel degenerative changes cervical spine worst at C5 -- C6 and resultant central spinal stenosis and with moderate left and mild right neural foraminal compromise remain similar to prior exam. No evidence of spinal or neural foraminal compromise/stenosis at any other level.Pre-and post-enhanced thoracic MRI:Examination demonstrate multiple small foci of T2 hyperintensity in the ,mid to lower thoracic cord which considering slight difference in technique between the exam demonstrate no definitive evidence of interval change or progression. None of the lesions demonstrate enhancement. The lesions span from T5 inferiorly and with a cluster of lesions at T10 through the conus similar to prior exam. Some of the lesions demonstrate subtle associated decreased cord caliber suggestive of volume loss. The signal intensity in the alignment of the tubercle remains within normal and without evidence of spinal canal or neuroforaminal compromise at any level. There is no detectable abnormal enhancement of the vertebral column.", "output": "1.Mild to moderate findings of chronic demyelinating disease of the cervical cord without convincing evidence of interval progression. Degenerative changes of cervical spine with resultant central spinal stenosis and bilateral neural foraminal compromise only at C5 -- C6 remains similar to prior exam. No spinal stenosis or neural foraminal compromise at other levels.2.Findings of chronic demyelinating disease of thoracic cord from T5 through the conus without enhancement or progression since prior exam."}
{"instruction": "Generate impression based on findings.", "input": "18 years Female (DOB:7/28/1997)Reason: ? vasculitis History: confusion and h/o lupusPROVIDER/ATTENDING NAME: JAMES AHN RIMAS V LUKAS MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a well-circumscribed focus of signal loss present in the left lentiform nuclei within the putamen which is associated with some enhancement.There is a tuft of enhancing serpiginous structures posteriorly with signal loss on susceptibility imaging located in the left frontal lobe adjacent to the left middle frontal gyrus which is suspected to represent a developmental venous anomalyThere is a mild degree of subcortical and periventricular punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are predominantly identified in the left hemisphere.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is relatively small to medium sized.. The right posterior communicating artery is medium-sized whereas the left posterior communicating artery is small to medium sized. The left vertebral artery is larger than the right vertebral artery. Findings also suggest a double origin left posterior inferior cerebellar artery. The vertebral arteries are similar in size.", "output": "1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is an ill-defined lesion present in the left basal ganglia. One possibility is that this may represent capillary telangiectasia.4.There is a lesion in the left frontal lobe which is suspected represent a developmental venous anomaly, however, it may be associated with capillary telangiectasia.5.There is a mild degree of subcortical and periventricular white matter lesions present predominantly in the left hemisphere. These are unusual at this age. Differential considerations include vasculitis as well as trauma, demyelinating disorder and vascular related lesions.6.Double origin left posterior inferior cerebellar artery."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Headache Cerebral aneurysm, nonrupturedClinical question: assess for thrombus developmentSigns and Symptoms: acute onset left hemiparesis MRI of the brainThere are multiple foci of subcentimeter sized diffusion restriction within the distal right MCA territory along the watershed zone adjacent ot the right superior frontal sulcus and in the right inferior parietal lobule as well as in the right with several mor scattered in the right frontal and parietal lobes. In addition, there are Periventricular and and subcortical white matter signal hyperintensities identified on FLAIR MRI without diffusion restriction some of which were not present on the 10/19/15 exam. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small air-fluid levels in the maxillary sinuses and left sphenoid sinus and scattered opacities in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Embolic occlusion coils are present at the patient's right anterior choroidal bilobed aneurysm (which is embedded into the medial aspect of the right temporal lobe) and the patient's basilar aneurysm. The anterior choroidal artery remains patent. There is no evidence for recanalization of either aneurysm at this time.There is redemonstration of a 2mm right ophthalmic artery aneurysm at the origin of the right ophthalmic artery. There is redemonstration of a left superior cerebellar origin 1 mm aneurysm. There is redemonstration of a 1 mm left PCOMA aneurysm.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery is identified. The posterior communicating arteries are small. The left vertebral artery is slightly smaller than the right vertebral artery.", "output": "1.Multiple subcentimeter foci of infarction predominantly located along the right hemispheric watershed zone. These could be related to distal emboli.2.No evidence for cerebrovascular occlusion.3.Status post embolic coil occlusion of a right anterior choroidal artery aneurysm without evidence for recanalization at this time and no change since the MRA earlier in the day. This aneurysm is embedded in the right temporal lobe.4.Status post embolization of a basilar/left AICA origin aneurysm without evidence for recurrence.5.Findings were discussed with Dr Kramer at the time of the exam.6.There is redemonstration of a 2mm right ophthalmic artery aneurysm at the origin of the right ophthalmic artery. 7.There is redemonstration of a left superior cerebellar origin 1 mm aneurysm.8.There is redemonstration of a 1 mm left PCOMA aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female with multiple sclerosis. 3T CCD MRI Javed MS protocol no DTI Redemonstrated are multiple variable sized T2 hyperintense lesions of the periventricular and subcortical white matter, also along the corpus callosum, and within the cerebellum. There appear to be several more punctate lesions on the current exam, however this may be technical in nature given the comparison study was obtained at 1.5 Tesla and the current exam at 3 Tesla.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, or midline shift. The midline structures and cranial-cervical junction are normal. Note is again made of a partially empty sella. Normal flow voids are identified in the major intracranial vessels. Minimal mucosal thickening can be found within ethmoid air cells and the left sphenoid sinus without air-fluid levels. The remaining paranasal sinuses and mastoid air cells are clear.", "output": "Redemonstrated are supratentorial and infratentorial brain lesions consistent with multiple sclerosis plaques. There appear to be several more punctate lesions, however this may be technical in nature given the comparison study was obtained at 1.5 Tesla and the current exam at 3 Tesla."}
{"instruction": "Generate impression based on findings.", "input": "Male, 15 years old, with history of recurrent juvenile angiofibroma, and two episodes of epistaxis since prior imaging, granulation tissue evident on the posterior septum. Assess and compare to prior imaging. Evidence of prior sinonasal surgery is seen for partial resection of a juvenile angiofibroma. Residual infiltrative enhancing tissue remains involving the left sphenoid bone, the pterygopalatine fossa, the left cavernous sinus, sella and clivus, and to a lesser degree the left masticator space. On comparison with the prior examination, the size and extent of this residual enhancing tissue has not convincingly changed. There is a greater degree of what likely represents sinus mucosal thickening along the residual walls of the left maxillary sinus. Mucosal thickening within the left ethmoidectomy bed has not significantly changed. No definite evidence of any new sinonasal lesion is seen.", "output": "Evidence of extensive prior sinonasal surgery is seen for partial resection of the juvenile angiofibroma. Enhancing tissue centered on the left sphenoid bone with extension to the surrounding spaces is redemonstrated which most likely represents tumor. Since the prior examination, no definite increase in tumor size is seen, and no new lesions are identified."}
{"instruction": "Generate impression based on findings.", "input": "Newly diagnosed breast cancer. Hepatic lesions suspicious for metastatic disease. Back pain but neurologically nonfocal. There are 7 cervical, 12 thoracic, 4 lumbar, and 1 lumbosacral transitional vertebra. This transitional vertebra is labeled L5 for the purposes of this dictation.There is normal curvature and alignment of the spine. There is no fracture or loss of height of the vertebra. However, there is hypodensity within the right C3 vertebra and the left C5 vertebra (series 8051 images 16 and 20 respectively). Also question of focal lesion within right T1 vertebra (series 8050 image 19). These lesions are nonspecific and enhancement pattern cannot be accurately characterized by CT. However, they could represent metastatic disease in this patient who has breast cancer newly diagnosed. Bone scan may be helpful for confirming active bone remodelling and detecting occult lesions elsewhere.Detection of intracanalicular and paravertebral metastatic disease is extremely difficult based on CT. However, there is no gross intracanalicular mass lesion that can be identified based on CT. The morphology of the cord and conus medullaris appear grossly normal. In this circumstance, clinical correlation is essential.Moderate cervical spine degenerative change is present. Findings are specified level by level:C2-C3: No disk herniation, thecal sac effacement, or foraminal narrowing.C3-C4: Left sided disk osteophyte complex and uncovertebral hypertrophy. As a result, there is mild narrowing of the ventral thecal sac on the left and moderate left foraminal narrowing.C4-C5: Questionable disk protrusion with at most partial ventral thecal sac effacement. Minimal foraminal narrowing secondary to uncovertebral hypertrophy and facet hypertrophy. There is acquired fusion of the right facet articulation at this level.C5-C6: Posterior disk osteophyte complex results in partial sac effacement. There is also severe right and minimal left foraminal narrowing secondary to uncovertebral hypertrophy and facet hypertrophy.C6-C7: Minimal posterior disk osteophyte complex with at most partial ventral thecal sac effacement. Mild bilateral foraminal narrowing secondary to uncovertebral hypertrophy.C7-T1: No gross disk herniation, thecal sac effacement, or foraminal narrowing. However, streak artifact obscures detail at this level.In the thoracic spine, there is no gross disk herniation or thecal sac effacement apart from some mild dorsal thecal sac partial effacement at right T8-T9 and T10-T11 from calcified ligamentum flavum hypertrophy. There is no osseous encroachment upon the neural foramina though small disk herniations could be easily obscured given image quality. There is endplate sclerosis and anterior osteophyte seen between T3 and T12.In the lumbar spine, there is minimal degenerative change. Findings are specified level by level:L1-L2: No disk herniation, thecal sac effacement, or convincing foraminal encroachment.L2-L3: Minimal diffuse disk bulge. No central canal stenosis or foraminal narrowing.L3-L4: Mild diffuse disk bulge eccentric to the left. While there is no central canal stenosis, there is mild to moderate left foraminal narrowing from the disk herniation. Also minimal facet hypertrophy.L4-L5: Mild diffuse disk bulge with some questionable encroachment on the lateral recesses. No central canal stenosis. Probably some mild foraminal narrowing bilaterally.L5-S1: Partially fused disk space. No disk herniation, central canal stenosis, or foraminal narrowing.In the extraspinal soft tissue structures, there is elevation of the right hypopharynx from retropharyngeal carotid. No cervical lymph nodes. There is a right pleural effusion with passive atelectasis and a calcified subcarinal lymph nodes and right hilar lymph nodes, better evaluated on earlier chest CT. The nodularity of the liver is not well demonstrated on this examination which is motion degraded and has a more circumscribed field-of-view; hepatomegaly still evident. Slice intracranial contents are unremarkable apart from some mild intracranial vasculature ossification. Hypodensity seen in the middle cerebellar peduncles is felt to be most likely artifactual.", "output": "1. Areas of hypodensity/bone lysis within the right C3 and possibly left C5, right T1 vertebra. At least the C3 lesion is suspicious for metastatic disease--correlative bone scan (nuclear medicine) may be of value. No other destructive osseous lesions and no compression fractures.2. This study is poorly sensitive for intracanalicular metastatic disease and paravertebrally metastatic disease. However, no gross compression of the cord or conus is seen. If there is strong concern for leptomeningeal disease, suggest CSF puncture. 3. Mild to moderate spinal degenerative changes. Small and subtle findings are potentially obscured given poor image quality.4. Chest and abdominal findings were better seen on prior dedicated imaging. Slightly increased right pleural effusion.Findings discussed with and acknowledged by Dr. Laffin 10/27/2012 11:38 AM ."}
{"instruction": "Generate impression based on findings.", "input": "Dysarthria following unspecified cerebrovascular disease [I69.922] / Essential (primary) hypertension [I10], Reason for Study: ^Reason: Concern for stroke History: As above There are new restricted diffusion lesions on the brainstem including right side of the lower midbrain, right side middle cerebellar peduncle, anterior aspect of lower pons, and right posterior aspect of medulla indicating acute ischemic infarct.Previously seen multifocal lower pontine and left middle cerebellar peduncle area restricted diffusion lesions has been decreased in signal intensity indicating normal evolution. There is no evidence of hemorrhage transformation.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. 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": "New acute ischemic infarcts on the brainstem as described above.Normal evolution of previously seen acute ischemic infarctions.No evidence of hemorrhagic transformation."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with right knee pain and swelling for 6 months. MENISCI: There is increased signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial articular surface consistent with a complex degenerative tear that extends to the body of the meniscus. There is blunting of the anterior horn of the meniscus suggestive of degeneration/tearing with a longitudinal component through the anterior horn of the lateral meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the lateral femoral condyle above the posterior horn of the meniscus as well as along the lateral tibial plateau underlying the posterior horn and body of the meniscus with underlying subchondral signal abnormality which is likely degenerative in etiology. There is a partial-thickness articular cartilage fissure along the lateral facet of the femoral trochlea.Note is made of curvilinear serpentine increased signal abnormality within the distal femoral metadiaphysis and epiphysis as well as within the proximal tibial metadiaphysis and epiphysis consistent with osteonecrosis/bone infarcts. There is apparent subchondral collapse/fracture along the weight bearing surface of the medial and lateral tibial plateau. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Osteonecrosis of the femur and tibia with apparent focal areas of subchondral collapse/fracture along the medial and lateral femoral condyles.2. Degenerative osteoarthritic changes of the right knee.3. Large joint effusion.4. Tearing of the lateral meniscus as described above."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Left frontal grade 3 oligodendroglioma with 1p19q deletion. Now off all therapy. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:No diffusion weighted findings.Examination demonstrates a focus of hemorrhagic encephalomalacia along the superior aspect of the left mid to posterior frontal lobe consistent with the site of previously treated/operated tumor. There is no evidence of interval change of this finding since prior exam. Post-enhanced images demonstrate no evidence of abnormal enhancement which is a similar observation is prior to study.There is postoperative changes of left frontal -- anterior parietal craniotomy with a small extra axial CSF signal intensity collection confined to the undersurface of craniotomy flap and likely representing an epidural CSF signal intensity postoperative collection. There is expected this enhancement of dura at this level similar to prior exam. There is subtle flattening and deformity of the brain parenchyma at the site of surgery secondary to this collection which may also be as result of adhesion. This appearance remains also identical to prior exam. This collection appears to bulge into the bur hole along the medial edge of craniotomy flap. This is also similar to prior study.Residual flair hyperintensity surrounding the surgical cavity consistent with gliosis is again noted. Unremarkable and stable pre-and post enhanced brain MRI otherwise.", "output": "1.Stable post treatment/surgical changes of the left demonstrate oligodendroglioma with out evidence of residual or recurrence of tumor.2.Stable postoperative changes of left frontoparietal craniotomy and extra-axial collection under the craniotomy flap as detailed.3.Unremarkable exam otherwise and without change"}
{"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 \u201ctime-out\u201d 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\u2019s 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."}
{"instruction": "Generate impression based on findings.", "input": "61 year old man with history of ischemic cardiomyopathy s/p heart transplant in May 2015 complicated by early grade 1A rejection, now admitted after surveillance right heart catheterization demonstrated elevated filling pressures. He is referred for cardiac MRI to evaluate for possible rejection. Left VentricleThe left ventricle is normal in size with low-normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 68 ml/m2 (normal range: 74+/-15), the LVEDV is 153 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19), the LV mass index is 33 g/m2 (normal range 85+/-15), and the LV mass is 76 g (normal range 164+/-36). There are no regional wall motion abnormalities present. The T2-STIR ratio between myocardium and skeletal muscle is 1.9 (normal is <2). Global relative enhancement is 2.8 (normal is <4). Native T1 relaxation time is 980ms, which is not elevated. ECV is slightly elevated at 32%. There is a focus of transmural late gadolinium enhancement in the basal inferior wall which involves 1/2 of the wall thickness and could be consistent with previous infarction, infiltration, inflammation or fibrosis. Aside from this segment, there is no late gadolinium enhancement noted.Left AtriumThe left atrium is enlarged consistent with history of transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 83 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 trace 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 mildly dilated (31mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are bilateral pleural effusions (right greater than left). There are sternotomy wires present. 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. Normal size LV with low normal systolic function (EF 54%).2. Global relative enhancement, T2-STIR myocardium:skeletal muscle ratios and native T1 relaxation times are normal, but there is a focus of late gadolinium enhancement in the basal inferior wall. While the pattern could suggest infarction (endocardial involvement), given the patient's clinical history a infiltrative, inflammatory, or fibrotic process is also possible.3. Normal size RV with mildly reduced systolic function (EF 45%).4. Mildly dilated main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "38 years, Female, facial twitching. Again seen are numerous periventricular and subcortical white matter T2/FLAIR hyperintense lesions in both hemispheres of the brain. Multiple infratentorial lesions including the brainstem, middle cerebellar peduncles, and cerebellar hemispheres are also again seen. Extent of confluent signal abnormality may limit detection of small new lesions, but there are at least 2 new lesions including the right inferior aspect of the mid callosal body (axial series 401 image 59, sagittal series 301 image 100) as well as the left frontal corona radiata (axial series 401 image 55, sagittal series 301 image 71). Upper cervical lesions are again seen but not well assessed.There is mild to moderate degree of parenchymal volume loss with thinning of the corpus callosum. There is a moderate burden of T1 hypointense lesions. No intracranial mass effect, midline shift, or herniation. No hydrocephalus. Major flow-voids are preserved. Calvarium and extracranial soft tissues are grossly unremarkable.", "output": "Numerous chronic supratentorial and infratentorial demyelinating lesions with at least two new lesions since 11/9/2015 as described above."}
{"instruction": "Generate impression based on findings.", "input": "Male 60 years old Reason: stroke? Mass lesion? History: R sided weakness. Limited evaluation demonstrates no evidence of intracranial hemorrhage or mass. There is hyperintensity on the diffusion and isointense signal on the ADC bilaterally in the prefrontal gyri, hippocampal, and left mesial temporal lobe. There is no convincing T2 signal to suggest that this is T2 shine through. These areas of apparent restriction do not reflect vascular territories. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a large mucous retention cyst in the left maxillary sinus, occupying approximately half the sinus. The partially evaluated orbits, skull, and scalp soft tissues are grossly unremarkable.", "output": "Findings of multiple areas of apparent diffusion restriction on this limited MRI may reflect the patient's recent toxic exposure, possibly representing early leukoencephalopathy. Recommend repeat study to fully evaluate when clinically possible."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent right temporal field visual loss. 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, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses. The pituitary gland has a convex superior border with height remaining within the normal range, at a maximum height of 9 mm. It also shows no definite focal lesion and does not impinge on the optic chiasm or efface the suprasellar cistern.", "output": "No evidence of acute intracranial abnormality."}
{"instruction": "Generate impression based on findings.", "input": "26 years Male (DOB:1/25/1990)Reason: looking for parenchymal etiology of seizure today History: seizure 12/21 AMPROVIDER/ATTENDING NAME: JUSTIN P. KLINE The CSF spaces are appropriate for the patient's stated age with no midline shift. Small focus of encephalomalacia is present in the left cuneus. This associated with some susceptibility effect related to hemosiderin deposition. This has not changed since the prior exam. There is an adjacent craniotomy site.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "The examination is stable. There is a small focus of encephalomalacia and prior surgery in the left occipital lobe."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with pain. Evaluate for AVN. MENISCI: The medial meniscus appears intact. The anterior horn of the lateral meniscus is markedly truncated consistent with a radial tear. The posterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness articular cartilage degeneration of the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is fluid between the superficial and deep fibers of the MCL which may represent an MCL bursitis.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Tear of the anterior horn of the lateral meniscus. No evidence of avascular necrosis.2. Near full-thickness articular cartilage degeneration as described above.3. Findings consistent with a MCL bursitis.4. Small-to-moderate size joint effusion.5. Nonspecific subcutaneous edema about the knee."}
{"instruction": "Generate impression based on findings.", "input": "Amputation of the right foot, swelling of the lower extremity There has been resection of the distal tibia and fibula at the level of the talocalcaneal articulation.There is cortical thinning and irregularity of the distal tibia and fibula. There is increased T2 signal within the marrow distally without definite corresponding low T1 signal. These findings are thought to reflect a combination of postsurgical change and reactive osteitis without definite osteomyelitis. The remaining marrow signal of the more proximal tibia and fibula is normal.There is diffuse soft tissue and muscular edema and inflammation of the lower leg. Following contrast administration, there is an irregular peripherally enhancing thick-walled fluid collection in the distalmost soft tissues overlying the amputation. Scattered areas of susceptibility artifact are noted relating to prior surgical intervention.", "output": "1. Surgical resection of the distal tibia and fibula with cortical thinning and irregularity of the remaining cortex. There is abnormal T2 signal without definite corresponding abnormal T1 signal in these findings are thought to represent a combination of postsurgical change and reactive osteitis without definite osteomyelitis.2. Irregular enhancing fluid collection within the distalmost soft tissues concerning for abscess.These findings were discussed with the ordering physician Dr. R. Krishnamoorthi at the time of interpretation."}
{"instruction": "Generate impression based on findings.", "input": "Female, 61 years old, with vertigo, slurred speech. Evaluate for stroke. Minimal scattered small foci of T2 hyperintensity are seen within the cerebral hemispheres showing no significant interval change. No restricted diffusion is demonstrated. No evidence of edema or mass effect is seen. A focus of susceptibility along the right lateral ventricle may represent chronic microhemorrhage or mineralization. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.Conventional aortic branching is seen. The origins of the great vessels are not well assessed due to technical artifact. Otherwise no significant stenosis is detected in the carotid vessels of the neck by NASCET criteria. The right vertebral artery is well visualized and free of significant stenosis through its cervical course. The left vertebral artery is diffusely smaller than the and does not opacify as uniformly as the right which could represent atherosclerotic disease or a technical artifact. No high-grade stenosis is suspected.", "output": "1.No acute intracranial abnormality. In particular, no evidence of acute ischemia is seen.2.MRA imaging of the neck is of somewhat limited quality, but no definite high-grade vascular stenosis is suspected."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female with catatonia. Evaluate for intracranial cause. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered punctate foci of FLAIR abnormality in the subcortical white matter which are nonspecific. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.", "output": "1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.A few scattered nonenhancing punctate foci of T2/FLAIR signal abnormality which are nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "Reason: pre-op for craniotomy on 2/24 History: olfactory meningioma, crani on 2/24 The patient has undergone frontal craniotomy for removal of a frontal lobe meningioma. There are some attendant postoperative changes present within the scalp tissues.There are foci of residual tumor present along the anterior cranial fossa at the floor in the midline measuring 53 x 34 mm in axial dimensions involving the cribriform plate and the adjacent intracranial fossa floor. Another residual component is present which is adjacent to the corpus callosum along the midline measuring 25 x 11 mm sagittal dimensions and 23 x 40 mm axial dimensions. There is some leptomeningeal enhancement present along the anterior-inferior aspect of the left frontal lobe and to a lesser degree medial inferior aspect of the right frontal lobe. This is non-specific.There is elevated T2 signal involving medial aspects of the frontal lobes bilaterally associated with some microhemorrhages. More prominently the portion of the frontal lobe brain parenchyma previously anterior to the contain some microhemorrhages and signal change and has a reexpanded into the tumor bed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the frontal sinuses and mucosal thickening ethmoid air cells and the maxillary sinuses as well as the sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.The patient is status post bifrontal craniotomy for removal of large meningioma . The clear majority of the meningioma has been removed. There are a couple foci of residual tumor present along the floor of the intracranial fossa and cribriform plate as well as adjacent to the corpus callosum.2.There are attendant postoperative changes present as detailed above.The posterior wall of the frontal sinus is not clearly defined.3.Examination was performed for stereotactic guidance during surgery."}
{"instruction": "Generate impression based on findings.", "input": "Female 56 years old with cirrhosis. Assess liver lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology without arterially enhancing or washout lesion. Specifically, the previously described lesion in the right hepatic dome is not seen on today's study. TIPS catheter with associated susceptibility artifact is again noted.SPLEEN: The spleen measures 11 cm in craniocaudal dimension. Stable 1.5 cm left artery aneurysm.PANCREAS: There is a 4 mm T2 hyperintense lesion in the pancreatic tail (series 7, image 22), not significantly changed compared to the previous exam. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Note is made of a duodenal diverticulum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Cirrhotic liver without suspicious liver lesion.2.Stable 1.5 cm splenic artery aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "Vestibular schwannoma 6 months surveillance. There are postoperative findings related to left retrosigmoid craniotomy. There is persistent intermediate T2 and enhancement within the left internal auditory canal, measuring up to approximately 1 cm in length. 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. There is a left maxillary sinus retention cyst.", "output": "Postoperative findings related to left retrosigmoid craniotomy with persistent intermediate T2 and enhancement within the left internal auditory canal, measuring up to approximately 1 cm in length, which may represent a combination of tumor and treatment effects. "}
{"instruction": "Generate impression based on findings.", "input": " Following a discussion of the procedure with the patient and her family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-outform was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine.Targeted CT examination demonstrates a lucent lesion with sclerotic borders within the right femoral head neck junction corresponding to the findings on recent CT and MRI examinations. The imaging findings are most consistent with that of an osteoid osteoma. Using CT guidance, a 13-gauge OnControl core biopsy needle was advanced into the lesion and 2 attempted biopsies were performed. The specimens were obtained and placed in 10% formalin. Subsequently, CT guidance was used to advance an AngioDynamics SDE RFA probe into the lesion. The lesion was heated to 70-80 degrees centigrade for 2:30 minutes at 35 W. The RFA probe was removed.The core biopsy specimens were hand carried to the Surgical Pathology labThe patient complained of right hip pain following the procedure but otherwise had no immediate complications. This was addressed with IV pain medication in conjunction with anesthesiology as documented in the in the medical record. A discussion was had with the family regarding the patient's pain which is thought to most likely be the result of the biopsy attempts and difficulty seeding the access system prior to ablation also a component of synovitis following the ablation may be a contributing factor. Routine post procedure instructions were communicated to the patient and her family.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient's skin.", "output": "CT-guided biopsy and radiofrequency ablation of right femoral neck osteoid osteoma."}
{"instruction": "Generate impression based on findings.", "input": "Female, 48 years old, history of brain metastases and CVA, esophageal cancer, on chemotherapy, status post whole brain radiation therapy, assess response. Redemonstrated is evidence of left frontal craniotomy. A resection cavity within the subjacent frontal lobe as well as surrounding T2 hyperintensity are not significant changed. Enhancement along the margins of the cavity has also not significantly changed.Also seen is evidence of a prior small left posterior parietal craniotomy. Small areas of T2 hyperintensity within the subjacent left temporal lobe are unchanged. No pathologic enhancement is seen within this resection bed.Four previously demonstrated enhancing lesions are again seen involving the right orbital gyrus, the right medial temporal lobe, and both cerebellar hemispheres. There has been no significant interval change in the size or morphology of these lesions, and no significant change in the degree of surrounding T2 hyperintensity. Several punctate foci of cortically-based enhancement are again seen involving the right middle frontal gyrus, right parietal lobe, and in the left occipital lobe (see key images). Most of these have not significantly changed from prior, and some lesions which were seen on the prior exam are no longer evident. They all correspond to areas of acute ischemia as demonstrated on the examination of 10/9/14.Sequelae of prior bilateral watershed and cortical ischemia are redemonstrated within the cerebral hemispheres and cerebellum. T1 hyperintensity along the superior frontal sulci may reflect cortical laminar necrosis. No evidence of new acute ischemia is seen.Scattered small foci of T2 hyperintensity within the periventricular white matter are demonstrated, not significantly changed and likely representative of chronic ischemic injury. A diffuse ill-defined periventricular hyperintensity, particularly along the occipital horns, has mildly progressed and may reflect the secondary effect of radiation.", "output": "1. Multiple intracranial enhancing lesions presumed to represent metastases have not significantly changed from the prior exam. No definite evidence of any new metastatic lesion is seen.2. Sites of prior surgery in the left frontal and left temporal lobes demonstrate a stable appearance with no evidence to suggest recurrent/progressive disease.3. Fluctuating punctate foci of cortically-based enhancement correspond to the sites of prior ischemic injury, likely representing evolution of ischemic injury, perhaps compounded by the effects of radiation. Continued attention to these lesions will be necessary on subsequent studies."}
{"instruction": "Generate impression based on findings.", "input": "Pancreatic cysts. Abdominal pain. Recently found to have pancreatic, omental and lung masses status post exploratory laparotomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour and normal in morphology. No focal hepatic lesion is identified. Artifact from a biliary stent is identified.SPLEEN: No significant abnormality noted.PANCREAS: Within the pancreatic head, there is a round, smoothly marginated, solid, T2 hyperintense lesion with minimal central necrosis and delayed enhancement measuring 2.5 x 1.8 cm (series 31, image 56). The SMA, SMV and portal vein are not involved. Two well defined, nonenhancing, T2 hyperintense cystic lesions are identified within the pancreatic body abutting the main pancreatic duct (series 501, image 25), the largest measuring 2.2 x 1.6 cm. The pancreatic duct is not significantly dilated. The pancreatic head appears edematous with some surrounding inflammation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is no evidence of bowel obstruction. Mesenteric edema is present. Peritoneal nodularity is identified on series 1204, image 354.BONES, SOFT TISSUES: No suspicious osseous lesion is identified.OTHER: A right lower lobe nodule with rim enhancement measures 2.3 x 2.0 cm (series 702, image 139), incompletely imaged, previously identified on CT chest January 6, 2015. Left basilar subsegmental atelectasis. Small bilateral pleural effusions. Nonspecific 5 mm well-circumscribed left breast enhancing nodule (series 1204, image 524).", "output": "1.Solid T2 hyperintense, enhancing pancreatic head lesion, for which differential considerations including neuroendocrine tumor (Given the lesion is well defined and does not frankly invade surrounding structures) versus adenocarcinoma. Correlation with biopsy results, CA 19-9 levels recommended. 2.Cystic lesions in the pancreatic body, possible pseudocysts versus mucinous neoplasm.3.Right lower lobe lung nodule better evaluated on CT. 4.Nonspecific peritoneal nodularity."}
{"instruction": "Generate impression based on findings.", "input": "73 years Female (DOB:8/15/1943)Reason: glioblastoma History: glioblastomaPROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a T2 and FLAIR hyperintense lesion involving the left hippocampus and adjacent choroid associated with peripheral contrast enhancement. This is associated with punctate foci of signal loss on susceptibility imaging within the left hippocampal lesion. It measured 17 mm width on the prior exam and measures 19 mm with on the current exam. It appears to extend further posteriorly on the current exam. The temporal horn of the left lateral ventricle appears to be slightly dilated. There is associated elevation of cerebral blood volume with this lesion.There is a 29 x 32 mm axial dimension focus of signal hyperintensity extending from the ependymal lining of the left lateral ventricle into the centrum semiovale as well as the body of the corpus callosum which previously measured 25 x 22 mm axial dimensions. Additionally, there is T2 and FLAIR signal hyperintensity present within the splenium of the corpus callosum which is stable and in a focus measuring 19 x 17 mm in the right inferior parietal lobule which previously measured 14 mm. Additionally there is T2 and FLAIR signal hyperintensity present along the right hippocampus and a 6 mm lesion present within the left superior frontal gyrus which have not significantly changed. Within the larger lesions are associated elevation of cerebral blood volume.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There are multiple lesions present within the brain parenchyma as detailed above some of which have increased in size and others which have not. In particular lesion present within the left hippocampus and choroid region has a more aggressive appearance and has enlarged and is associated with widening of the involved left lateral ventricle. This is consistent with the diagnosis of glioblastoma and could represent primary multifocal neoplasm."}
{"instruction": "Generate impression based on findings.", "input": "Breast cancer. There has been interval decrease in size and number of enhancing bilateral cerebellar lesions that are essentially leptomeningeal in distribution. The supratentorial compartment appears to be unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration with a mildly T1 hyperintense subcentimeter cystic nodule associated with the roof of the third ventricle. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. Interval decrease in the burden of leptomeningeal metastatic disease involving the cerebellum.2. Subcentimeter third ventricular colloid cyst."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with history of thymic carcinoma. Status post chemo/RT, please evaluate, CHEST:LUNGS AND PLEURA: Multiple small calcified micronodules are identified consistent with a previous granulomatous infection. Centrilobular emphysema is again noted. No pleural effusion can be identified.MEDIASTINUM AND HILA: There is redemonstration of an anterior mediastinal mass measuring 28 mm x 14.3 mm (image 47, series 4), previously, measuring 15 mm x 28.8 mm. Port-A-Cath with its tip in the SVC. A coronary artery and aortic calcifications. Cardiac size is normal. There is no evidence of pericardial effusion.No mediastinal or hilar lymphadenopathyCHEST WALL: Right-sided port. Degenerative changes in the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Hypodense subcentimeter lesions, most likely representing cystsSPLEEN: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule is stable, measuring 14.1 mm x 18.5 mm (image 92, series 4).KIDNEYS, URETERS: Redemonstration of a small exophytic mass arising from the superior pole. The left kidney. (Image 96, series 4). Dedicated CT or MRI is recommended to evaluate this lesion. Several subcentimeter hypodense lesions in the right kidney, most represent cysts. Again noted is an accessory right renal artery.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic diseaseBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "1. Anterior mediastinal soft tissue mass is stable and presumably represents the residual of this patient's thymic carcinoma.2. Stable right adrenal nodule and small exophytic left renal mass that is indeterminate. Dedicated CT or MRI is recommended to evaluate these lesions.3. Centrilobular emphysema with evidence of a previous granulomatous infection.4. No evidence of metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Female, 17 years old, with a low-grade neural glial tumor in the right temporal lobe with history of seizures, presenting following recent head trauma. An ill-defined region of T2 hyperintensity and parenchymal thickening is again seen in the posterior medial right temporal lobe showing no significant change in size or morphology. As before, this lesion does not enhance. Sequelae of prior stereotactic biopsy of this lesion are redemonstrated.Elsewhere intracranially, no areas of significant parenchymal signal abnormality, edema or mass effect are seen. No pathologic parenchymal or extra-axial enhancement is observed. There are no findings to suggest acute intracranial hemorrhage or any other posttraumatic sequelae. No abnormal fluid collections are evident and the ventricular system is normal in size and morphology.", "output": "1.Stable nonenhancing lesion in the posterior medial right temporal lobe.2.No acute intracranial abnormality or any obvious posttraumatic sequelae."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic lung cancer, EGFR+, on Erlotinib and immunotherapy. There is no significant interval change in the enhancing lesion in the right cerebellar hemisphere that measures 3 x 3 mm in axial cross-section. There is a an unchanged enhancing extra-axial lesion along the left anterior clinoid process region. There is encephalomalacia within the left gyrus rectus associated with postoperative changes. There is a chronic lacunar infarct in the left basal ganglia with hemosiderin deposition. There are a few unchanged scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute intracranial hemorrhage or acute infarction. The ventricles 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. There is metal susceptibility effect in the left frontal calvarium.", "output": "1. Unchanged punctate metastasis in the right cerebellar hemisphere.2. Unchanged paraclinoid lesion may represent a meningioma.3. Encephalomalacia in the left gyrus rectus related to prior surgery.4. Chronic lacunar infarct in the left basal ganglia and a background of probable mild white matter chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "T1N2b p16 negative right retromolar trigone squamous cell carcinoma, status post induction chemotherapy with carboplatin/taxol followed by 5/5 cycles of DFHx and right neck dissection now reporting persistent posterior left sided neck pain. There are interval postoperative findings related to right neck dissection. There is no evidence of residual significant cervical lymphadenopathy. There is extensive dental artifact, which limits assessment for the possibility of tumor in the upper aerodigestive tract. There is a right vallecular retention cyst that measures up to 15 mm. The thyroid and major salivary glands are unremarkable. There is multilevel degenerative cervical spondylosis. The imaged intracranial structures are unremarkable. There are bilateral lens implants. There is a persistent irregular right apical pulmonary nodule.", "output": "1. Interval postoperative findings related to right neck dissection, without evidence of residual significant cervical lymphadenopathy. 2. Extensive dental artifact, which limits assessment for potential tumor in the upper aerodigestive tract. "}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male patient with gait difficulty. Evaluate for cerebral ischemia. There is no diffusion diffusion abnormality to suggest acute infarct. Again seen is encephalomalacia with adjacent increased T2 signal involving the right occipital and posterior temporal lobes from remote infarct. There is associated susceptibility effect consistent with chronic blood products associated with the prior infarct. Patchy foci of T2 signal hyperintensity in the periventricular white matter and in the pons is compatible with chronic small vessel ischemic disease. Mild prominence of the ventricles and sulci likely from age-related atrophy.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.", "output": "1.No evidence of acute infarct, hemorrhage, or mass effect.2.Chronic right temporal occipital infarct and chronic small vessel ischemic disease similar to prior.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female, 61 years old, with assess for compulsive disorder, preoperative planning exam for laser fiber placement. Bilateral T2 hyperintense foci are redemonstrated adjacent to the frontal horns of the lateral ventricles representing sequelae of prior laser ablation. As before, the focus on the right is more conspicuous than the focus on the left. However, there has been no significant interval change in the size or morphology of these lesions. On postcontrast images, there is minimal enhancement at the left focus but no convincing enhancement on the right. Brain parenchymal morphology is otherwise unremarkable. No abnormal fluid collections are seen. Ventricular size and morphology are unchanged.", "output": "Expected findings are seen compatible with prior laser ablation adjacent to the bilateral frontal horns."}
{"instruction": "Generate impression based on findings.", "input": "19 year-old male swimmer with shoulder pain, rule out labral tear. ROTATOR CUFF: The rotator cuff tendons and muscles appear intact and within normal limits. SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. No frank fluid is noted within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum and articular cartilage appear normal. BICEPS TENDON: The tendon of the long head of the biceps is within normal limits.", "output": "Normal shoulder without specific findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Reason: any paraspinal neurofibromas? History: girl with nf1 and rather severe lower back pain. There is an incompletely characterized T2 hyperintense lesion that measures up 11 mm in the right posterior abdomen lateral to the psoas muscle at the level of L3-4. There is disc space narrowing and decreased T2 signal within the L3-4 disc with associated endplate marrow signal alterations. However, there is no significant spinal canal or neural foramen stenosis. There is an ovoid T2 hyperintense lesion in the right S2-3 neural foramen that measures 6 mm in width. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is a partially-imaged cystic left adnexal structure.", "output": "1. An ovoid T2 hyperintense lesion in the right S2-3 neural foramen that measures 6 mm in width may represent a perineural cyst or neurofibroma. Characterization is limited without intravenous contrast.2. An incompletely characterized T2 hyperintense lesion that measures up 11 mm in the right posterior abdomen may represent a neurofibroma among other possibilities. Dedicated abdominal imaging may be useful for further evaluation.3. Degenerative disc disease at L3-4 without significant spinal canal or neural foramen stenosis.4. Partially-imaged cystic left adnexal structure. Dedicated pelvic imaging may be useful for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Lower extremity weakness and numbness and history of metastatic RCC. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are multiple prominent vessels within the iliac bones and sacrum of uncertain significance. The vertebral bone marrow signal is otherwise unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are multiple partially imaged liver lesions. There is an intrinsically T1 and T2 hyperintense lesion. There are multiple enlarged retroperineal lymph nodes. There are bilateral pleural effusions, right larger than left.", "output": "1. No evidence of metastases involving the thoracic or lumbar spine.2. Multiple partially imaged liver metastases.3. Nonspecific left renal lesion, which may represent a hemorrhagic cyst.4. Retroperitoneal lymphadenopathy likely represents metastatic disease.5. Bilateral pleural effusions, right larger than left."}
{"instruction": "Generate impression based on findings.", "input": "5-year-old male with HgbSS and osteo of distal right humerus status post surgical intervention. Interval drainage of the previously seen enhancing fluid collection along the anterior margin of the distal humeral metaphysis. There is no residual fluid collection or any additional fluid collection in the proximal humerus. BONE AND MARROW: Cortex underlying the site of the previous fluid collection appears intact. There is heterogeneous signal and enhancement within the distal humerus which likely represent postprocedural changes. The bone marrow of the proximal humerus is homogeneous without enhancement.SYNOVIUM: Normal.MUSCULATURE: Increased T2 signal in the musculature adjacent to the distal humerus compatible with edema/inflammation.ADDITIONAL", "output": "1. No additional fluid collection in the proximal humerus or residual fluid collection at the surgical site.2. Postprocedural changes in the distal humerus and adjacent soft tissues. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 44 years old, with back pain and history of metastasis to the spine, evaluate for change of the lesion. A pathologic compression deformity of the L4 vertebral body with evidence of prior kyphoplasty is redemonstrated. Complete loss of vertebral body height is seen, similar to the prior examination. Retropulsion results in a similar mild degree of spinal canal stenosis particularly affecting the left lateral recess. As on the prior examination, there is severe narrowing of the left L4-5 neural foramen and moderate narrowing of the left L3-4 neural foramen.Signal abnormality and patchy enhancement involving the left L4 pedicle and transverse process have become less conspicuous than on the prior examination. A hemorrhagic cavity seen previously in the adjacent posterior paraspinal soft tissues has resolved. Generalized inflammation within the left posterior soft tissues has improved.A small sclerotic lesion within the T12 vertebral body is unchanged. A lesion within the L1 vertebral body has become more sclerotic than on the prior examination and perhaps slightly smaller. No new marrow space lesions are identified.", "output": "1.Stable pathologic compression deformity of the L4 vertebral body. This results in a mild generalized spinal canal stenosis with significant narrowing of the left L4-5 and L3-4 neural foramina, similar to that seen previously.2.Interval resolution of a hemorrhagic cavity seen previously within the left posterior paraspinal soft tissues. Inflammation in these soft tissues has also improved.3.A small sclerotic lesion in the T12 vertebral body is unchanged. A lesion within the L1 vertebral body has become more sclerotic and slightly smaller. No new osseous lesions are identified."}
{"instruction": "Generate impression based on findings.", "input": "59 years Female (DOB:5/2/1956)Reason: history of brain mets s/p RT History: nonePROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 3 mm enhancing focus along the left parietal lobe in the superior parietal lobule which is also identified on the prior exam and appears similar in size.. A couple punctate foci of enhancement present in the left middle frontal gyrus which are stable compared to the prior exam. There is a punctate focus of enhancement in the right orbital gyrus along its medial aspect which is also present on the prior exam and is stable. There are a couple punctate lesions present in the right inferior parietal lobule which are stable compared to the prior exam .On susceptibility imaging there is a punctate focus of signal loss in the left inferior parietal lobule which is not associated with contrast enhancement in those also present prior exam. An additional nodular focus of signal loss and susceptibility is present in the right precentral gyrus.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There is redemonstration of multiple tiny lesions in the supratentorial brain which are compatible with metastatic disease. These appear stable compared to the previous exam."}
{"instruction": "Generate impression based on findings.", "input": " The intracranial internal carotid arteries are normal in course and caliber. There is perhaps minimal narrowing along the proximal inferior left M2 segment. The middle and anterior cerebral arteries are otherwise unremarkable. There is a fetal type right posterior cerebral artery, with nonvisualized right P1 segment. The post-PICA left V4 segment is developmentally diminutive. The right vertebral artery is dominant. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.There is redemonstration of the rounded T1 hyperintense lesion within the anterior third ventricle near the foramen of Monro measuring up to 1.4 cm, most likely representing a colloid cyst. There is a prominent mucosal retention cyst in the right maxillary sinus.MRA NECK", "output": "1.No evidence of flow-limiting stenosis or vascular occlusion.2.Mild focal narrowing at the left carotid bifurcation.3.Suboptimal visualization of proximal V1 segments likely in part due to tortuosity.4.Redemonstration of probable colloid cyst.5.Hypoenhancing lesions within the thyroid gland bilaterally which are nonspecific. Thyroid ultrasound recommended for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with neutropenic fever, sore throat for 1 week and an enlarged lymph node in the right neck. Evaluate for abscess. Enlarged right cervical lymph node near the carotid bifurcation (image 47, series 10535) does not appear necrotic and measures 15 mm in short dimension, indicating inflammation. No other enlarged lymph nodes or evidence of abscess.Patent and unremarkable vasculature. Asymmetric prominence of the right adenoids. Nonspecific thickening of the tongue base is symmetric and may be correlated clinically for significance. Airway appears patent. Paranasal sinuses and mastoid air cells are well-pneumatized. No significant prevertebral soft tissue swelling. Cervical spine with unremarkable alignment.Visualized upper lungs are unremarkable.", "output": "Enlarged right cervical lymph node and nonspecific tongue base thickening associated with right parapharyngeal adenoidal enlargement. Please correlate with clinical exam findings."}
{"instruction": "Generate impression based on findings.", "input": "Aneurysm CTA of intracranial circulation:60 cc of Omnipaque 350 was administered for this study.Axial 0.9 contiguous CT images of head after administration of contrast were obtained. 3-D reformatted images were acquired utilizing an independent workstation.Axial, coronal and sagittal 2-D MIP images are also rendered.Examination demonstrates an aneurysm of anterior communicating artery which involves the entire length of the anterior communicating artery. The aneurysm extends from the junction of the right A1 with anterior communicating artery to the junction of the left A1 with the anterior communicating artery. It also appears to incorporate the origins of the A2 segments of anterior cerebral arteries. The aneurysm measures 8.2 mm in transverse axis, 7.2-mm in AP axis and 7.7-mm in cranial -- cephalad axis. The aneurysm is smooth and rounded and with no evidence of any intraluminal defect.The bilateral A1 segments of anterior anterior cerebral arteries are symmetrical in size. There is also normal visualization of bilateral A2 segments and distal branches of the anterior cerebral arteries with no additional abnormality.There is normal visualization of bilateral middle cerebral arteries without evidence of aneurysm.Normal appearing bilateral supraclinoid internal carotid arteries and a single dominant right posterior communicating artery without aneurysm.Intracondylar components of vertebral arteries are normal bilaterally and the normal visualization of bilateral pica branches.Vaso-artery, superior cerebellar arteries and posterior cerebral arteries are also well visualized and without evidence of pathology.In comparison with MRA of intracranial circulation from Ingalls open MRI study dated 8 -- 3 -- 11 there is no appreciable interval change.Nonenhanced head CT:Examination demonstrates no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.New patchy subcortical and periventricular foci of increased signal intensity in bilateral cerebral hemispheres as was noted on prior MRI are brief to represent small vessel ischemic disease of indeterminate age.The cortical sulci and ventricular systems as well as CSF cisterns remain within normal for patient's stated age of 73.Calvarium is intact. Visualized mastoid air cells and paranasal sinuses are unremarkable.Incidental note is made of bilateral soft tissue density within the external auditory canals with no evidence of any bony changes. Findings are believed to represent debris within the external auditory canals. Recommend And further evaluation by direct inspection.", "output": "1.Single locule anterior communicating artery aneurysm which appears to incorporate the entire length of anterior communicating artery. The aneurysm has a smooth round configuration and measures 8.2 x 7.2 X 7.7 mm in three dimensional measurements. There is no evidence of hemorrhage, vasospasm or mass effect.2.Negative CTA of intracranial circulation otherwise.3.Nonenhanced head CT demonstrates moderate findings of small vessel ischemic disease of indeterminate age."}
{"instruction": "Generate impression based on findings.", "input": "Female, 26 years old. Knee pain, anterior joint line. MENISCI: The menisci are normal.ARTICULAR CARTILAGE AND BONE: Foci of low signal within the articular cartilage of the lateral patellar facet inferiorly and the central femoral trochlea inferiorly may represent small foci of degeneration, but we see no fluid-filled cartilage defects. Bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is focal intermediate signal intensity within the medial insertional fibers of the quadriceps tendon, perhaps representing very mild focal tendinosis. There is also mild edema of the quadriceps fat pad which is of questionable significance. There is mild increased signal intensity within the proximal patellar tendon, which may reflect mild tendinosis, but the patellar tendon otherwise appears normal. ADDITIONAL", "output": "1.No meniscal tear.2.Minimal insertional tendinosis of the distal quadriceps and proximal patellar tendons.3.Small foci of cartilage degeneration involving the patellofemoral joint."}
{"instruction": "Generate impression based on findings.", "input": "lower extremity weakness There is a minimal kyphotic angulation from C4 to C6 with disc disc desiccation indicating degenerative spondylosis.The cranial-cervical junction is normal. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: no neuroforaminal narrowing or spinal stenosis. C4-C5: there is minimal uncovertebral joint hypertrophy on the left, no neuroforaminal narrowing or spinal stenosis. C5-C6: diffuse bulging of disc with minimal uncovertebral joint hypertrophy on the right side inducing minimal spinal canal narrowing as well as minimal to mild right neuroforaminal narrowing. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.", "output": "1. Degenerative spondylosis of C spine with disc degenerations.2. Minimal to mild spinal canal stenosis at the level of C56, with minimal to mild neural foraminal stenosis on the right side of C56.3. Spinal cord signal intensity is normal and no abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified hearing loss, right ear [H91.91], Reason for Study: ^Reason: evaluate partially enhancing lesion from prior exam History: evaluate partially enhancing lesion from prior exam Redemonstration of multifocal variable sized ring-enhancing lesions on bilateral hemisphere with the susceptibility artifacts, unchanged since prior scan. There is no associated surrounding edema. Considering those lesions correspond to the CT findings of calcifications, differential diagnosis remained as neurocysticercosis, or other granulomatous infections. The ventricles, sulci and cisterns are unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "1. Unchanged multiple bihemispheric ring enhancing nodular lesions without surrounding edema since prior scan.2. No evidence of new ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": "65 year old woman with sarcoidosis referred to evaluate for possible cardiac sarcoidosis. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 99 ml/m2 (normal range: 65+/-11), the LVEDV is 225 ml (normal range 109+/-23), the LV end systolic volume index is 64 ml/m2 (normal range 18+/-5), the LVESV is 145 ml (normal range 31+/-10), the LV mass index is 68 g/m2 (normal range 67+/-11), and the LV mass is 155 g (normal range 114+/-24). There is global hypokinesis with regional wall motion abnormalities. The basal to mid inferior and inferolateral walls are thinned and most hypokinetic. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 160 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 91 ml (normal range 35+/-13). 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 at least moderate 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 FindingsThere is a large burden of mediastinal lymphadenopathy. 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. Moderate left ventricular dilation with moderately reduced systolic function (LVEF 36%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. There is pronounced thinning and hypokinesis of the basal inferior and inferolateral walls. These segments are free of myocardial infarction. This abnormality could represent hibernating myocardium due to the presence of a severe coronary artery stenosis supplying viable myocardium. 3. Normal right ventricular size with mildly reduced systolic function (RVEF 43%).4. Severe left atrial dilation.5. At least moderate mitral regurgitation. 6. See extra-cardiac findings. "}
{"instruction": "Generate impression based on findings.", "input": "Female 81 years old with right ankle pain and radiograph showing periosteal reaction. Evaluate for osteomyelitis. The study was ordered with contrast but the patient declined contrast at the time of the exam. ARTICULAR SURFACES AND BONE: Soft tissue ulceration along the lateral ankle measures approximately 3 cm in AP and 5 cm in craniocaudal dimension. The marrow signal in the underlying fibula is normal.There is narrowing, sclerosis and cyst formation at the articulation of the medial cuneiform and the navicular bone as well as at the median cuneiform - second metatarsal joint and lateral cuneiform - third metatarsal joint indicating osteoarthritis. No fractures are identified. There is no tibiotalar joint effusion.TENDONS: The Achilles tendon, flexor and extensor tendons are normal in appearance.LIGAMENTS: The lateral ligaments and deltoid ligament are intact.ADDITIONAL", "output": "Soft tissue ulceration but no evidence of osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 57 years old, with bilateral lower extremity pain, numbness and possible weakness in the setting of prior surgery. Evidence of posterior instrumented fusion is seen with bilateral pedicle screws and stabilization rods spanning L5 and S1. Interbody devices have also been placed in the L5-S1 disc space.A very mild scoliotic curvature of the lumbar spine is seen. Sagittal alignment is within normal limits. Vertebral body height and morphology are unremarkable. Mild fatty endplate degenerative signal change is seen anteroinferiorly at L4. Elsewhere, marrow signal characteristics are within normal limits. No evidence of marrow edema is detected. No evidence of worrisome spinal or paraspinal enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits, except as discussed by level below.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. Left foraminal and far lateral disc protrusion which effaces the inferior aspect of the neural foramen. The exiting L3 nerve root does not appear to be significantly affected, but the protrusion does partially efface the left lateral recess and may contact the transiting L4 nerve root. No significant generalized spinal canal stenosis. No significant right foraminal narrowing. L4-5: Marked facet hypertrophy with ligamentum flavum thickening. Bulging disc. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina nerve roots. Moderate bilateral foraminal narrowing. L5-S1: Postoperative findings. No significant spinal canal stenosis. No significant foraminal narrowing suspected within the limitations of some artifactual distortion due to the orthopedic instruments. A small defect within the left iliac bone may represent a bone graft harvest site.", "output": "1.Postoperative findings compatible with instrumented posterior fusion from L5 to S1.2.Left foraminal and far lateral disc protrusion at L3-4 which narrows the neural foramen and effaces the left lateral recess. The transiting L4 nerve root may be affected by this process.3.Moderate to severe generalized spinal canal stenosis at L4-5 due to a combination of disc bulge and posterior element hypertrophy. Moderate foraminal narrowing is also evident at this level.4.Although the L5-S1 level is slightly degraded by artifact, no significant spinal canal or foraminal stenosis is suspected."}
{"instruction": "Generate impression based on findings.", "input": "Coccygeal dimple, r/o spina bifida History: Hair coming from dimple. There is a vitamin E capsule positioned on the skin overlying the coccyx. However, there is no evidence of underlying cyt or sinus tract. There is appears to be slight sacral dysraphism, although MRI is rather insensitive for such abnormalities. 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 conus medullaris is positioned at the T12-L1 level, which is normal. There is no evidence of fibrofatty filum. The paravertebral soft tissues are unremarkable. The cerebellar tonsils are not low-lying. The urinary bladder appears to be distended.", "output": "1. No evidence of underlying cyt or sinus tract. 2. Suggestion of possible mild sacral spina bifida occulta, although MRI is rather insensitive for such abnormalities. 3. The conus medullaris is positioned at the T12-L1 level, which is normal. 4. No evidence of fibrofatty filum."}
{"instruction": "Generate impression based on findings.", "input": "17 years Female (DOB:2/14/1999)Reason: CCM Protocol, QSM/Permeability, 3T Scanner, CCM3, yearly follow up please evaluate for changes History: CCM3 SurveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple lesions identified on susceptibility imaging present in both hemispheres of the supratentorial brain as well as the brainstem. The largest one is located in the left side of the brainstem at the junction of the pons and the left middle cerebellar peduncle and measures 12 mm on T2 imaging. It appears stableOne in the right periventricular white matter in the right parietal lobe measures 10 mm on the current exam and the 5 mm on the prior exam.One in the right postcentral gyrus which on the prior exam measured 13 x 10 mm on current exam represents hemosiderin and is smaller. A smaller on in the right precuneus is stable . One in the left periventricular white matter is also stable.On susceptibility imaging many small punctate foci of susceptibility effect are identified in the frontal lobes and periventricular white matter which are also identified on the prior exams unchanged.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There are multiple cavernous hemangiomas present. Compared to the previous exam the lesion in the right periventricular white matter in the right parietal lobe has enlarged. Another lesion in the right postcentral gyrus has decreased in size. The rest of the lesions do not appear to have changed substantially. Findings were communicated to Dr. Issam Awad at the time of this interpretation."}
{"instruction": "Generate impression based on findings.", "input": "History of bladder cancer status post cystectomy. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. Subcentimeter punctate T2 hyperintensities in the medial and anterior segments are too small to characterize, unchanged and likely cysts. Normal postcontrast enhancement without a suspicious lesion, ductal dilatation or vascular abnormality. Cholelithiasis within a normally distended gallbladder.SPLEEN: The spleen is normal in size and signal intensity without a discrete lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small benign-appearing retroperitoneal/left paraaortic nodes similar to prior study.BOWEL, MESENTERY: Small fat-containing umbilical hernia.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral fat containing inguinal hernias, unchanged small widemouthed periumbilical hernia. OTHER: No significant abnormality noted.", "output": "Stable examination with no evidence of metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "16-year-old girl with history of lymphatic malformation of the posterior left chest status post debulking. CHEST:LUNGS AND PLEURA: No significant abnormality of the lungs or pleura.MEDIASTINUM AND HILA: The heart and pericardium are normal. No mediastinal or hilar lymphadenopathy noted.CHEST WALL: A marker was placed over the palpable mass.A lobulated, T1 iso and T2 hyperintense mass measuring approximately 54 x 34 mm is seen within the left erector spinae musculature at the level of T9/T10 (series 601, image 22). This mass enhances and contains multiple flow voids on T2 weighted images. The mass extends anteriorly to the left T9 neural foramen (series 1505, image 255). A second mass with similar signal and enhancement characteristics is seen in the inferior latissimus dorsi. This mass measures approximately 39 x 19 mm (series 601, image 14) and extends through the chest wall but is extrapleural. A third, 12 x 9 mm mass is seen in the inferior left paraspinal musculature (series 601, image 4) with similar signal and enhancement characteristics. These masses appear to have increased in size and extent from the CT. Scattered foci of diffusion restriction are noted within these masses.Additional fat signal is seen throughout the left paraspinal and posterior chest wall musculature.Left thoracic curve noted. The spinal canal appears normal.UPPER ABDOMEN: The partially visualized liver, spleen, and kidneys appear normal. The gallbladder is normal.", "output": "Multiple masses in the left paraspinal and posterior chest wall musculature with signal and enhancement characteristics most suggestive of hemangiomas. These masses have increased in size compared to 2008."}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of meningioma ,yearly follow up , eval for changes History: yearly follow up eval for changes. Extra-axial homogenously enhancing lesion in the left cerebellum along the tentorium is unchanged in size measuring 1.7 x 1.8 cm, previously 1.5 x 1.8 cm. This lesion is adjacent to the left transverse sinus which is focally narrowed but patent proximally and distally, similar to the prior exam. There is an additional enhancing lesion in the left frontal high convexity which is calcified on prior CTs measuring 7 mm in thickness and is also unchanged in size. No new enhancing lesions are present.A few punctate scattered foci of T2 hyperintensity in the periventricular white matter are nonspecific and unchanged. Prominent ventricles and sulci likely reflects mild volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1.Meningioma along the left cerebellum is stable.2.Subcentimeter enhancing extra-axial lesion along the left high convexity with calcification is consistent with an additional meningioma and also remain stable."}
{"instruction": "Generate impression based on findings.", "input": "Male, 74 years old, with vertigo. Concern for stroke. Small foci of restricted diffusion are seen within the right inferior cerebellar hemisphere and the right cerebellar tonsil. There is also a punctate focus of restricted diffusion within the medulla. No supratentorial restricted diffusion is seen.A chronic right cerebellar infarct is redemonstrated similar to prior. Scattered foci of periventricular T2 hyperintensity are also demonstrated appearing grossly similar to prior. No pathologic parenchymal or extra-axial enhancement is observed.No evidence of significant generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Ventricles are normal in size and morphology.Sequelae of sinonasal surgery are redemonstrated. Scattered paranasal sinus opacification appears similar to prior.The right vertebral artery is of small caliber and demonstrates only thready opacification through its cervical segments. The left vertebral artery is unremarkable. The carotid vessels are free of significant stenosis in the neck.", "output": "1.Small foci of restricted diffusion are seen within the right cerebellar tonsil, the right cerebellar hemisphere and the medulla. Findings were discussed with Dr. Bernard at 3:30 PM on 5/18/2016.2.In correlation, the right vertebral artery is of small caliber and demonstrates only thready opacification throughout its extent.3.A large chronic right PICA territory cerebellar infarct is unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Male 58 years old Reason: cause of intrahepatic and extrahepatic biliary dilation History: chest pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology, no suspicious hepatic lesions. The vasculature are patent. The gallbladder contains multiple tiny layering stones without wall thickening or surrounding inflammation. The gallbladder is mildly distended.The CBD is mildly dilated measuring 12mm up to the level of the ampulla where it tapers smoothly. The ampulla is prominent and projects into the duodenum. T2 hypointense stone is seen in the distal CBD as seen in image 21 of series 201.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is mildly dilated at 4mm. No evident mass. No parenchymal or surrounding inflammationADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colon is distended with above average stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Findings suspicious for a small distal CBD stone causing obstruction.2. Above average stool burden in the colon.3.Cholelithiasis without specific findings of acute cholecystitis. Gallbladder is mildly distended."}
{"instruction": "Generate impression based on findings.", "input": " The last well formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. There are type II endplate degenerative changes at L4-5, along with mild reactive edema in the L4-5 disk. There is moderate loss of T2 signal in L4-5 disk with mild loss of disk height. There is mild loss of T2 signal in all other lumbar disks without significant loss of disk height at any other level. The conus terminates at L1-2 and shows normal caliber and signal.T11-12: No disk herniation or spinal stenosis.T12-L1: No disk herniation or spinal stenosis.L1-2: Right far lateral disk protrusion without significant spinal canal or neural foraminal stenosis.L2-3: Minimal diffuse disk bulge, moderate bilateral facet arthropathy and ligamentum flavum thickening causing no significant neural foraminal or spinal canal stenosis.L3-4: Mild disk bulge with central annular fissure, moderate bilateral facet arthropathy and ligamentum flavum thickening causing no significant spinal canal or neural foraminal stenosis.L4-5: Diffuse disk bulge, moderate bilateral facet arthropathy causing no significant spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis, with disk material approaching the right exiting L4 nerve root in the neural foramen.L5-S1: Diffuse disk bulge, mild facet arthropathy with no significant spinal canal stenosis or neural foraminal stenosis.", "output": "1.Type II endplate degenerative changes at L4-5 with mild reactive degenerative edema in the L4-5 disk. Mild right and minimal left neural foraminal stenosis at L4-5, with disk material approaching the right exiting L4 nerve root in the neural foramen.2.Moderate multilevel facet degenerative disease as described above."}
{"instruction": "Generate impression based on findings.", "input": "Assess for neuropathy/radiculopathy versus inflammation versus less likely spinal involvement: neck pain with extension. There has been near-interval resolution of findings related to pharyngitis with minimal residual retropharyngeal edema. There is no evidence of significant cervical lymphadenopathy in the neck. The thyroid and major salivary glands are unremarkable. The osseous structures and cervical spinal are unremarkable. The imaged intracranial structures are also unremarkable. There is a subcentimeter left maxillary sinus retention cyst.", "output": "1. Near-interval resolution of findings related to pharyngitis with minimal residual retropharyngeal edema.2. The osseous structures and cervical spinal are unremarkable. Please refer to the separate shoulder MRI report for additional details."}
{"instruction": "Generate impression based on findings.", "input": "74 year old male patient with history of heart transplant and prostate cancer, Gleason 6. Last biopsy in 1/2012. PELVIS:PROSTATE:Prostate Size: 4.8 x 6.4 x 5.0 cm.Peripheral Zone: There is a lesion within the right apex with mild T2 hypointensity, moderate hypointensity on ADC, and some early enhancement measuring approximately 10 x 4 mm (image 124, series 804). Central Gland: There are BPH nodules. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No definite extraprostatic 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": "Tumor in the right apex without specific evidence of extraprostatic extension. "}
{"instruction": "Generate impression based on findings.", "input": " There has been interval decrease in size of the dominant left temporoparietal lesion, now measuring up to are approximately 15 mm. Otherwise, there is no significant interval change in the multiple smaller periventricular and pericallosal T2 hyperintense white matter lesions, accounting for differences in technique. There is no evidence of acute hemorrhage or infarction. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. 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 tumefactive demyelinating lesion in the left temporoparietal region. Otherwise, no significant interval change in the intracranial demyelinating lesions."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with bilateral lower extremity weakness status post L3 perispinal tumor resection, L3 left hemilaminectomy and hemipediculotomy and fusion. Evaluate for cord compression. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. Degenerative changes are also seen involving the cervical spine most prominently in the affecting the C4-5 level where there is grade 1 anterolisthesis of C4 on C5 and disc height loss. At this level there is also mild to moderate spinal canal stenosis but no compromise of the spinal cord. Redemonstrated are postoperative findings compatible with resection of the tumor from the left L3 paraspinal region which are unchanged and better characterized on the dedicated lumbar spine MRI from 12/2/2016. There is some additional neural foraminal encroachment involving the lumbar spine mainly at L2-3. There is mild posterior subluxation of L3 on L4 which is unchanged since the prior exam.", "output": "This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.Postoperative findings involving previous resection of a left L3 paraspinous tumor are grossly unchanged although not completely evaluated. Refer to the dedicated lumbar spine MRI performed on 12/3/2016 for further characterization. There is encroachment of the left-sided exiting nerve roots at L3-4.Additional degenerative changes are seen in the cervical spine including grade 1 anterolisthesis of C4 on C5 with at most mild-to-moderate spinal canal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: question avascular necrosis History: pain in knees. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Curvilinear bands of signal abnormality within the medial and lateral femoral condyles as well as the lateral aspect of the patella are compatible with avascular necrosis. The overlying cartilage appears intact. We see no subchondral fracture or articular surface collapse. No edema is associated with osteonecrosis. The articular cartilage appears normal.LIGAMENTS: The anterior cruciate ligament and posterior cruciate ligament are intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "Uncomplicated avascular necrosis and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Syncope and collapse Syncope and collapseClinical question: evaluate for stroke vs. Seizure nidusSigns and Symptoms: as above MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense foci are present in the brainstem.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disc desiccation presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina. There is some disc desiccation present at this level.At C3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with some uncovertebral osteophytes predominantly in the left side and ligamentum flavum hypertrophy. There is associated flattening of the spinal cord and effacement of spinal fluid ventral and posterior the spinal cord. There is cord T2 signal hyperintensity within the spinal cord at this level especially the left hemicord. There is encroachment of left-sided exiting nerve roots at this level due to disc material and osteophytes Overall there is severe spinal stenosis present associated with findings suggesting cord edema.At C4-5 there is loss of disc space height, disc desiccation as well as endplate uncovertebral osteophytes. The uncovertebral osteophytes and disc material is more prevalent on the left side where there is encroachment of the left-sided exiting nerve roots. There is also effacement of spinal fluid ventral and posterior the left hemicord at this level and partial effacement of spinal fluid ventral and posterior the right hemicord. There is hypertrophy of the ligamentum flavum present. Overall there is moderate spinal stenosis at this level. There is mild flattening of the spinal cord.At C5-6 there is loss of disc space height, disc desiccation as well as endplate and uncovertebral osteophytes associated with encroachment of the exiting nerve roots within the neural foramina bilaterally. There is hypertrophy of the ligamentum flavum present. There is also effacement of the spinal fluid ventral and posterior the spinal cord at this level. Overall there is moderate spinal stenosis at this level with mild cord flatteningAt C6-7 there is loss of disc space height, endplate and uncovertebral osteophytes as well as encroachment of the exiting nerve roots within the neural foramina bilaterally. There is partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree of spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal. Disc material extends into the neural foramina bilaterally at this level and is associated with some encroachment of the exiting nerve roots within the neural foramina bilaterally.The vertebral artery flow voids appear to be intact.There is enlargement of the left thyroid lobe with a heterogeneous lesion which is incompletely visualized on this exam.", "output": "1.There is severe spinal stenosis present at C3-4 associated with flattening the spinal cord and cord signal change suspicious for cord edema suspicious for spondylitic myelopathy. Please correlate with patient's clinical history for spondylitic myelopathy.2.There is a moderate degree of spinal stenosis present at C4-5 associated with mild cord flattening due to degenerative changes.3.There is a moderate degree of spinal stenosis at C5-6 associated with some mild/minimal cord flattening related to degenerative changes.4.There is encroachment of exiting nerve roots bilaterally at C5-6 and C6-7 as well as on the left-sided C3-4 and C4-5 due to degenerative changes.5.The left lobe of the thyroid gland appears enlarged and heterogeneous. This is not adequately imaged on this examination. Please correlate with patient's clinical history and symptoms.6.Periventricular and subcortical white matter lesions of a mild to moderate degree as well as some patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 7.There is no evidence for acute ischemic cerebral infarction."}
{"instruction": "Generate impression based on findings.", "input": "Reason: low back pain, eval disc dz History: low back pain, radicular pain, degenerative disc dz Five lumbar type vertebral bodies are presumed to be present. The lumbar spine appears slightly straightened. The vertebral body heights are well-maintained. There is mild loss of disc height at L5-S1. The remaining intervertebral disc heights are well-maintained. There is loss of the normal T2 signal within the intervertebral discs of L4-5 and L5-S1, consistent with disc desiccation. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is mild disc bulge with superimposed right foraminal disc protrusion, which may exert slight mass effect on the descending L5 nerve root. There is a small tear of the right far lateral annular fissure. Mild to moderate right greater than left facet arthropathy is present. There is no significant compromise to the spinal canal or neural foramina.L5-S1: There is mild disc bulge with left foraminal prominence. Mild right and moderate left neuroforaminal stenosis. There is no significant compromise to the spinal canal.", "output": "1. Mild disc bulge at L4-5 with superimposed right foraminal disc protrusion, which may exert slight mass effect on the descending right L5 nerve root.2. Mild disc bulge at L5-S1 with left foraminal prominence and mild right and moderate left neuroforaminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "38 years Male (DOB:8/14/1977)Reason: ? extent of resection History: panhypopituitarismPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE MRI pituitary:Since prior examination patient has undergone transsphenoidal surgery for a pituitary mass. On the current exam the overall dimensions of the patient's mass were 29 x 20 x 24 mm. On the prior exam the mass measured 36 x 24 x 26 mm. There is a central nonenhancing component which has T1 signal hyperintensity within it suggestive of blood products. There is suprasellar extension. The mass is 1 or 2 mm below the level of the optic chiasm on the current exam whereas previously it was abutting the. There is no opacification of the sphenoid sinus and there is mucosal thickening in the maxillary sinuses and ethmoid air cells.", "output": "Since the prior exam there is been surgical debulking of the patient's pituitary mass suspected to represent pituitary adenoma. There is somewhat less mass effect on the current exam when compared to the prior."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for biliary leak. Status post OLT with perihepatic fluid collections. ABDOMEN:LIVER, BILIARY TRACT: The portal vein and its branches are patent. There is increased biliary ductal dilatation with branching pulmonary defect within the biliary tree compatible with pneumobilia seen on recent CT. No hepatic lesion is identified. Rim-enhancing fluid collection in the gallbladder fossa measures 2.7 x 0.8 cm coronally, from previously 4.0 x 4.2 cm. At 20 minutes hepatobiliary phase, contrast is seen avidly enhancing the biliary system and does not appear to fill the drained collection, suggesting against a biliary leak or fistulous communication. Drainage catheter again noted within the collection.SPLEEN: Mild splenomegaly is redemonstrated.PANCREAS: Fatty involution of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple and proteinaceous cysts, stable from prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "Significant interval decrease in size of drained abscess in the gallbladder fossa without evidence of biliary leak or fistula."}
{"instruction": "Generate impression based on findings.", "input": "Lower back pain, left leg occasionally gives out 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 normal in position.There is congenital narrowing of the lumbar spine with superimposed prominence of the epidural fat consistent with epidural lipomatosis. Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. There is mild mass effect on the thecal sac related to epidural lipomatosis. No significant neural foraminal stenosis.L3-L4: No significant disc disease. There is moderate degree of mass effect on the thecal sac related to epidural lipomatosis. Mild bilateral neural foraminal stenosis. Moderate bilateral facet arthropathy.L4-L5: No significant disc disease. There is moderate mass effect on the thecal sac related to epidural lipomatosis. No significant neural foraminal stenosis. Mild facet arthropathy.L5-S1: No significant disc disease. There is moderate degree of mass effect on the thecal sac related to epidural lipomatosis. No significant neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues demonstrate prominence of the subcutaneous fat but are otherwise within normal limits.", "output": "Diffuse epidural lipomatosis involving the lumbar spinal canal associated with at least moderate degree of spinal canal stenosis at the L3-L4, L4-L5, and L5-S1 levels. No significant disc disease or high-grade neural foraminal stenosis at any level.Multilevel facet arthropathy, relatively worse at the L3-L4 level, which may be contributing to patient's low back pain."}
{"instruction": "Generate impression based on findings.", "input": "Pituitary adenoma, history of resection: yearly follow up. Pituitary: There are postoperative findings related to transphenoidal surgery. There is no significant interval change in size of the lobulated enhancing sellar and suprasellar mass, which measures up to approximately 15 mm and abuts the left lateral aspect of the optic apparatus, which otherwise demonstrates normal signal characteristics. The cavernous sinus appear to be unchanged.Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles are unchanged in size and configuration. There is no midline shift or herniation.", "output": "No significant interval change in the residual macroadenoma, which abuts the left lateral aspect of the optic apparatus. "}
{"instruction": "Generate impression based on findings.", "input": "Right intranasal mass asses for intracranial invasion: right nasal congestion. There is a lobulated and heterogeneous mass within the right nasal cavity that measures up to 55 mm in length. There is mucosal thickening and fluid in the right maxillary and ethmoid sinuses, as well as mucosal thickening in the right frontal sinus, a left maxillary sinus retention cyst, and fluid in the bilateral sphenoid sinuses. There is deviation of the nasal septum to the left. There are secretions in the nasopharynx. There are bilateral lens implants. There is a chronic lacunar infarct in the right basal ganglia and scattered foci of nonspecific cerebral white matter T2 hyperintensity.", "output": "1. Preoperative planning MRI demonstrates a mass centered in the right nasal cavity with superimposed obstructed sinonasal inflammatory disease, likely both acute and chronic.2. Chronic lacunar infarct in the right basal ganglia."}
{"instruction": "Generate impression based on findings.", "input": "19 year-old male with right lower quadrant pain. Rule out appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatomegaly. The liver measures more than 22 cm craniocaudally. No focal hepatic parenchymal lesions. Gallbladder is normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lateral subcapsular renal hematoma probably arises from a right lower pole multiloculated cystic lesion which measures approximately 3.5 by 4.5 cm at axial image 55/152 of series 3. A second similar lesion is in the anterior upper pole of the right kidney measuring 2.6 cm in diameter at axial image 37/152 of series 3. These lesions most likely represent benign angiomyolipomas, but this cannot be confirmed on a post contrast CT scan examination alone. Further evaluation with precontrast noncontrast views of the kidneys and/or MRI of the kidneys would be helpful for further evaluation. The left kidney is normal. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Difficult to identify the appendix with the presence of constipation involving the cecum and ascending colon, but no evidence of abscess, free air or local inflammatory changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: L5 vertebral segment is transitional with sacralization on the left side.OTHER: No significant abnormality noted", "output": "Subcapsular hematoma in the right renal midpole, probably due to angiomyolipoma. This could be confirmed with noncontrast scan of the kidneys and/or kidney MRI examination. No definite evidence of appendicitis. Hepatomegaly. Transitional L5 vertebral segment, sacralized on the left."}
{"instruction": "Generate impression based on findings.", "input": "Female 69 years old; Reason: third ventriculostomy,suspected aqueductal stenosis History: 6 month follow up. No acute intracranial hemorrhage. No intra- or extra-axial fluid collections. Again seen is a recumbent AP paramedian frontal burr hole. Linear low attenuation traversing the right frontal lobe and terminating into the right lateral ventricle likely result of prior instrumentation. Punctate focus of air within the right frontal horn has resolved.Redemonstration of enlargement of the lateral and third ventricles, which are unchanged compared to previous exam. Periventricular low attenuation of white matter is similar to prior exam corresponding to regions of small vessel ischemic strokes on prior MRI study and are unchanged. Possibility of underlying periventricular exudate of CSF should also be considered.The visualized osseous structures and soft tissue extracranial components are without abnormalities.", "output": "1.No significant interval change in the size of the supratentorial enlarged ventricular system. "}
{"instruction": "Generate impression based on findings.", "input": "Loss of smell and taste sense. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate nonspecific foci of T2 hyperintensity in the bilateral frontal lobe white matter. The brain parenchyma and olfactory bulbs appear 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, nasal cavity, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "No evidence of acute intracranial hemorrhage, mass, or acute infarct. The olfactory bulbs are grossly intact. "}
{"instruction": "Generate impression based on findings.", "input": " For the purposes of numbering, there are 5 lumbar type vertebral bodies. Alignment is anatomic. There is no marrow edema or replacement. Vertebral body heights and intervertebral disc spaces are preserved. The conus is normal in signal and morphology and terminates at the mid L2 level. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: No significant spinal canal or neural foraminal stenosis.L1/2: No significant spinal canal or neural foraminal stenosis.L2/3: No significant spinal canal or neural foraminal stenosis.L3/4: Mild disc desiccation. No significant spinal canal or neural foraminal stenosis.L4/5: Mild disc desiccation. There is minimal right foraminal bulging of the intervertebral disc with no significant spinal canal or neural foraminal stenosis.L5/S1:Minimal facet joint arthropathy with no significant spinal canal or foraminal stenosis.SI Joints: No significant abnormalities noted.", "output": "Minimal degenerative changes of the lumbar spine with no specific findings to account for patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "History of myelofibrosis. Screening for clinical trial. Needs specific measurement of the spleen. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Small right hepatic cyst. No enhancing hepatic lesions. No biliary ductal dilatation. Patent vasculature.SPLEEN: Marked splenomegaly measuring 21.5 cm in length (prior 23 cm). Multiple subcentimeter foci of T2 signal intensity are again seen and show no contrast enhancement.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.BONES, SOFT TISSUES: Stable hemangiomas at L2, L3,, and S1.OTHER: No significant abnormality noted.", "output": "1.Marked splenomegaly, which has slightly decreased in the interval measuring 21.5 cm (prior 23 cm)."}
{"instruction": "Generate impression based on findings.", "input": " There is continued evolution of postsurgical changes from T6 to T9 including left T7, T8 and T9 hemilaminectomies and left T8 pedicle resection for resection of aneurysmal bone cyst. There is no definite residual osseous tumor. Interval resolution of enhancement superior and inferior to the resection site which was reactive. There is mild dorsal epidural enhancement from the T9 to T11 levels which may represent postsurgical change. There is no evidence of abscess. There is interval resolution of the left pleural effusion.The vertebral column alignment is within normal limits. The vertebral body and disc space heights are otherwise preserved. The spinal cord displays normal signal and morphology with the conus terminating at L1.", "output": "1. Evolution of postsurgical changes from T6 to T9, including left T7, T8 and T9 hemilaminectomies and resection of the left T8 pedicle, without definite evidence of residual or recurrent tumor. 2. Decrease in previously seen epidural enhancement superior and inferior to the resection site which represented reactive change. Minimal residual epidural and soft tissue enhancement at the resection site may represent postsurgical change. "}
{"instruction": "Generate impression based on findings.", "input": "Right shoulder pain and weakness ROTATOR CUFF: Metallic susceptibility artifact overlies the greater tuberosity relating to prior rotator cuff repair. There is a small full-thickness tear of the supraspinatus tendon at the level of the distal acromion best appreciated on series 9 image 16 of 24. There is otherwise no full-thickness rotator cuff tear identified. There is mild atrophy of the supraspinatus muscle with a minimal amount of atrophy along the myotendinous junction of the infraspinatus. The remaining rotator cuff musculature is normal inSUPRASPINATUS OUTLET: There is mild osteoarthritis of the and acromioclavicular joint. A trace amount of fluid is seen in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degeneration of the labrum without evidence of full-thickness tear/detachment.BICEPS TENDON: The biceps tendon is intact although there is a small amount of circumferential fluid present within the biceps tendon sheath which is likely the result of communication with a small amount of joint fluid. ADDITIONAL", "output": "Small full-thickness tear of the supraspinatus tendon. Additional findings are described above."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic lung cancer with diffuse bone metastases, on Nivolumab, now with blurred and double vision due to left lateral rectus palsy. There is an infiltrative enhancing lesion that measures up to approximately 3 cm involving the left aspect of the clivus, in the region of Dorello's canal. There is also a subcentimeter lesion in midline of the frontal bone. There are postoperative findings related to decompression of the upper cervical spine with an expansile mass involving C2 with indentation of the spinal cord. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific scattered cerebral white matter T2 hyperintensity, as well as unchanged areas of encephalomalacia in the right perirolandic region and anterior right frontal lobe. There is no abnormal intracranial enhancement. 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 and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the maxillary sinuses. There is also a small amount of fluid within the left mastoid air cells.", "output": "1. A lesion involving the left aspect of the clivus likely represents metastatic disease and may account for the double vision. Another subcentimeter lesion in the frontal bone also likely represents a metastasis. Otherwise, no evidence of intracranial metastases.2. Partially-imaged postoperative findings related to decompression of the upper cervical spine with a metastasis involving C2 with compression of the spinal cord. Discussed with Dr. Maitland at 3PM on 5/8/15."}
{"instruction": "Generate impression based on findings.", "input": "Pain. Torn cuff? ROTATOR CUFF: There is mild increased signal intensity within the anterior fibers of the supraspinatus tendon at its insertion on the greater tuberosity suggesting tendinosis, but I see no fluid-filled tear of the supraspinatus. The supraspinatus muscle is within normal limits. There is mild heterogeneity of signal of the infraspinatus tendon which may reflect minimal tendinosis, but I see no tear, and the muscle appears normal. The teres minor tendon and muscle appear normal. There is a focal near full-thickness to full-thickness tear of the subscapularis tendon just proximal to its humeral insertion medial to the tendon of the long head of the biceps. This tear is approximately 8 mm in greatest dimension. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint with anterior acromial spurring associated with mild impression upon the superior fibers of the supraspinatus muscle. I see no fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint, with cartilage loss posteriorly. There is also tearing of the superior and posterior labrum with formation of small para labral cysts. There is minimal posterior translation of the humeral head with respect to the center of the glenoid. Intermediate signal intensity within the anterior labrum likely reflects degeneration. There is no joint effusion. BICEPS TENDON: The tendon of the long head of the biceps appears slightly thickened within the rotator interval and contains mild increased signal intensity centrally, suggesting mild tendinosis.", "output": "1.Focal near-full-thickness to full-thickness tear of the insertional fibers of the subscapularis.2.Osteoarthritis and labral tearing.3.Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": " There is no evidence of intracranial mass, acute infarct, mass effect or herniation. There is persistent ill-defined enhancement in the postsurgical area in the left frontal lobe, likely post-operative, without new or nodular enhancement. Previously seen tiny focus of high DWI signal in the right periatrial white matter is no longer present. There are stable postoperative findings related to left sided craniotomy with foci of encephalomalacia in left frontal lobe, and left occipital lobe with stable ex vacuo dilatation of the trigone of the left lateral ventricle.There is moderate degree of confluent periventricular and subcortical white matter T2 prolongation which is unchanged. Aside from differences in technique, there is redemonstration of numerous foci of punctate small susceptibility effect in the pons, cerebellar hemispheres, and bilateral cerebral hemispheres including the basal ganglia. There are stable small bilateral subdural effusions in the posterior fossa which may be secondary to volume loss. There is a small right maxillary sinus mucous retention cyst. There is new patchy increased T2 signal in the left mastoid air cells.", "output": "1.No evidence of intracranial metastases.2.Stable foci of encephalomalacia left frontal and occipital lobes.3.Stable nonspecific periventricular and subcortical white matter changes which may be related to posttreatment change or possible underlying chronic small vessel ischemic changes."}
{"instruction": "Generate impression based on findings.", "input": "58 year old male patient with biopsy proven prostate cancer. Evaluate extent of prostate cancer invasion. PELVIS:PROSTATE:Prostate Size: 4.6 x 2.8 x 3.5 cm. Peripheral Zone: There is a region of T2 hypointensity and corresponding low ADC values extending from the right base to mid gland of the peripheral zone compatible with tumor. This measures approximately 1.0 x 0.5 cm in one region (image 19, series 901). The capsule overlying this lesion is indistinct compatible with extraprostatic extension and there is questioned involvement of the adjacent neurovascular bundle on the right.There is an additional smaller focus of signal abnormality within the left mid-gland measuring 0.5 x 0.4 cm which is also suspicious for tumor (image 20, series 901). Central Gland: There are BPH nodules.Seminal Vesicles: No definite involvement.Extracapsular Extension: As described above.BLADDER: There is irregularity and thickening of the inferior bladder wall. These regions of abnormality are intrinsically high on T1 which limit evaluation for enhancement.LYMPH NODES: Non-specific external iliac lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There are asymmetric dilated venous vessels anterior to the right gluteus musculature.", "output": "1.Large area of signal abnormality within the right mid-gland and right base of the peripheral zone most compatible with neoplasm and with extraprostatic extension and questioned involvement of the neurovascular bundle.2.Smaller lesion within the left mid-gland of the peripheral zone also suspicious for prostatic neoplasm.3.Significant irregularity and thickening of the bladder wall is concerning for neoplasm; direct visualization is recommended for further evaluation. 4. Asymmetric prominent posterior right lower extremity veins. While this could be normal anatomy, collateral vessel formation is another consideration in the setting of chronic deep venous thrombosis; if there is clinical concern for DVT, ultrasound may be considered. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for HCC History: HCV cirrhosis, elevated AFP ABDOMEN:LIVER, BILIARY TRACT: There is a dominant focal hepatic lesion at the junction of segments 5 and 6 with reference measurements as below. The lesion demonstrates increased T2 signal, restricted diffusion, decreased T1 signal, and predominantly peripheral enhancement. There is an additional similar smaller lesion at the hepatic dome at the junctions of segments 7 and 8 with reference measurements below. This lesion mildly attenuates the right hepatic vein which remains patent. No additional focal hepatic lesions are identified.The gallbladder appears within normal limits. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cyst. RETROPERITONEUM, LYMPH NODES: Few mildly prominent nonspecific periportal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/29/2016 10:30:00)HEPATIC SEGMENT 5/6 LESION: 3.5 x 4.1 cm (Image 270, Series 10).HEPATIC SEGMENT 7/8 LESION: 2.1 x 1.9 cm (Image 288, Series 10).", "output": "Two focal hepatic lesions which are highly suspicious for neoplasm. The lesions do not meet diagnostic criteria for HCC. Top differential considerations include cholangiocarcinoma, metastatic adenocarcinoma, or undifferentiated carcinoma.Findings discussed with BOYLE, ELIZABETH at 2:15 PM on 11/29/2016."}
{"instruction": "Generate impression based on findings.", "input": "14 years Female (DOB:4/10/2002)Reason: syrinx with new leg pain and numbness to the top of her foot. Please do with tethered cord protocol. Evaluate for changes. History: leg pain and numbness to the top of her foot.PROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. Conus medullaris moves anteriorly in the prone position. The conus medullaris ends at the mid L2 vertebral level.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "No compromise to lumbar spinal canal or neural foramina. The patient's syrinx does not extend to the conus medullaris. There is no convincing evidence for tethered cord."}
{"instruction": "Generate impression based on findings.", "input": "Eethesioneuroblastoma; received 2 cycles of chemotherapy; assess for response to therapy. Face: There is a right sinonasal mass that extends from medial maxillary sinus, through the infundibulum into the middle meatus and anterior ethmoid air cells. The tumor measures up to approximately 30 mm in craniocaudal extent, 30 mm in the anteroposterior dimension, and 20 mm transversely, which is similar to the size of the tumor in August 2015. There are obstructed secretions and mucosal thickening in the right maxillary sinus, frontoethmoid, frontal sinuses. There is apparent dehiscence of the posterior wall of the right nasolacrimal duct, which appears narrowed, but no evidence of intracranial or intraorbital extension of the tumor. There appears to be a mildly asymmetrically prominent right level 2B lymph node. There is leftward nasal septal deviation. There is a subcentimeter probable nasopharyngeal retention cyst.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a prominent perivascular space in the right basal ganglia. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.", "output": "1. A right sinonasal mass measuring up to 30 mm that involves the right maxillary, middle meatus, and ethmoid sinuses is compatible with residual esthesioneuroblastoma without evidence of intraorbital or intracranial extension. 2. A mildly asymmetrically prominent right level 2B lymph node is nonspecific.3. No evidence of intracranial hemorrhage, mass, or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": " Brain parenchyma appears within normal limits. No findings to suggest demyelinating disease. No abnormal enhancement. No intracranial mass or mass effect. No evidence of ischemia or hemorrhage. Ventricles and sulci are within normal limits. Cerebellar tonsils are borderline low with preserved rounded morphology. There is a left maxillary sinus mucus retention cyst. Calvarium and extracranial soft tissues are otherwise unremarkable.CERVICAL SPINE", "output": "There is no evidence of demyelinating disease in the brain or spine or other significant abnormality to explain patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "41 years Male (DOB:4/12/1974)Reason: h/o L frontal anaplastic pleomorphic xanthoastrocytoma s/p resection and RT History: eval for EODPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left frontal craniotomy for left frontal lobe surgery. There is a small linear focus of enhancement present along the inferior medial aspect of the resection site which is stable compared to prior exam. There is also small focus of T1 signal hyperintensity adjacent to the frontal horn of left lateral ventricle. Perfusion imaging does not demonstrate any areas of increased microvascularity. The signal characteristics of the apparent fluid within the resection cavity are slightly different from that of spinal fluid.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "The patient is status post left frontal lobe surgery. The appearance of the resection site is stable compared to the prior exam. Small focus of enhancement at the surgical site remains stable. It is quite possible that it is related to postoperative effect."}
{"instruction": "Generate impression based on findings.", "input": "Status post TACE RFA of a segment 5 lesion. Evaluate for residual or recurrent tumor. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology and contour.The hepatic dome ablation zone measures 2.1 x 1.7 cm (series 801/369), unchanged.The peripheral segment 5/8 ablation zone measures 3.0 x 1.6 cm (series 801/289), compared to 2.8 x 1.5 cm previously.The segment 3 ablation zone measures 1.8 x 1.1 cm (series 801/189), compared to 1.7 x 1.4 cm previously.The new segment 5 ablation zone measures 3.1 x 1.2 cm (series 801/174). No residual enhancing lesion.No new arterial enhancing lesion or other discrete mass lesion. Trace perihepatic ascites, unchanged.Normally distended gallbladder. No biliary ductal dilatation.SPLEEN: The spleen measures 10.4 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal inferior pole cyst.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm is partially imaged measuring 4.2 x 4.4 cm (series 601/1) in maximal cross-section with asymmetric mural thrombus. It measures 4.5 cm in transverse dimension on the coronal images. BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Fluid and peripheral enhancement without restricted diffusion in the right lower anterior chest wall soft tissues along the recent RFA tract.OTHER: No significant abnormality noted.", "output": "1.Interval TACE/RFA of the segment 5 lesion without evidence of residual or recurrent tumor. Relatively stable bilobar ablation zones without evidence of tumor recurrence.2.Cirrhosis with no new new suspicious liver lesion.3.Fluid and peripheral enhancement of new RFA tract; correlate for signs and symptoms of infection. 4.Partially evaluated infrarenal abdominal aortic aneurysm. "}
{"instruction": "Generate impression based on findings.", "input": "Cervical radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Central disc protrusion similar to prior with minimal narrowing of the spinal canal at this level. No significant neural foraminal stenosis. C5-6: Disc bulge with central protrusion and ligamentum flavum thickening contribute to moderate spinal canal stenosis at this level, not appreciably changed since 9/29/2014. There is mild left worse than right neural foraminal stenosis, which is also similar to prior. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "Compared to 9/29/2014, there is no significant change in degenerative changes at the C4-C5 and C5-C6 levels, with up to moderate spinal canal stenosis at the C5-C6 level. No cord signal abnormality. There is mild bilateral, left worse than right, C5-C6 neural foraminal stenosis which is also not significantly changed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Cmc joint injury History: Pain and swelling thumb CMC joint There is focal edema within the base of the first metacarpal dorsomedially. There is slight depression of the overlying articular surface, which may represent a small impaction fracture. There is perhaps mild thickening of the capsular structure of the joint which may reflect mild sprain injury, particularly the intermetacarpal ligament. No additional bone marrow abnormality is noted. There is small amount of fluid in the first CMC joint. We see no findings of TFCC, lunotriquetral, or scapholunate ligament disruption. There is small collection of fluid intensity volar to the distal radius along the proximal margin of the radiolunotriquetral ligament that may represent a small ganglion or synovial cyst. Median and ulnar nerves appear normal. Extensor and flexor tendons are within normal limits without evidence of tenosynovitis.", "output": "Small focus of edema at the base of the first metacarpal with slight focal depression of the overlying the articular surface, which may represent a small impaction fracture. Other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "36 are old male with progressive left hip pain with history of car accident. There is linear increased signal abnormality traversing the anterior superior labrum at the 2 o'clock position indicating a tear. Additionally, there is heterogeneous signal abnormality traversing the posterosuperior labrum at the 10 o'clock position also suspicious for a tear. There is a small amount of fluid within the joint without evidence of a large effusion. The imaged musculature of the left hip is normal in appearance. There is peritrochanteric increased signal abnormality on fluid sensitive sequences with associated enhancement on postcontrast sequences with foci of low signal internally indicating a mild bursitis. The bone marrow signal abnormality is within normal limits.", "output": "1. Tearing of the acetabular labrum as described above.2. Findings consistent with a mild trochanteric bursitis."}
{"instruction": "Generate impression based on findings.", "input": " There multiple patchy foci of decreased diffusion throughout the right frontal, parietal, and occipital lobes predominantly in a watershed distribution. This minimal susceptibility effect associated with more confluent regions in the right precentral gyrus with adjacent prominence of the sulcal vessels throughout the right frontal lobe. There is also mild leptomeningeal enhancement with apparent nodularity at the right central sulcus (or tortuous dilated vessels). In addition, there multiple punctate foci of T2 hyperintensity within the left sided supratentorial white matter. The ventricles and basal cisterns are normal in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses and scalp soft tissues are unremarkable. The skull is mildly thickened.", "output": "1.Numerous foci of restricted diffusion throughout the right cerebral hemisphere are most compatible with acute/subacute infarcts. These appear predominantly in the watershed distribution. Small foci of susceptibility are also seen indicative of petechial hemorrhages. There is prominence of the pial collaterals with mild leptomeningeal enhancement and apparent nodular enhancement at the right central sulcus. This nodularity may be related to tortuous dilated collateral vessels; however, if there is possibility of underlying infection and infectious vasculopathy, suggest lumbar puncture and vascular imaging for further evaluation. 2.Additional nonspecific punctate foci of T2 hyperintensity throughout the left cerebral hemisphere.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Numbness in hands, recurrent stenosis? History of foraminotomy. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Kyphotic angulation again seen at C3-4 which is unchanged. Alignment is otherwise maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology. There is evidence of prior left-sided foraminotomies at C4-C5, C5-C6, and C6-C7.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild disk osteophyte complex and kyphotic attenuation with partial effacement of the ventral thecal sac. No significant compromise to the spinal canal or neural foramina. C4-5: Again seen is uncovertebral hypertrophy and facet hypertrophy greater on the left with interval postsurgical changes of left-sided foraminotomy. No significant spinal canal or right foramina stenosis.C5-6: There is small disk osteophyte complex with bilateral uncovertebral hypertrophy and facet arthropathy. Interval postsurgical changes of left-sided foraminotomy. There is moderate right-sided foraminal narrowing related to uncovertebral hypertrophy and right-sided extrusion which is minimally worsened in the interval. There is associated effacement of the right ventral thecal sac, otherwise no significant spinal canal stenosis. C6-7: Interval left-sided foraminotomy. Again seen is prominent left-sided uncovertebral spur with small disk component. Spinal canal and right neural foramen appear patent.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "Degenerative changes in the cervical spine with interval left-sided foraminotomies at the left C4-C5, C5-C6, and C6-C7 levels compared to 4/8/2014. There is no new disk extrusion on the left to explain recurrent symptoms. There may some residual foraminal narrowing despite the foraminotomy which could be further assessed with CT to better define the osseous anatomy if surgery is contemplated.Minimal interval increase in disk extrusion at the right C5-C6 level with associated effacement of the right ventral thecal sac and moderate right foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": " There are postoperative findings related to suboccipital craniectomy and C1 laminectomy for decompression of Chiari malformation. The cerebellar tonsils areunchanged in appearance, laying 7 mm below the basion. There are unchanged mildly diminished CSF spaces ventrally and dorsally at the foramen magnum. There is unchanged diminished CSF flow ventrally and dorsally at the craniocervical junction with a retro-odontoid turbulence. There is unchanged tenting of the left dorsal cerebellar surface compatible scarring. The partially imaged pituitary is prominent but within normal limits for age and better assessed on prior dedicated pituitary studies. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. 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 paranasal sinuses are unremarkable.", "output": "Unchanged postoperative findings related to Chiari decompression with diminished and turbulent flow at the craniocervical junction as well as findings suggestive of an arachnoid adhesion."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with a left breast cancer, status post neoadjuvant chemotherapy. The patient received a lumpectomy and complete axillary lymph node dissection in 9/2014 at outside institution, but residual left breast cancer and metastatic left interpectoral and left internal mammary lymph nodes were confirmed after surgery. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The known left breast cancer at 7 o'clock position is smaller, measuring 21 x 22 x 12 mm (AP x ML x CC: previously 32 x 29 x 36 mm). The mass attaches to the pectoralis major muscle.Skin thickening in the left breast is again seen.The enlarged left interpectoral lymph node and left internal mammary lymph node are no longer present. No abnormal left axillary lymph node.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region. One normal morphology right axillary lymph node with a marker clip, consistent with proven benign lymph node.", "output": "Decrease in size of known left breast cancer.Complete imaging response of left interpectoral lymph node and left internal mammary lymph nodeBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Status post fourth ventricular choroid plexus tumor resection. There are postoperative findings related to suboccipital craniotomy with diffuse areas of scalp swelling. There is residual lobular enhancing mass in the inferior fourth ventricle that measures up to 15 mm. There are patchy areas of high T2 signal and restricted diffusion within the bilateral cerebellar hemispheres. There is a right transfrontal ventricular catheter that terminates in the left lateral ventricle. The ventricles continue to decrease in size, along with the associated periventricular T2 hyperintensity. There is mild high T2 signal in the parenchyma surrounding the catheter. There is no evidence of acute cerebral infarction or intracranial hemorrhage. There is a 6 mm wide arachnoid cyst anterior to the anterior temporal pole. There is a retention cyst in the left maxillary sinus. Scalp fiducial markers are present.", "output": "Postoperative findings related to partial resection of a fourth ventricular choroid plexus tumor with patchy areas of acute infarction within the bilateral cerebellar hemispheres, but essentially resolved ventricular dilatation persistent obstructive hydrocephalus and transependymal edema, with a right transfrontal ventricular shunt catheter in position."}
{"instruction": "Generate impression based on findings.", "input": "Male, 33 years old, with essential tremor status post unilateral deep brain stimulator, now planning for implantation on the other side. Since the prior examination, a left frontal approach deep brain stimulator lead has been placed coursing posteriorly and inferiorly to terminate within or just below the left thalamus. No unexpected or acute findings are identified on this limited examination. Brain parenchymal morphology and signal characteristics are otherwise unremarkable.", "output": "Findings compatible with interval placement of a left-sided deep brain stimulator."}
{"instruction": "Generate impression based on findings.", "input": "A 57 year old female with personal history of diabetes, osteoarthritis and overwight who was referred to cardiac MRI after she was diagnosed with idiopathic ventricular tachycardia. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 89 ml/m2 (normal range: 65+/-11), the LVEDV is 207 ml (normal range 109+/-23), the LV end systolic volume index is 48 ml/m2 (normal range 18+/-5), the LVESV is 112 ml (normal range 31+/-10). There is global mild hypokinesis with regional variation. Normal LV thickness. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Normal native myocardial T1-times. No findings to support active inflammation/edema of the myocardium.No intracavitary thrombus was seen.Left AtriumThe left atrium is mildly dilated (110ml).Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 205 ml (normal range 110+/-24), the RV end systolic volume index is 53 ml/m2 (normal range 22+/-8), and the RVESV is 122 ml (normal range 35+/-13). No regional wall motion abnormalities were noted.Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely, the leaflets are thickened 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 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. The left ventricle is mildly dilated with mildly reduced systolic function, the LVEF is 46%. There is global mild hypokinesis with regional variation. Normal LV thickness. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Normal native myocardial T1-times. No findings to support active inflammation/edema of the myocardium. No evidence of infiltrative disease. 3. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 40%. No regional wall motion abnormalities.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with left breast multicentric breast cancer, presents for needle localization. On review of the prior studies, breast MRI dated 7/20/2016 and mammogram dated 6/21/2016. Target spiculated mass morphology is located in the left breast in the superior region located anterior 12 o\u2019clock, with adjacent 'lock-shaped' clip. Another target focal asymmetry with few pleomorphic calcifications at the left upper inner quadrant is located at the 2:00 position, also with adjacent biopsy clip.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 7 cm Kopans needle was placed through the lesion. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Wire placement was performed for the two sites, anterior 12:00 lesion and posterior 2:00 lesion. Repeat two view orthogonal mammograms reveal the spring wire to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Tremblay performed the procedure under direct supervision of Dr. Abe, who was present during the procedure at all times.Orthogonal digital specimen radiographs obtained from the more anterior target reveals the spiculated mass, lock shaped biopsy marker and spring wire to be within the specimen. Of note, spiculations extend to the anterior and superior margins of the specimen. Findings discussed with Dr. Jaskowiak , and additional tissue was resected along the margins (no image).Orthogonal digital specimen radiographs obtained from the more posterior target, reveals the clip and spring wire to be within the specimen. Additional tissue from lateral margin was excised (no image).", "output": "Successful double needle localization of the left breast anterior upper mass and upper outer focal asymmetry.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "16 year-old male with non-Hodgkin's lymphoma and metastatic disease presents with headache. There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Reidentified is a large frontal abnormality with mixed soft tissue and calcific attenuation with spiculation and intra-cranial soft tissue component. This finding is unchanged when compared to the previous MRI examination of 2/29/08. Similar imaging findings have been seen with PNET tumors such as neuroblastoma, clinical correlation is advised. This appearance can also be seen in atypical aggressive type meningiomas.", "output": "No acute abnormalities. Cranial/intracranial lesion, stable as described above. The differential again includes an atypical type of meningioma however similar findings have been seen with metastatic PNET. Correlate clinically."}
{"instruction": "Generate impression based on findings.", "input": "Patient with Li-Fraumeni syndrome, surveillance evaluation There is scattered fibroglandular tissuein both breasts.Moderate parenchymal enhancement is noted bilaterally.At least 2 benign morphology foci identified in the right breast 12:00 and 10:00 position, close to the skin with corresponding T2 signal most likely representing a benign fibroadenoma or intramammary lymph node.An oval slowly enhancing heterogeneous mass in the right breast 2:00 position measures 13 x 7 x 11 mm (AP X ML X CC), close to the skin most likely corresponds to the infected sebaceous cyst as seen on ultrasound dated 1/2/2015. It has bright T1 characteristics suggestive of proteinaceous component. Oval enhancing mass in the left breast 6:00 position measuring 8 x 7 x 6 mm (AP X ML X CC) needs further evaluation with MR directed ultrasound. Possible dark septations within the enhancing mass suggest a fibroadenomaNo abnormal enhancement is seen elsewhere in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Mild dependent right-sided pleural effusion.", "output": "1. 8 mm enhancing oval mass in the left breast 6:00 position needs further evaluation with MR directed ultrasound. Lesion shows few dark septations and could represent a benign fibroadenoma. If the lesion is not seen on ultrasound, 6 month follow up MRI is recommended. 2. Benign characteristic foci in the right breast and is slowly enhancing 13 mm mass close to the skin most likely is the patient's cyst at 2:00 position.3. No abnormality noted within the axillary region.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female patient with weakness and history of brain metastases. There are postsurgical changes of a left frontal craniotomy for resection of a left frontal lobe intraparenchymal tumor. The resection cavity is smaller in size and contains a small amount of fluid with a thin T2 hypointense rim compatible with hemosiderin deposition. There is new circumferential enhancement of the resection cavity without nodularity or focal asymmetric thickening. Vasogenic edema within the left frontal lobe is markedly improved.Multiple additional enhancing lesions are significantly smaller in size or no longer visualized. For example a centrally cystic tumor within the left temporal lobe now measures 15 x 10 mm, previously 31 x 24 mm (image 11, series 1101). A solid tumor within the right medial temporooccipital lobe now measures 9 x 8 mm, previously 24 x 19 mm (image 14, series 1101). No new enhancing lesion is identified.A nonenhancing T2 hypointense extra-axial mass along the left cranial vertex, just posterior to the resection cavity, compatible with a calcified meningioma is unchanged.There is no evidence of acute infarct. Mild periventricular T2 signal abnormality may related to chronic small vessel disease or post-therapy changes. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Bilateral maxillary sinus mucous retention cysts and a left sphenoid mucous retention cyst. There is partial opacification of the mastoid air cells. The orbits are grossly unremarkable.", "output": "1. Post-operative findings of the left frontal lobe with decreased size of the resection cavity but new circumferential enhancement; this is suspected to represent post-therapy change, however, the possibility of residual/recurrent tumor cannot be excluded. 2. Multiple additional metastatic lesions are smaller in size or no longer visualized."}
{"instruction": "Generate impression based on findings.", "input": "Female, 55 years old, with history of cystic lesion in the spine status post resection. Assess for recurrence. Findings are redemonstrated compatible with T3-4 hemilaminectomy. The postoperative soft tissue fluid collection seen on the prior examination has resolved.A loculated cystic lesion is seen within the spinal canal, dorsal to the spinal cord, extending from T3 through T8. The overall size and morphology of this lesion does not appear to have significantly changed from the prior examination. Again, it is noted that the lesion expands into and chronically widens the neural foramina from T4 through T8.The spinal cord is not significantly deformed and there is no evidence of pathologic cord signal abnormality. No areas of spinal canal or neuroforaminal stenosis are seen. The intervertebral discs are preserved. Spinal alignment is anatomic. Marrow signal characteristics are within normal limits.Multiple pulmonary nodules are seen along with a thin right pleural effusion. Multiple hepatic masses are also partially visualized.", "output": "1.Stable loculated cystic lesion within the spinal canal dorsal to the spinal cord.2.No evidence of spinal cord edema.3.Multiple pulmonary and hepatic masses are partially visualized."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female with LLE cellulitis, elevated inflammatory markers. Rule out myositis, abscess, osteo There is thickening and enhancement of the skin as well as reticulation and enhancement of the subcutaneous fat compatible with marked cellulitis. There is poorly defined crescentic of nonenhancing tissue within the subcutaneous fat along the anterior peripheral deep fascia that may simply represent confluent edema, although it is impossible to exclude a phlegmon/developing abscess. Mild increased signal intensity within the soleus muscle as well as the flexor digitorum longus muscle may reflect very mild myositis. Bone marrow signal intensity is within normal limits. Small knee joint effusion with extension posteromedially into a tiny Baker's cyst. Mild osteoarthritis affects the knee. Relatively mild subcutaneous edema affects the right leg on the large field-of-view coronal images.", "output": "1. Cellulitis and possible mild myositis without evidence of osteomyelitis. Nonenhancing tissue within the subcutaneous fat along the anterior peripheral deep fascia probably simply represents confluent edema, although it is impossible to exclude a phlegmon/developing abscess."}
{"instruction": "Generate impression based on findings.", "input": "Ankle swelling and pain, changes most pronounced on the dorsum of foot Bones: Mild degenerative changes similar to the plain film without new abnormality. Specifically marrow signal and osseous structures remain well aligned and unremarkable. No abnormal intraosseous abnormalities or abnormal fluid collections. Particular attention was placed onThe patient placed marker overlying the dorsal and lateral aspectsSoft tissues: Mild diffuse soft tissue swelling and stranding is observed without specific focal abnormality. Specifically no abnormal fluid collections. Surrounding musculature otherwise unremarkable. No abnormal fluid collections.Ligaments: Visualized ligaments appear intact.Tendons: Tendons are also well visualized and normal in appearance, both in size, signal characteristics and contourOther: Of note are multiple engorged veins observed on the medial and inferior aspects of the ankle opposite to the patient described focal areas of pain. These are of uncertain clinical significance.", "output": "Mild degenerative changes without discrete focal soft tissue abnormalities to account for patient's pain and surrounding mild to moderate nonspecific swelling.."}
{"instruction": "Generate impression based on findings.", "input": "Reason: bilateral shoulder pain History: bilateral shoulder pain ROTATOR CUFF: There is mild increased signal intensity within the supraspinatus tendon near its in insertion on the greater trochanter, which is consistent with tendinopathy and appears unchanged from prior. There is no evidence of tearing. The infraspinatus, subscapularis and teres minor muscles and tendons are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears grossly intact and the glenohumeral joint is within normal limits.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "1. Supraspinatus tendinopathy, not significantly changed from the prior exam.2. Acromioclavicular joint osteoarthritis. "}
{"instruction": "Generate impression based on findings.", "input": " Examination is motion degraded. There are numerous foci of decreased diffusion within the right cerebral hemisphere including the right frontal cortex, subcortical white matter, and corona radiata in a mainly deep watershed distribution, including the right hand motor area. There is also involvement of the right anterior caudate. Few right parietal lesions also seen. In addition, there are also patchy foci of T2 hyperintensity within the left supratentorial white matter without diffusion abnormality, most compatible with chronic small vessel ischemic disease. There is a focus of extra-axial soft tissue along the left parietal convexity with corresponding flair hyperintensity measuring up to 6 mm in thickness.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The distal right internal carotid artery flow void appears diminutive. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.", "output": "1. Motion degraded exam which was terminated prematurely. There are mutliple foci of acute infarct involving the right frontal and to lesser extent right parietal lobes in a mainly deep watershed distribution. In addition, the distal right internal carotid artery flow void appears diminutive suggestive of stenosis and could be further characterized with MRA.2. Focus of extra-axial soft tissue along the left parietal convexity with FLAIR hyperintensity measuring up to 6 mm in thickness. Finding is favored to represent a a meningioma but not not well evaluated given motion artifact and absence of contrast. No significant mass effect.Findings of multiple infarcts discussed with Dr. Cejas at 5:10pm on 1/10/15I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified ptosis of eyelid Paralytic strabismus, third or oculomotor nerve palsy, partialClinical question: any change in 3 rd nerve lesion or other abnormalitiesSigns and Symptoms: 3rd nerve lesion, migraines, ptosisComments: Please do thin cuts FIESTA sequence, compare with previous imaging for any changes. Mom would like MRI either May 8th or 15th if possible. MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The small and subtle enhancing focus adjacent to the right midbrain at the expected location of the origin of the right oculomotor nerve is less conspicuous on the current exam. It is better seen on the coronal post gadolinium axial SPGR images (series 1701 image 48). It can also be seen on 3D FIESTA - image 47 series 1401. It is abutting the medial division of the superior cerebellar artery. It is best seen when comparing to the 7/11/13 exam when it was more conspicuous.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities with opacification of the maxillary sinus and mild mucosal thickening in some of the ethmoid air cells. The visualized portions of the mastoid air cells are partially opacified. MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact . There is disconjugate gaze present.The small and subtle enhancing focus adjacent to the right midbrain at the expected location of the origin of the right oculomotor nerve is less conspicuous on the current exam. It is better seen on the coronal post gadolinium axial SPGR images (series 1701 image 48). It can also be seen on 3D FIESTA - image 47 series 1401. It is abutting the medial division of the superior cerebellar artery. It is best seen when comparing to the 7/11/13 exam when it was more conspicuous.", "output": "The small lesion along the proximal portion of the right oculomotor nerve is barely visible on the current exam."}
{"instruction": "Generate impression based on findings.", "input": "History of mesothelioma status post debulking surgery. Evaluate disease status. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement. No focal suspicious lesion. There is extrahepatic biliary ductal dilatation with the common bile duct measuring 1.1 cm which tapers smoothly to the level of the ampulla. This is likely related to the patient's cholecystectomy and is stable. No obstructive stone or mass lesion is evident.Stable subcentimeter hepatic cyst and benign hemangioma. SPLEEN: No significant abnormality noted.PANCREAS: 7 mm lobulated cystic lesion in the pancreatic head without communication with the pancreatic duct which is normal in caliber. There is no suspicious mural nodularity or postcontrast enhancement. This likely reflects a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral T2 hyperintense and T1 hypointense well-defined nonenhancing lesions compatible with simple renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes of a midline abdominal incision.OTHER: No significant abnormality noted.", "output": "No specific evidence of residual or recurrent tumor."}
{"instruction": "Generate impression based on findings.", "input": " No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening on bilateral maxillary sinus.", "output": "Normal brain MRI."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old male complaining of headache, to evaluate There is hyperdensity abnormal signal and fullness in the sella. MRI study is recommended for further evaluation of this region.The attenuation and morphology of the brain parenchyma is within normal limits for patient's stated age. No evidence of hemorrhage, edema, mass-effect or midline shift is detected. Cortical sulci, ventricular system and all CSF cisterns are within normal limits. Calvarium, visualized paranasal sinuses, orbits and mastoid air cells are also normal.", "output": "There is hyperdensity abnormal signal and fullness in the sella. MRI study is recommended for further evaluation of this region. No acute intracranial hemorrhage or cortical ischemia is identified."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: cord compressionSigns and Symptoms: LE weakness Five lumbar type vertebral bodies are presumed to be present. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine. There is diffuse marrow replacement present associated with patchy enhancement of the lumbar vertebrae and the visualized sacrum. There is redemonstration of epidural fat accumulation within the lower lumbar spine and sacral spinal canal.There is a posterior convex bulging of epidural lesion into the spinal canal at L4 and L5 which was also present on the prior exam. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy redemonstrated at this level associated with a diffuse disc bulge and effacement of the fat surrounding the exiting nerve roots within the left neural foramen There is mild anterior subluxation of L5 on S1 which is stable compared to the prior exam. There is effacement of the CSF within the thecal sac at this level and in the sacral spinal canal. There is epidural thickening present behind the L4 and L5 vertebral bodies which has progressed and is associated with narrowing of the spinal canal. The thecal sac appears to be narrowed in the CSF appears to be effaced within the distal thecal sac from the L3-4 disc space level inferiorly. Compared to the prior exam and epidural thickening and associated infiltration of the fat planes at the epidural space appears to have progressed. There is also effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level which is related to diffuse disc bulge and facet hypertrophy and was present on the previous exam as well. There is bilateral facet hypertrophy at L4-5 and L5-S1 which was previously presentAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.Since the prior examination the patient has developed greater epidural thickening which narrows the distal thecal sac and effaces spinal fluid substantially at the L4 and L5 vertebral body levels and sacral spinal canal. This appears to represent infiltrating lesion within epidural lipomatosis. This results effectively in spinal stenosis at the L4 and L5 vertebral body levels as well as the sacral spinal canal.2.Diffuse skeletal metastases.3.Findings were discussed with the radiation oncology service.4.Findings were discussed with Dr Ansari.5.There is facet hypertrophy present in the lower lumbar spine."}
{"instruction": "Generate impression based on findings.", "input": "Male 42 years old Reason: chronic knee pain, eval for medial meniscus tear History: right knee pain MENISCI: There is complex tearing of the posterior horn of the medial meniscus with at least two vertical components, one extending to the superior surface and a second extending to the undersurface. The lateral meniscus demonstrates normal signal intensity and morphology.ARTICULAR CARTILAGE AND BONE: There is mild diffuse thinning of the cartilage overlying the medial femoral condyle with an approximately 9 mm full thickness defect anteriorly (series 9, image 15).LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Complex tearing of the posterior horn of the medial meniscus with at least two vertical components as described above.2. Full-thickness defect in the cartilage overlying the medial femoral condyle."}
{"instruction": "Generate impression based on findings.", "input": " The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle cisterns bilaterally or within the internal auditory canals.Limited visualization of the intracranial structures demonstrates ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. Partially empty sella is noted. There is also distention of the optic sheaths and suggestion of bulging of the optic nerve heads.", "output": "1. No lesions within the cerebellopontine angles, internal auditory canals, or inner ears are appreciated.2. Partially empty sella is noted with distension of the optic sheaths and suggestion of papilledema. These findings are highly suggestive of intracranial hypertension. Suggest correlation with ophthalmologic exam."}
{"instruction": "Generate impression based on findings.", "input": "Male; 49 years old. History: Right knee instability. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Incidental bone infarct in the tibial metadiaphysis, likely of no clinical significance.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Normal examination, without specific findings to account for the patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "Left Bells palsy, not improving after 4 weeks. Internal Auditory Canals: There is diffuse enhancement along the left facial nerve, including cisternal, labyrinthine, tympanic, mastoid, and parotid segments. The right cranial nerve 7 and 8 complex is intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There are unchanged areas of encephalomalacia in the right parietal and left temporal lobes, as well as in the left cerebellum. There are also multiple foci of T2 hyperintensity in the subcortical and periventricular white matter, which are also unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. Diffuse enhancement along the left facial nerve may represent an inflammatory neuritis. Otherwise, no evidence of mass lesions.2. Unchanged areas of encephalomalacia in the right parietal and left temporal lobes, as well as in the left cerebellum superimposed upon a background of probable chronic small vessel ischemic disease, but no evidence of acute infarction."}
{"instruction": "Generate impression based on findings.", "input": "99-year-old female with a diabetic foot ulcer. Rule out osteomyelitis. There is ulceration of the soft tissues of the distal aspect of the great toe. Although on these images, it appears that the distal phalanx protrudes through the soft tissue ulceration, consultation with Dr. Raychaudhuri reveals that the bone does not protrude through the soft tissues nor can it be probed on physical examination. On the T2 weighted STIR sequences there is abnormal signal intensity throughout the majority of the distal phalanx. However, the signal intensity in the T1-weighted images is normal and there is no frank cortical destruction. There is signal abnormality within the subcutaneous fat, particularly dorsal to the distal phalanx, likely representing edema. The signal intensity of the proximal phalanx of the great toe and first metatarsal is normal. There is focal edema within the middle phalanx of the second toe seen on the STIR sequences with normal signal intensity on T1-weighted images. We see no adjacent ulceration to confirm osteomyelitis. The remaining phalanges and metatarsals appear normal. There is atrophy of the musculature of the forefoot.", "output": "1. Edema within the distal phalanx of the great toe on STIR sequences with normal-appearing marrow on T1-weighted images. This pattern of signal abnormality is typically seen with reactive osteitis rather than osteomyelitis, however, given the extent of signal abnormality, follow-up examination with dedicated radiographs is recommended in 7-14 days to exclude osteomyelitis.2. Nonspecific edema-type signal abnormality in the second toe only seen on STIR sequences. We see no ulceration in the surrounding area to confirm osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Assess extent of anterolateral thigh - looking for abscess, tracking areas of edema/possible pus History: Increasing WBC, pain anterolateral hip/thigh Please note that MRI pelvis was not performed due to inability of patient to tolerate exam. Service was paged at the time of the exam without response.There is a large collection of rim-enhancing fluid signal intensity within the subcutaneous fat along the lateral aspect of the right hip that appears to communicate with the skin surface. This collection penetrates the iliotibial band to enter the gluteus medius muscle as well as extending posteromedially between the greater trochanter and gluteus maximus muscle. Anteriorly, the collection extends deep to the tensor fascia lata. The cranial extent of this collection is beyond the field of view of this study. The caudal extent of the collection lies at the level of the subtrochanteric femur and overall the collection is at least 15 cm in craniocaudal dimension and approximately 11 cm in greatest transverse dimension. Foci of signal void within the collection likely represents air. Cutaneous skin staples are noted along the lateral aspect of the hip.Although the gluteus medius muscle is not included in its entirety, additional smaller rim-enhancing collections are noted within the muscle which may communicate with the larger subcutaneous collection. There is edema surrounding the collection with subcutaneous edema along the lateral aspect of the thigh down to just above the knee which appears to enhance, indicating cellulitis. There is also edema of the gluteus maximus muscle, tensor fascia lata, vastus lateralis, vastus intermedius, sartorius and tracking between the quadriceps musculature. Additional edema is present within the adductor muscles of the hip and thigh with relative sparing of the posterior musculature. Diffuse subcutaneous edema is also present. Bone marrow signal intensity is within normal normal limits. Slightly prominent right-sided inguinal lymph nodes are present. Osteoarthritis affects the knee with a small joint effusion.", "output": "1.Large rim-enhancing fluid collection with deep extension into the gluteal musculature and extension to the skin surface. We cannot exclude abscess on the basis of this study.2.Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": " The marrow is diffusely abnormal throughout both the thoracic and lumbar spines. Specifically this demonstrates a marrow infiltration pattern which is diffusely hypointense on T1, and diffusely mildly hyperintense on STIR. There are no acute compression deformities.Thoracic spine:The vertebral body heights and disc spaces are maintained. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are bilateral pleural effusions, right greater than left.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 no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:There are no acute fractures. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation is present L4/5 and L5/S1 with mild disc height loss at L4/5 and moderate disc height loss at L5/S1. There is a small Schmorl's node involving the superior endplate of L5.L1/2: UnremarkableL2/3: Mild facet hypertrophy without stenosisL3/4: Mild facet hypertrophy without stenosisL4/5: Mild disc bulge, ligamentum flavum thickening, mild to moderate bilateral facet hypertrophy, and bilateral facet effusionsL5/S1:Grade 2 anterolisthesis of L5 on S1, diffuse annular disc bulge with disc uncovering, and severe bilateral facet hypertrophy with fusion. There is moderate bilateral neural foraminal stenosis.", "output": "1.The marrow is diffusely abnormal throughout both the thoracic and lumbar spines. Specifically this demonstrates a marrow infiltration pattern which is diffusely hypointense on T1, and diffusely mildly hyperintense on STIR. These MRI findings are compatible with a diffuse marrow infiltrative process, consistent with the patient's known history of multiple myeloma.2.There are no acute compression deformities.3.There are bilateral pleural effusions, right greater than left.4.L5/S1:Grade 2 anterolisthesis of L5 on S1, diffuse annular disc bulge with disc uncovering, and severe bilateral facet hypertrophy with fusion. There is moderate bilateral neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "20 year old female patient status post orthotopic liver transplant with developmental delay. Cholestasis, evaluate for biliary obstruction. Evaluation is limited as described above. ABDOMEN:LIVER, BILIARY TRACT: Post-surgical changes of a left hepatic lobe liver transplant. There is a bowel loop intimately associated with the porta hepatis which presumably represents a hepaticojejunostomy. There is no evidence of intrahepatic biliary ductal dilatation. No focal hepatic lesion is identified. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts and right upper pole renal atrophy. 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": "Limited study as described above. Within limitations, no evidence of intrahepatic biliary ductal dilatation. If there is continued clinical concern for biliary pathology, evaluation by CT may be better tolerated in the future. "}
{"instruction": "Generate impression based on findings.", "input": "Right sphenoid meningioma: headache. Brain: There is an enhancing dural based right paraclinoid mass that measures up to 27 mm, which is not significantly changed. The tumor abuts the right cisternal optic nerve and exerts mild mass effect upon the adjacent right medial temporal lobe. There is no evidence of intracranial hemorrhage or acute infarct. There are scattered cerebral white matter T2 hyperintense foci. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are prominent arachnoid granulations in the bilateral greater wings of the sphenoid bones. There is mild scattered mucosal thickening in the paranasal sinuses.Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.", "output": "1. No significant interval change in the right paraclinoid meningioma.2. Chronic small vessel ischemic white matter disease."}
{"instruction": "Generate impression based on findings.", "input": " There are low-lying cerebellar tonsils (left greater than right) with a pointed morphology extending up to 10 mm below the foramen magnum, to the level of posterior arch of C1. The CSF space around the brainstem and upper cervical cord by the tip of the cerebellar tonsils is effaced. There is no acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no hydrocephalus. There is no midline shift. The skull and extracranial soft tissues are unremarkable.", "output": "Findings consistent with Chiari I malformation. No hydrocephalus."}
{"instruction": "Generate impression based on findings.", "input": "30 year old woman with breast cancer s/p resection, NSVT, concern for possible LV dysfunction and effusion on technically difficult echocardiogram, referred for cardiac MR to evaluate for infiltrative disease. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 94 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 51 ml/m2 (normal range 18+/-5), the LVESV is 89 ml (normal range 31+/-10), the LV mass index is 31 g/m2 (normal range 67+/-11), and the LV mass is 55 g (normal range 114+/-24). 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 edema.The native T1 myocardial relaxation time is normal (<1100ms).There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 88 ml/m2 (normal range 69+/-14), the RVEDV is 156 ml (normal range 110+/-24), the RV end systolic volume index is 45 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). 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 drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsBilateral breast implants are present. Remnant thymus tissue noted. 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. Mildly dilated left ventricle with mildly reduced systolic function (EF 46%). There is global hypokinesis.2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. Normal sized right ventricle with normal systolic function (EF 50%).4. Trivial pericardial effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "16-year-old female with right knee swelling. Evaluate healing of lateral femoral condyle microfracture at 6 months postop. Some sequences are limited by patient motion artifact.MENISCI: There is increased signal abnormality within the posterior horn and body of the lateral meniscus which extends to the tibial and femoral articular surface and presumably represents prior tearing or postsurgical changes of prior partial meniscectomy. No fluid-filled tear is identified to confirm a re-tear of the meniscus. The anterior horn appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is heterogeneity of the articular cartilage along the weightbearing portion of the lateral femoral condyle above the posterior horn of the meniscus presumably representing postsurgical changes from prior microfracture. No full-thickness articular cartilage defect is identified in this area. The articular cartilage of the medial tibiofemoral compartment is relatively spared. There is focal near full-thickness articular cartilage degeneration along the lateral facet of the patella with underlying degenerative subchondral signal abnormality.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. Note is made of patella alta. The Insall Salvati ratio measures 1.6.ADDITIONAL", "output": "1. Postsurgical changes prior partial lateral meniscectomy and lateral femoral condyle microfracture/chondroplasty as described above. No fluid-filled defects are identified within the lateral meniscus to confirm re-tear.2. Patella alta which can be seen in patients with patellofemoral instability.3. Probable loose body within the joint space as described above."}
{"instruction": "Generate impression based on findings.", "input": "Right knee pain, meniscal tear versus loose body MENISCI: There is blunting of the free edge of the body of the medial meniscus which is new from the prior exam and likely represents inner edge fraying/tearing. The anterior and posterior horns of the medial meniscus are intact.There is poorly defined increased signal throughout the lateral meniscus representing extensive degeneration and degenerative tearing. Additionally, there appears to be a vertically oriented tear of the posterior horn with blunting of the free edge of the anterior horn that could reflect interval tearing or the sequela of partial meniscectomy. There is further lateral extrusion of the body of the lateral meniscus with deformity of the contour likely representing a combination of degeneration and tearing.ARTICULAR CARTILAGE AND BONE: The full-thickness defect of the articular cartilage of the medial femoral condyle previously seen on the prior exam is no longer evident. This has instead been replaced with an osseous protuberance measuring approximately 15 mm in width and 4 mm in depth and likely represents the site of interval microfracture surgery. The articular cartilage overlying the bony protuberance is thinned and there is a focal full-thickness defect of the articular cartilage immediately medial to this protuberance measuring approximately 5 mm. Additional heterogeneity of the remaining articular cartilage of the medial femoral condyle suggests mild degeneration. There is also focal degeneration of the articular cartilage of the medial tibial plateau immediately posterior to the truncated body of the medial meniscus. There is mild edema type signal within the subchondral bone of the medial femoral condyle as well. There has been progression of cartilage degeneration of the lateral compartment with portions of the weightbearing surface of the lateral tibial plateau essentially devoid of articular cartilage. There has also been progression of subchondral cystic change although the subchondral edema within the tibial plateau is not as prominent. Furthermore, there has been progression of thinning of the articular cartilage of the lateral femoral condyle posteriorly with areas of full-thickness degeneration.There is moderate degeneration of the articular cartilage of the patellofemoral joint which has also progressed from the prior exam with areas of new full-thickness clefts in the femoral trochlea.There is also progression of osteoarthritis of the proximal tibiofibular joint.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Tricompartmental progression of osteoarthritis with meniscal tears and other findings described above. No discrete loose body is identified within the joint."}
{"instruction": "Generate impression based on findings.", "input": "58 year old with veno thromboembolic disease, HTN and aortic dilation (on CT) presenting for cardiac and aortic assessment. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 182 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). There is subendocardial late gadolinium enhancement in the base-mid inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is consistent with myocardial infarction. There is tardo-kinesis in this area, otherwise no regional wall motion abnormalities were seen. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 100 ml (normal range 54+/-17).Right AtriumThe right atrium is not well seen.Aortic ValveThe aortic valve opens widely and there is least mild 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 common right innominate and left common carotid (\"pseudo bovine arch\", a normal variant) and normal left subclavian. The aortic root is dilated. The portion of the arch just beyond the the take-off of the branch vessels is tortuous and appears narrowed. The descending thoracic aorta is also severely tortuous. Measurements as below: Sinus of Valsalva: 42 mm x 41 mm x 41 mmSinotubular junction: 40 mm x 40 mmMaximally dilated portion of the ascending aorta: 49x50 mmMid-arch 48 x 50 mmPost-branch narrowing 29 x 24 mmDescending aorta 31 x 31 mm 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. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%. There is subendocardial late gadolinium enhancement in the base-mid inferolateral wall which could be consistent with previous MI. 2. The right ventricle is normal in size and systolic function (RVEF 51%)3. Dilated Thoracic Aorta, measurements as above. 4. Aortic valve not well-seen on this study. Suggest transthoracic echocardiography to assess for bicuspid aortic valve and evaluate for aortic regurgitation. "}
{"instruction": "Generate impression based on findings.", "input": "Presacral fluid collection. History of ulcerative colitis status post total abdominal colectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Probable gallbladder sludge within an otherwise unremarkable gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate cysts and too small to characterize presumed renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post total abdominal colectomy. Right lower quadrant end jejunostomy. The proximal small bowel is collapsed without gross abnormality. The stomach, duodenum and distal small bowel is well distended without wall thickening, abnormal enhancement or adjacent inflammatory changes.BONES, SOFT TISSUES: Mild anterior abdominal wall laxity without evidence of complication.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: In the presacral space there is a fluid-filled peripherally enhancing collection measuring 2.4 x 1.5 cm (series 21/37) which has been previously noted on CT to contain high attenuation debris. Along the left inferolateral aspect the collection appears to be intimately related to the ileoanal pouch (per EPIC patient has history of J-pouch with typical appearance on CT) (series 6, image 26). A collapsed portion of the blind end of the J-pouch is a consideration, however a presacral fluid collection is still favored. Along the right inferolateral aspect of the collection there is a fistulous tract extending inferiorly communicating with a tract (series 21 image 39 through 44) at the 7 o'clock position of the anus and exiting at approximately the 1:00 position of the anus and inferoanteriorly to the left labia (series 21 image 47 through 55).There are no significant adjacent soft tissue inflammatory changes. The ileoanal pouch abuts abut the posterior lower uterus and posterior vaginal wall and there are adjacent dependent small bowel loops in the pelvis. The pouch is tethered to the left lateral posterior pelvic wall. The small bowel loops appear to be opacified with high intensity oral contrast which does not appear to communicate into the ileoanal pouch. Communication with the vagina cannot be entirely excluded.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "The presacral collection has slightly increased in size. It intimately abuts the superior aspect of the ileoanal pouch which raises the possibility that this is the free end of the pouch, however a loculated fluid collection is favored. There is a fistula extending from the collection into the anal canal and the left labia as described above.There is no clear fistulous communication between the ileoanal pouch and the dependent small bowel loops in the pelvis or the adjacent uterus and vaginal canal. A limited barium enema may be considered to evaluate the ileoanal pouch and assess the possibility of communication with the aforementioned presacral fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "Female, 58 years old. Lateral joint line pain and locking MENISCI: There is a complex tear and degeneration of the posterior horn of the lateral meniscus as well as globular signal within the anterior horn of the lateral meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the medial and lateral compartments. There is complete loss of the articular cartilage of the undersurface of the patella. There is bone marrow edema within the lateral tibial plateau.LIGAMENTS: The cruciate and collateral ligaments are unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1.Severe osteoarthritis with cartilage loss most prominently affecting the undersurface of the patella.2.Complex tear of the lateral meniscus as above.3.Joint effusion with possible synovitis."}
{"instruction": "Generate impression based on findings.", "input": "Acute left-sided numbness. Please evaluate for infarct. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate and confluent areas of abnormal T2/Flair hypertensity in the periventricular and subcortical white matter, consistent with mild small vessel ischemic changes. The ventricles and sulci are prominent, consistent with mild age-related 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. Left maxillary sinus mucous retention cyst or polyp is seen.", "output": "1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Findings compatible with mild chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "History of trauma MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Generalized thinning of the hyaline cartilage without focal defect.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Small amount of joint effusion. Otherwise exam is within normal limits."}
{"instruction": "Generate impression based on findings.", "input": " There is slight straightening of the upper cervical spine which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: Mild bilateral uncinate hypertrophy without stenosis.C5/6: Mild posterior osteophyte disc complex without stenosis.C6/7: UnremarkableC7/T1: Unremarkable", "output": "Negative noncontrast cervical spine MRI. Specifically, there are no MRI findings to explain the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Developmental delay. Possible seizure. Brain parenchyma appears within normal limits for age. No intracranial mass or mass-effect. No findings to suggest cortical dysplasia, heterotopic gray matter, or other findings to suggest seizure focus. Myelination appears within normal limits. There is an apparent focus of T1 hyperintensity in the left parietal cortex seen on the 3-D T1 sequences, axial series 1003 image 33/70 which is not seen on the spin echo T1 sequence and most likely artifactual. Midline structures including the corpus callosum as well as the posterior fossa structures appear within normal limits. No hydrocephalus. No extra-axial collections. Bone marrow signal is normal. There is mild mucosal thickening involving the bilateral maxillary sinuses and patchy opacification of the bilateral ethmoid air cells. Mastoid air cells are clear. Extracranial soft tissues are unremarkable.", "output": "Brain MRI appears within normal limits. No findings to suggest a possible epileptogenic focus are appreciated."}
{"instruction": "Generate impression based on findings.", "input": " MRI Brain:A moderately sized area of somewhat patchy restricted diffusion is seen within the right occipital lobe correlating with the CT abnormality. Minimal susceptibility effect is seen in this area which could indicate petechial blood product. No frank hematoma is seen. One or two small foci of restricted diffusion are also suspected within the left occipital lobe. Mild local edema seen, but there is no significant generalized mass effect effect, midline shift or herniation. Minimal periventricular T2 hyperintensity is seen. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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.MRA Brain: The intracranial left vertebral artery is small and poorly visualized whereas on the prior MRA it was well-demonstrated. A possible mild narrowing of the mid basilar artery is seen, but this is unchanged. A moderate focal stenosis of the left distal P2 PCA is unchanged. Otherwise, no obvious anterior or posterior circulation deficits are seen. Redemonstrated is a 3 x 4 mm right MCA bifurcation aneurysm without significant change from the previous exam. A 2 mm aneurysm arising from the left A2 segment of the ACA is unchanged as well. MRA Neck: Descending aortic dissection is partially visualized on this examination. There is common origin of the brachiocephalic and left common carotid arteries. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is a smaller left and dominant right vertebral artery. There is no evidence of stenosis or occlusion.", "output": "1.Findings compatible with acute infarction involving the right greater than left posterior occipital regions.2.Moderate focal stenosis of the left P2 PCA, unchanged. Possible mild narrowing of the mid basilar artery, unchanged.3.Poor visualization of the intracranial left vertebral artery is new from the prior MRA and could represent a technical artifact or superimposed atherosclerotic disease.4.Aneurysms at the right MCA bifurcation and along the left A3 ACA are unchanged. No definite evidence of any new aneurysm is seen.5.A descending aortic dissection is partially visualized."}
{"instruction": "Generate impression based on findings.", "input": " Images are somewhat limited by patient motion. The thoracic spine is in normal alignment, with slight straightening of the normal lower thoracic kyphosis. The vertebral body heights are well-maintained. There is multilevel disc narrowing, up to moderate severe in degree at T5-T6 and T3-T4. No worrisome focal marrow signal abnormality is appreciated. Heterogeneous hyperintense T2 and isointense T1 signal is seen in a rounded configuration along the posterior L1 vertebral body extending into the right pedicle, most compatible with a hemangioma. A smaller hemangioma is seen in the posterior superior T10 vertebral body. The spinal cord is of normal caliber and signal.Mild disc bulges are seen from T2-T3 through T5-T6. There is up to moderate foraminal narrowing at these levels. There is mild to moderate central spinal canal stenosis at T5-T6.At T6-T7, there is a left foraminal disc protrusion with left facet arthropathy resulting in moderate-severe left foraminal narrowing.At T7-T8, there is a left paracentral disc extrusion which migrates cranially by approximately 6 mm. There is minimal central spinal canal stenosis.At T8-T9, there is a left paracentral/foraminal disc protrusion which indents the ventral thecal sac with moderate-severe left foraminal narrowing.At T9-T10, there is a right paracentral disc protrusion which indents the ventral thecal sac with mild central spinal canal stenosis.T10-T11, there is a mild disc bulge mild central spinal canal stenosis. There is mild bilateral facet arthropathy and ligamentum flavum thickening resulting in moderate-severe right and left and mild to moderate right foraminal narrowing.At T11-T12, there is a mild diffuse disc bulge with overall moderate central spinal canal stenosis. There is moderate bilateral facet arthropathy and ligamentum flavum thickening resulting in moderate-severe right and severe left foraminal narrowing.At T12-L1, there is a trace disc bulge with right foraminal prominence and mild bilateral facet arthropathy. There is overall moderate central spinal canal stenosis as well as moderate right greater than left foraminal narrowing.The counting image demonstrates interval progression of previously seen cervical multilevel spondylosis along the mid to lower cervical spine, with now a large posterior osteophyte disc complex at C4-C5, with at least moderate-severe central spinal canal stenosis at that level.There is a nonspecific oval T2 hyperintense lesion within the right kidney.", "output": "1. Multilevel thoracic spondylosis with up to moderate central spinal canal stenosis at T11-T12, as well as multiple levels of high-grade foraminal narrowing as detailed above.2. Significant cervical spondylosis partially imaged, now most significant at C4-C5 where there is likely moderate severe central spinal canal stenosis. Dedicated MRI of the cervical spine may be obtained as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "57 years Male (DOB:2/5/1959)Signs and Symptoms: left lateral neck pain and radiating left arm painPROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal. There is left-sided facet hypertrophy present associated with encroachment of left-sided exiting nerve roots within the neural foramen. There is disc desiccation present at this level. This has not changed significantly since the prior exam.At C3-4 there is a right paramedian disc protrusion present associated with uncovertebral osteophytes and narrowing of the right neural foramen. There is some effacement of spinal fluid ventral to the right hemicord at this. There is disc desiccation present at this level. This has not changed significantly since the prior exam.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation present at this level. There is a broad-based central disc protrusion at this level. This has not changed significantly since the prior exam.At C5-6 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with uncovertebral and endplate osteophytes. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level there is partial effacement of spinal fluid ventral to the spinal cord with a mild degree of spinal stenosis at this level. This has not changed significantly since the prior exam.At C6-7 there is no significant compromise to the spinal canal. There is disc desiccation and a broad-based left paramedian disc protrusion at this level associated with mild encroachment of left-sided exiting nerve roots within the neural foramen. This has not changed significantly since the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.", "output": "There are multilevel degenerative changes present in the cervical spine associated with a mild degree of spinal stenosis at C5-6 and encroachment of exiting nerve roots within the neural foramina at C5-6 bilaterally, the left side at C2-3 and C6-7 and the left side at C3-4. These findings have not changed significantly since the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Newly diagnosed small cell lung cancer. Initial CNS staging. Signs and symptoms: No CNS symptoms. Pre-and post-enhanced brain MRI:Examination demonstrate multiple small nonhemorrhagic enhancing metastatic lesions in the supra-and infratentorial brain parenchyma.There is a left posterior frontal metastatic lesion measuring at approximately 11 mm sized with minimal associated surrounding edema and no mass effect (post-enhanced SPGR series 13 image 147).There is a small 7.9-mm metastatic lesion in the left anterior temporal lobe on series 13 image 66.There is a left posterior temporal -- occipital metastatic lesion measuring approximately 6 mm on series 13 image 51.There is a right cerebellar metastatic lesion measuring at 4.9-mm on series 13 image 36.There is a 7.7-mm metastatic lesion in the inferior left cerebellum on series 13 image 26.There are a few nonspecific small foci of flair hyperintensity in the subcortical and periventricular white matter which could represent mild chronic small vessel ischemic strokes.Ventricular system and the CSF spaces are within normal and with maintained midline.Unremarkable images through the orbits.Mild diffuse chronic sinusitis more severe in the right chamber of the sphenoid and bilateral maxillary sinuses (left greater than right).No convincing evidence of calvarial metastatic lesions.", "output": "1.Multiple small supra-and infratentorial parenchymal metastatic lesions as detailed/measured above. The lesions demonstrate minimal surrounding edema and no mass effect. No convincing evidence of osseous metastatic lesions.2.Negative diffusion weighted images and findings suggestive of very minimal chronic small vessel ischemic strokes.3.Mild diffuse chronic sinusitis more severe in the right chamber of the sphenoid sinus and the maxillary sinuses (left greater than right)."}
{"instruction": "Generate impression based on findings.", "input": "T4N0 adenoid cystic carcinoma of minor salivary gland/maxillary sinus with intracranial extension. There has been interval partial left maxillectomy. Thre is diffuse mild left maxillary sinus mucosal thickening, with persistent patchy enhancement in the underlying left maxillary alveolus and retromaxillary region. There is also persistent perineural tumor extension involving the left infraorbital nerve, pterygopalatine fossa, Vidian canal, foramen rotundum, foramen ovale, and cavernous sinus, as well as along the cisternal segment of the left trigeminal nerve, but no evidence of intraparenchymal extension. There is also persistent enhancing tumor within the medial left extraconal orbit, which measures up to 6 mm in width. There is no discernible residual right pituitary tumor. 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. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable.", "output": "1. Interval post-treatment findings in the left sinonasal region with persistent perineural tumor involving the left trigeminal nerve branches with intracranial extension, as well as persistent patchy enhancement in the underlying left maxillary alveolus and retromaxillary region. 2. Persistent left medial orbit extraconal tumor.3. No evidence of brain parenchymal metastases."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old male with history of left hepatic lobe lesion seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with reticular T2 hyperintense pattern compatible with fibrosis. Enlarged portal vasculature compatible with portal hypertension. Quadrate lobe lesion measuring 14.0 x 13.0 cm does not demonstrate arterial enhancement. On delayed imaging there is equivocal signal loss.Focus of hyperenhancement in segment 6 is favored to be perfusional in etiology.SPLEEN: Marked splenomegaly measuring up to 27 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive upper abdominal periaortic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Gastric varices.", "output": "1.Cirrhotic liver morphology with findings of portal hypertension and variceal formation.2.Nonenhancing quadrate lobe lesion with equivocal signal loss on delayed imaging is indeterminant. Continued close followup is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Patient with history of vasectomy, evaluate MRI compatibility of the testicular clips. The scrotum and the testicles are not included on the field of view of this study. However, on the inferior edge of the image, there is a metallic density that corresponds to the metallic clips seen on recent CT from 10/6/2015. As a general rule, such clips are safe in the standard MRI environment.", "output": "Although the vasectomy clips are not included on the field of view of the current study, as a general rule such clips are safe for MRI."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with left shoulder pain. ROTATOR CUFF: There is a full-thickness tear of the posterior fibers of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring 11 mm in AP dimension. There is near full-thickness articular surface tearing of the anterior fibers of the infraspinatus at the level of its insertion on the greater tuberosity measuring approximately 15 mm in AP dimension. There is partial thickness undersurface tearing of the subscapularis tendon at the level of its insertion on the lesser tuberosity without significant retraction. Teres minor tendon appears intact. There is diffuse fatty atrophy of the teres minor muscle. No mass lesions are identified within the quadrilateral space. There is minimal fatty infiltration at the level of the myotendinous junction of the infraspinatus.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint with inferior osteophyte formation resulting in impression upon the superior fibers of the supraspinatus.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is increased signal abnormality and heterogeneity of the superior and superior posterior glenoid labrum indicating degenerative tearing with extension into the biceps anchor.BICEPS TENDON: There is a longitudinal split tearing of the intra and extra articular portion of the long head of the biceps.ADDITIONAL", "output": "1. Full-thickness tearing of the rotator cuff as described above.2. Degenerative tearing of the glenoid labrum with extension into the biceps anchor.3. Longitudinal split tear of the long head of the biceps tendon.4. Degenerative osteoarthritic changes of the glenohumeral joint and acromioclavicular joint."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for interval change. Signs and symptoms: Status post removal of calvarial implant with resection of recurrent tumor. Nonenhanced head CT:Examination demonstrates a large left temporal and parietal craniectomy.The parietal bone posterior to the craniectomy site demonstrates extensive lytic changes which traverses the midline to the right paramedian. This is a new finding since prior exam and is best appreciated on axial images 27 through 30. Finding is concerning for osteomyelitis. Fluoroscopy and an enhanced MRI exam is recommended.There is a surgical drain traversing the craniectomy site.There is no evidence of intracranial hemorrhage.There is a focus of encephalomalacia in the left posterior temporal similar to prior study.There is diffuse decreased density of left posterior frontal parietal white matter similar to prior study. This is believed to represent either residual in the normal and or partial encephalomalacia considering the duration of presence of this finding. There is slight ex vacuo dilatation of the left lateral ventricle and without evidence of midline shift. Follow up with an enhanced study is limited for better overall assessment.", "output": "1.There is interval surgical removal of a large craniotomy flap in the left temporal -- parietal and frontal as described.2.Negative changes of the posterior edge of craniectomy site is a new finding since prior exam.3.Extensive residual vasogenic edema and or combination of edema and encephalomalacia in the left hemisphere.4.No evidence of intracranial hemorrhage or midline shift."}
{"instruction": "Generate impression based on findings.", "input": " MRI of the brain is within normal limits. No intracranial mass or mass effect. The ventricles and sulci are within normal limits. There is no diffusion abnormality to suspect acute stroke. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Small left maxillary sinus mucus retention cyst.", "output": "No intracranial mass or mass effect. Brain parenchymal volume appears within normal limits. No findings to suggest significant vascular disease."}
{"instruction": "Generate impression based on findings.", "input": "History of questionable Crohn's disease presenting with chronic abdominal pain mainly in the left upper quadrant. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Nonspecific borderline splenomegaly without a focal lesion.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: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained.The terminal ileum is well visualized and demonstrates normal wall thickness and signal intensity without abnormal enhancement, restricted diffusion, or perienteric inflammatory changes. The remainder of the small bowel is similarly unremarkable.No fixed narrowing or upstream/prestenotic dilatation to suggest a flow-limiting stricture.No evidence of sinus or fistulous tract formation.Trace free pelvic fluid is within physiologic limits.No loculated fluid collection.The colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained.The terminal ileum is well visualized and demonstrates normal wall thickness and signal intensity without abnormal enhancement, restricted diffusion, or perienteric inflammatory changes. The remainder of the small bowel is similarly unremarkable.No fixed narrowing or upstream/prestenotic dilatation to suggest a flow-limiting stricture.No evidence of sinus or fistulous tract formation.Trace free pelvic fluid is within physiologic limits.No loculated fluid collection.The colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence of active bowel inflammation, flow-limiting stricture or sinus/fistulous disease; normal appearing terminal ileum.Nonspecific borderline splenomegaly without a focal lesion."}
{"instruction": "Generate impression based on findings.", "input": "Female 30 years old Reason: Evaluate for disc herniation History: Right lower extremity pain, previous thoracolumbar fusion for adolescent scoliosis There is moderate levoscoliosis of the lumbar spine with a rotational component. Thoracic dextroscoliosis is better seen in prior radiograph. Five lumbar type vertebral bodies are presumed to be present. The right side of the L2-3 disc space is diminished, otherwise the vertebral body and disk heights are well-maintained. There is evidence of prior osseous fusion involving the lower thoracic spine extending to the L4 level, which can be better assessed on CT. No focal marrow signal abnormality is appreciated. The conus medullaris is normal in appearance and terminates at the L1-2 level. The cauda equina nerve roots are displaced rightward likely related to the spinal curvature.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: Mild disc bulge. There is mild right neural foraminal narrowing. There is no significant compromise to spinal canal.L5-S1: There is no significant compromise to spinal canal or neural foramina.", "output": "Levoscoliosis of the lumbar spine. Mild right neural foraminal narrowing at L4-5. Spinal canal and neural foramina are otherwise patent."}
{"instruction": "Generate impression based on findings.", "input": "Perianal fistula. PELVIS:PROSTATE/SEMINAL VESICLES: Wedge-shaped T2-weighted mild hypointensity in the left medial mid-gland peripheral zone, likely prostatitis in a patient of this age. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thin fluid filled enhancing and restricting fistula tract appears to originate at the right anterolateral aspect of the lower anal canal extending caudally in the intersphincteric space to the right gluteal fold without an associated fluid collection. There is mild adjacent ischioanal phlegmonous inflammation without a liquified drainable fluid collection. OTHER: No significant abnormality noted.", "output": "Right-sided intersphincteric fistula extending to the right gluteal fold without an associated fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "Female 42 years old with left knee and ankle pain Knee: There are tiny osteophytes and there is a slight lateral tilt of the patella but otherwise the knee appears normal.Ankle: There is a mild Haglund deformity and small posterior and plantar calcaneal spurs appearing similar to the prior study.", "output": "1.Mild Haglund deformity and small calcaneal spurs perhaps of no clinical significance. We otherwise see no findings to explain the patient's ankle pain.2.Small osteophytes in the knee and mild lateral tilt of the patella."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Right temp lobe cystic lesion. Eval for change History: none- surveillance There is been no significant interval change in the appearance of a nonenhancing oval CSF signal intensity cystic lesion involving the mesial right temporal lobe, just superior to the hippocampus. It currently measures 8 x 17 mm in greatest axial dimensions on 801/14, x 6 mm CC on 701/15, compared to previous comparable measurements of 8 x 16 x 6 mm on the baseline exam. There is again a minimal rim of T2/FLAIR hyperintensity, predominantly anteriorly.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is a stable punctate focus of nonspecific T2/FLAIR hyperintensity in the left superior frontal gyrus white matter posteriorly. There are no new areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening in the left maxillary sinus.", "output": "Continued stable appearance of nonenhancing cystic lesion in the mesial right temporal lobe, just superior to the hippocampus with minimal marginal FLAIR abnormality. The differential diagnosis is unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Traumatic brain injury, evaluate pituitary. Brain: There are numerous scattered foci of high T1 signal and susceptibility effect within the right inferior frontal, left basal ganglia, and left frontal, temporal, and insular lobes with associated vasogenic edema, as well as small areas of restricted diffusion in the left insular and basal ganglia. There is also edema in the left posterior corpus callosum, hypothalamus, left more than right, left thalamus, posterior limb of the right internal capsule, and midbrain. There are also scattered foci of susceptibility effect in the midbrain, pons, and right basal ganglia. There are small subdural hematomas along the bilateral cerebral convexities, measuring up to 3 mm in thickness. There is no midline shift or herniation. There is mild effacement of the left lateral ventricle. There is a mega cisterna magna. The major cerebral flow voids are intact. Mucosal thickening of the right maxillary sinus is noted. The orbits are grossly unremarkable. The multiple skull fractures are better depicted on the prior CT. There is a 10 mm thick left scalp hematoma and bilateral tympanomastoid fluid, with T1 hyperintense components suggestive of blood products.Pituitary: The pituitary gland is not enlarged and demonstrates an intact posterior bright spot and enhancement. The infundibulum also appears to be intact.", "output": "1. Interval evolution of stigmata related to supratentorial and infratentorial diffuse axonal injury and hemorrhagic contusion with mild medialization of the left uncus. 2. Interval evolution of the small bilateral cerebral convexity subdural hemorrhages.3. Multiple skull fractures are better delineated on the prior CT.4. Edema related to traumatic brain injury is present within the hypothalamus, but the pituitary and infundibulum appear to be intact.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " Alignment is anatomic. There are no subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. There is trace prominence of the cervical central spinal canal from C2/C3 to C5/C6. There is no significant scoliosis, however, the distal cervical cord is eccentrically positioned within the spinal canal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is mucosal thickening of the visualized paranasal sinuses. C2/3: No significant canal or neural foraminal stenosis.C3/4: No significant canal stenosis. There is mild left uncovertebral and facet hypertrophy with mild left neuroforaminal stenosis.C4/5: No significant canal stenosis. Minimal left uncovertebral hypertrophy without neural foraminal stenosis. C5/6: No significant canal stenosis. Minimal left uncovertebral hypertrophy without neural foraminal stenosis.C6/7: No significant canal or neuroforaminal stenosis.C7/T1: No significant canal or neuroforaminal stenosis.", "output": "1. Minimal cervical spondylosis with mild left neuroforaminal stenosis at C3/C4.2. Trace prominence of the central spinal canal from C2/C3 to C5/C6 which is non-specific."}
{"instruction": "Generate impression based on findings.", "input": "49 year old male patient with history of renal cell carcinoma status post partial nephrectomy. Evaluate for renal recurrence or distant metastasis. ABDOMEN:LIVER, BILIARY TRACT: A subcentimeter lesion within the right hepatic lobe is too small to characterize, but unchanged. No suspicious hepatic lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes of partial right nephrectomy within the right upper pole. No evidence of residual tumor in the surgical bed. No suspicious renal lesion is identified bilaterally.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": "Status post right partial nephrectomy without evidence of residual/recurrent disease or metastatic disease in the abdomen."}
{"instruction": "Generate impression based on findings.", "input": " Brain MRI:There is small focus of restricted diffusion with matching ADC hypointensity within the left thalamus consistent with an acute lacunar infarct.There are foci of T2 hyperintensity within periventricular and subcortical white matter as well as within the pons without restricted diffusion, mass effect, or susceptibility abnormality.The ventricles and sulci are normal in size. 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. There are no extraaxial fluid collections or subdural hematomas. Other than scattered sporadic foci of mucosal thickening, the paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. A previously identified potential focus of hyperdensity within the left MCA on comparison CT demonstrates MRA evident flow. Incidental note is made of bilateral posterior communicating artery origin infundibuli.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified.", "output": "1.Acute left thalamic lacunar infarct.2.Chronic small vessel ischemic disease.3.Negative MRA of the brain.4.Negative MRA of the neck."}
{"instruction": "Generate impression based on findings.", "input": " There is an intramedullary abnormality within the cervical cord at the level of C6/7. It is slightly expansile, T1 hypointense, T2 hyperintense, measuring 5 mm transverse x 4 mm AP x 11 mm craniocaudal dimension.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no significant degenerative changes and there are no stenoses.", "output": "There is an intramedullary abnormality within the cervical cord at the level of C6/7. It is slightly expansile, T1 hypointense, T2 hyperintense, measuring 5 mm transverse x 4 mm AP x 11 mm craniocaudal dimension. Given this constellation of features, this most likely represents a small syrinx, and other T2 hyperintense etiologies such as inflammatory or neoplastic processes are felt to be less likely. However, contrast enhancement is recommended to further characterize the lesion."}
{"instruction": "Generate impression based on findings.", "input": "Cervicalgia [723.1] / Cervical spondylosis without myelopathy [721.0] / Brachial neuritis or radiculitis NOS [723.4], Reason for Study: ^Reason: History of neck, pain failed conservative treatment History: diffuse spondylosis, neck pain, radiculopathy. C-Spine:The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. There are minimal bulging of discs at the level of C45, 56 and 67 without evidence of spinal canal stenosis or neuroforaminal stenosis.T-Spine:There is normal thoracic kyphosis.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. T45 disc shows focal central protrusion which abuts thecal sac.No neuroforaminal stenosis is seen.L-Spine:There is normal lumbar lordosis.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L1-L2: There is central to left broad-based disc protrusion which abuts thecal sac, however, no neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation. There is a broad-based disc bulging with a focal disc protrusion central to right which narrows right side lateral recess. Degenerative changes of bilateral facet joints. No evidence of spinal stenosis. L3-L4: Diffuse bulging of disc with disc desiccation. Facet joint fluid collections indicating facet arthritis with ligamentum flavum thickening. No neuroforaminal narrowing or spinal stenosis. L4-L5: Diffuse bulging of disc with bilateral ligamentum flavum thickening causing minimal spinal canal stenosis. Associated bilateral facet arthritis were seen. No neuroforaminal narrowing. L5-S1: Disc desiccation with minimal bulging of disc. No neuroforaminal narrowing or spinal stenosis.", "output": "1. No evidence of spinal cord signal abnormality.2. Minimal bulging of cervical spine discs from C45 to C67 without evidence of spinal canal stenosis or neuroforaminal stenosis.3. Focal disc protrusion at the level of T45.4. Multiple degenerative disc disease of lumbar spine as described above."}
{"instruction": "Generate impression based on findings.", "input": "History of NSCLC and brain mets status post crani and SRS to left posterior lesion in November 2014. Surveillance. Compared to 2/17/2015, there is no significant change in 6 x 8 x 10 mm peripherally enhancing lesion within the left occipital lobe which has been previously radiated. There is surrounding FLAIR hyperintensity which represent edema and/or gliosis and remains unchanged.Again seen are postoperative findings related to right frontoparietal craniectomy and cranioplasty with unchanged confluent T2/flair hyperintensity in the right frontal lobe. Small amount of chronic blood products. Multiple additional areas of T2/flair hyperintensity in the periventricular and subcortical white matter including the left basal ganglia are also unchanged. No new intracranial mass or mass-effect. No midline shift or herniation. No new enhancing lesions to suggest disease progression. No hydrocephalus. Enhancing lesion involving the right squamosal temporal bone does not appear significantly changed. No new calvarial metastases are appreciated. Interval improvement in mucosal thickening involving the left maxillary sinus.", "output": "1. No new lesions or new mass-effect to suggest disease progression. Compared to 2/17/2015, no significant change in 6x8x10 -mm peripherally enhancing left occipital lesion which has been radiated. Continued follow-up of this lesion is suggested.2. No significant change in enhancing right temporal osseous metastases.3. Postsurgical changes in the right frontal lobe without local disease recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Low back pain and radiation of pain down the right lower extremity. There is disc dessication with loss of height and slight disc bulging at L5-S1, as well as ligamentum flavum thickening and facet hypertrophy with trace joint effusions, which result in mild bilateral neural foraminal narrowing. There is also facet and ligamentum flavum hypertrophy at L4-5, with mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. Otherwise, there is no significant degenerative disease at T12 through L4. 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": "Degenerative spondylosis in the lower lumbar spine with mild neural foraminal narrowing bilaterally at L4-5 and L5-S1."}
{"instruction": "Generate impression based on findings.", "input": "Reason: ? Left pectoralis major tendon tear History: pain, weakness with adduction Multiple sequences are degraded by motion and pulsation artifact limiting evaluation of the pectoralis muscle and tendon. There is marked atrophy of the sternal and clavicular heads of the left pectoralis muscle. The pectoralis tendon can be followed to the anterior edge of the proximal biceps muscle at which point it appears discontinuous from what we suspect to be a pectoralis tendon fragment that is attached to the humerus, although it is difficult to define what is tendon and what may be scar tissue on this study. These findings are suggestive of a chronic tear of the distal pectoralis tendon with the distal end perhaps scarred down to the biceps muscle. We see no edema or hematoma within the muscle or peritendinous structures to indicate an acute injury. We suspect that there is mild osteoarthritis of the acromioclavicular joint.", "output": "Markedly limited study due to extensive artifact shows atrophy of the left pectoralis major muscle and what appears to be a tear of the distal tendon. The tendons can be followed to the anterior edge of the biceps at which point it appears discontinuous from a separate low signal intensity structure at the expected site of the insertion of the tendon on the humerus that may represent a tendon stump or scar tissue."}
{"instruction": "Generate impression based on findings.", "input": "Right knee pain Evaluation is suboptimal as a dedicated knee coil was unable to be used due to the size of the knee.MENISCI: There is abnormal morphology and signal intensity of the posterior horn of the medial meniscus indicating a complex tear with possible partial root avulsion. There is attenuation of the body of the medial meniscus which is also slightly extruded medially. The anterior horn of the medial meniscus is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is partial-thickness degeneration of the articular cartilage of the medial femoral condyle just above and anterior to the torn posterior horn of the medial meniscus. There is thinning of the articular cartilage of the medial tibial plateau especially posteriorly. The lateral compartment cartilage is relatively intact. The patellofemoral compartment demonstrates near full-thickness degeneration of the articular cartilage of the femoral trochlea centrally and along the medial facet and partial degeneration of the articular cartilage of the medial patellar facet. Tricompartmental osteophytes are present and the underlying marrow signal is normal.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted. There is nonspecific subcutaneous edema anterior to the patella which may be clinically insignificant.ADDITIONAL", "output": "1. Complex tear of the posterior horn of the medial meniscus.2. Osteoarthritis and cartilage loss of the knee, further described above.3. Small to moderate joint effusion with additional findings detailed above."}
{"instruction": "Generate impression based on findings.", "input": "History of esophageal cancer, status post resection and C3 to C6 anterior-posterior spinal fusion, now with severe neck pain, and likely C6-C7 instability. Again seen are postsurgical changes of partial C4 and C5 corpectomy, placement of cage, and anterior fusion from C3 to C6 with anterior plate and screws. Posterior fusion hardware also seen from from C3 to C6 including posterior rods, screws, and bone graft. Compared to 12/17/2014, there is interval development of lucencies involving the inferior aspect of the C6 vertebral body and the superior aspect of the C7 vertebral body better seen on CT from the same day. The C6 screws are no longer embedded within solid bone. There is loss of the C6-C7 intervertebral disk space with foci of air. There is mild widening of the bilateral C6-C7 facet joints. No significant hardware displacement is appreciated. Mild 4-5 retrolisthesis is similar to prior and better seen on CT.Marrow signal changes involving the residual C4 and C5 vertebral bodies again seen and correspond to sclerosis seen on prior CTs. No prior postoperative MRI is available, however there is diffuse T1 hypointensity and T2 hyperintense marrow signal abnormality involving the C7 vertebral body extending into the pedicle. There is suggestion of T2 hyperintensity in the inferior C6 vertebral body and C6-7 disc space although not well seen due to susceptibility artifact and loss of height. Susceptibly artifact slightly limits evaluation. There is mild to moderate bilateral right worse than left neural foraminal narrowing at C6-C7 and on the right at C5-6 and C4-5. There is mild spinal canal narrowing from C3 to C6 with effacement of the ventral and dorsal thecal sac related to disc material. C6-7 spinal canal narrowing is worse since MRI from 10/14/2014. No cord signal abnormality is appreciated.", "output": "1. There are postoperative changes in the cervical spine including C4-5 corpectomy, C3-6 anterior fusion and C3-6 posterior fusion. Compared to CT from 12/17/2014, interval collapse of the C6-7 disc space and lytic changes involving the inferior C6 and superior C7 vertebral bodies noted with some loss of height, worse at C6 than C7; these findings are better appreciated on CT. There are new foci of air and within the C6-7 disc space and widening of the C6-7 facet joints consistent with instability at this level. The inferior C6 screws are no longer surrounded by solid bone. These findings are also better appreciated on the CT.2. There is new, diffuse edema involving the C7 vertebral body and the suboptimally visualized inferior C6 vertebral body and C6-C7 disk space, which while may be on a mechanical basis/instability at C6-7 with associated osseous erosive changes, raises possibility of new infection at the C6-C7 level.3. Mild spinal canal stenosis from C3 to C6 with effacement of the ventral greater than dorsal thecal sac related to disc-osteophyte complexes and postoperative changes. C6-7 spinal canal narrowing is worse since preoperative MRI from 10/14/2014. Contrast sequences may be helpful to better evaluation for infection and epidural extension if there is clinical suspicion. No cord signal abnormality."}
{"instruction": "Generate impression based on findings.", "input": "49 years, Female, metastatic lung cancer, status post SRS, assess for recurrent/progressive disease. Again seen are postsurgical changes of frontal craniotomy for resection of right superior frontal gyrus mass. There is a small focus of enhancement along the medial surface of the right frontal gyrus abutting the falx measuring approximately 6 x 7 x 7 mm and appears more nodular in the interval (best appreciated on coronal series 1201 image 136). There has been further collapse of the underlying resection cavity. There are chronic blood products in this region. Mild T2/ FLAIR hyperintensity in the right superior frontal gyrus is also not significant changed and may represent residual edema and/or gliosis.Remainder of the brain parenchyma is unremarkable for age. No new metastatic foci. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There is interval development of moderate mucosal thickening involving the bilateral maxillary sinuses with small fluid levels, which may reflect acute sinusitis. There is also mild ethmoid and sphenoid sinus opacification.There is diffuse low T1 marrow signal which is nonspecific without discrete destructive osseous lesions.", "output": "1. Continued evolution of posttreatment changes of radiation and prior resection of right superior frontal gyrus mass. There is interval increase in nodular enhancement along the medial surface of the right superior frontal gyrus which may represent posttreatment change. Recurrent metastasis seems less likely but would recommend a close follow-up exam to better exclude this possibility. 2. No new foci of metastasis elsewhere in the brain."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: lower back pain with RLE radiculopathy Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a moderate degree of bilateral facet hypertrophy at this level-right worse than left.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge present at this level. There is bilateral facet and ligamentum flavum hypertrophy - right worse than left. There is effacement of the fat at the lateral recess is bilaterally right worse than left which is a result of both disc bulge and facet hypertrophy. There is moderate encroachment of the nerve root at the right lateral recess and mild encroachment of the nerve root at the left lateral recess at this level. The exiting nerve roots within the neural foramina are surrounded by fat at this level. There is a Schmorl's node present which is eccentric towards the right side. There are some endplate reactive changes at this level with the minimal signal hyperintensity on the T2 STIR images. There is a right far lateral disc protrusion at this level which mildly abuts the right-sided exiting nerve root as it exits the neural foramen. Overall there is mild to moderate spinal stenosis at this level. Comparison with the prior CT of the abdomen from 1/4/2013 does not indicate any obvious change, although subtle change may be overlooked due to differences in modality.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge present at this level. There is partial effacement of the fat at the lateral recesses bilaterally at this level and some mild strangulation of the thecal sac. There is ligamentum flavum hypertrophy present. The exiting nerve roots within the neural foramina are surrounded by fat at this level. There is a left far lateral disc protrusion at this level which abuts the left-sided exiting nerve root after it exits the neural foramen at this level. Overall there is mild spinal stenosis at this level. Comparison with the prior CT of the abdomen from 1/4/2013 does not indicate any obvious change, although subtle change may be overlooked due to differences in modality.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.There is moderate encroachment of the nerve root at the right lateral recess and mild encroachment of the nerve root at the left lateral recess at L4-5 related to facet hypertrophy and disk bulge. Please correlate with patient's clinical symptoms and dermatome distribution of pain as this would affect potentially the L5 nerve roots.2.There is mild encroachment of the nerve roots at the lateral recesses at L3-4 related to combination of disc bulge and ligamentum flavum hypertrophy.3.There are far lateral disc protrusions on the right side at L4-5 and on the left side at L3-4 which abut the exiting nerve roots after they exit the neural foramina. This appears slightly worse at the L3-4 level."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female presents with low back pain. Thoracolumbar spine: The bones appear demineralized suggestive of osteopenia/osteoporosis. There are multiple compression fractures of varying severity throughout the thoracic and lumbar spine. Multilevel degenerative disc disease throughout the thoracic and lumbar spine is also noted. There is facet joint osteoarthritis of the lumbar spine.There may be slight retropulsion of a couple of the lower thoracic vertebra. Please refer to accompanying MRI for further detailed characterization. The thoracic spine is kyphotic with otherwise no gross malalignment. No frank instability of the lumbar spine between flexion and extension views. Aortic calcifications are noted.", "output": "Multilevel compression fractures involving the thoracic and lumbar spine. No findings to suggest lumbar spine instability. Please refer to accompanying MRI for further detailed characterization."}
{"instruction": "Generate impression based on findings.", "input": " MRI BRAIN: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Fluid is incidentally noted in an aerated right petrous apex. The midline structures and craniocervical junction are within normal limits.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.", "output": "1. No evidence of acute infarct.2. No evidence of flow-limiting stenosis or aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "History of right-sided gaze deviation of unresponsiveness following right hemicolectomy. Previous lacunar strokes with left-sided weakness. There is extensive patchy and confluent high T2 signal in the periventricular and subcortical cortical white matter, which has progressed since 2007. Multiple chronic lacunar infarcts are redemonstrated, especially in the left basal ganglia, right external capsule, right cerebellar hemisphere, and pons. There are also numerous scattered foci of susceptibility effect. A slightly larger focus of susceptibility artifact is redemonstrated in the left thalamus. There is no evidence of mass or acute infarct. There is no abnormal intracranial enhancement. 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. There are bilateral lens replacements. There is a right maxillary sinus probable mucocele that mildly expands the right infundibulum, similar to the CT from 1/12/2014. There is a small left maxillary sinus retention cyst. The skull and scalp soft tissues are grossly unremarkable.", "output": "1. No evidence of acute infarct or intracranial mass.2. Findings compatible with chronic small vessel ischemic disease and multiple lacunar infarcts, which have progressed since 2007. 3. Scattered foci of susceptibility artifact are compatible with nonspecific chronic microhemorrhages. A slightly larger focus in the left thalamus also likely relates to a remote hemorrhage, as it was apparent on the MRI from 2007.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 64M with osteoporosis secondary to tertiary parathyroidism, evaluate for parathyroid hyperplasia, evaluate thyroid gland. History: osteoporosis. There is an 8 mm minimally enhancing nodule (7/29) posterior to the left inferior thyroid gland which may represent a parathyroid adenoma or enlarged lymph node. The thyroid gland is otherwise normal appearing. No additional mass or lymphadenopathy is seen throughout the neck. The remaining major salivary glands are unremarkable. The major cervical vessels are patent. The airways are patent. The imaged intracranial structures show prominent ventricles and sulci, suggesting mild atrophy. Periventricular and subcortical T2 hyperintensities may reflect mild small vessel ischemic disease but are partially visualized. The imaged portions of the lungs are clear. Mild degenerative changes of the visualized spine. Mild mucosal thickening of the right maxillary sinus.", "output": "Nodule posterior to the left inferior thyroid gland may represent a parathyroid adenoma or lymph node."}
{"instruction": "Generate impression based on findings.", "input": "A 78 year old male hospitalized because of osteomyelitis and right below knee amputation because, recent diagnosis of congestive heart failure with left ventricular ejection fraction of 36%, moderately reduced right ventricular function, severe aortic regurgitation, moderate tricuspid regurgitation and severe aortic root dilation. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%, the LV end diastolic volume index is 231 ml/m2 (normal range: 74+/-15), the LVEDV is 411 ml (normal range 142+/-34), the LV end systolic volume index is 166 ml/m2 (normal range 25+/-9), the LVESV is 296 ml (normal range 47+/-19), the LV mass index is 127 g/m2 (normal range 85+/-15), and the LV mass is 226 g (normal range 164+/-36). There is global severe hypokinesis with regional variation. Left AtriumThe left atrium is moderately dilated (142ml). Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 126 ml/m2 (normal range 82+/-16), the RVEDV is 224 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 140 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is severe aortic regurgitation (non-dedicated sequences)Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. In non-dedicated sequences, the aortic root is severely dilated and the ascending aorta is mildly dilated. The arch and descending thoracic aorta are normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (33mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral pleural effusion were seen: moderate on the right and mild on the left. 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. The left ventricle is severely dilated with severely reduced systolic function, the LVEF is 28%. There is global severe hypokinesis with regional variation. 2. The right ventricle is mildly dilated with moderately reduced systolic function, the RVEF is 37%. 3. There is moderate biatrial dilation. 4. There is severe aortic regurgitation.5. The aortic root is severely dilated and the ascending aorta is mildly dilated. The aortic arch and thoracic descending aorta are within normal limites. 6. The main pulmonary artery is mildly dilated (33mm).7. See extra-cardiac findings.8. Only non-contrast images were acquired due to patient inability to complete contrast portions of the study (i.e. there are no late gadolinium enhancement or MRA images acquired).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for gallstone in duct History: epigastric pain, N/V Examination mildly limited by motion.ABDOMEN:LIVER, BILIARY TRACT: The liver is mildly prominent in size measuring up to 22 cm in the craniocaudal dimension with an otherwise normal morphology. There is a mildly T2 hyperintense structure within hepatic segment 5 with reference measurements below which is nonspecific but lacks suspicious enhancement characteristics and which is most likely benign. There are a few additional scattered subcentimeter structures which are too small to characterize but likely represent cysts. The hepatic vasculature appears patent.The gallbladder demonstrates normal distention. Cholelithiasis. No gallbladder wall thickening or pericholecystic fluid. No intra or extrahepatic biliary ductal dilatation. No choledocholithiasis is identified.SPLEEN: There is diffuse mildly decreased parenchymal signal suggestive of hemosiderin deposition. Scattered areas of increased T2 signal and enhancement within the spleen are nonspecific but may reflect hemangiomas.PANCREAS: The pancreas demonstrates diffusely decreased T1 signal, restricted diffusion, and mildly heterogeneous enhancement without evidence of focal necrosis. Mild fat stranding surrounds the pancreatic tail without discrete fluid collection. The pancreatic duct is not dilated. The main pancreatic duct crosses the common bile duct anteriorly and terminates in the minor papilla consistent with pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole simple cyst. No hydronephrosis.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.INDEX LESION MEASUREMENTS (Current exam date/time: 9/20/2016 04:00:00)HEPATIC SEGMENT 5 LESION: 0.9 x 0.8 cm (Image 23, Series 6).", "output": "1.Findings compatible with pancreatitis without evidence of complication.2.Pancreas divisum.3.Cholelithiasis without evidence of cholecystitis or choledocholithiasis.4.Mild hepatomegaly. Hemosiderin deposition within the spleen which may be related to sickle cell disease."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with history of renal cancer, concern for hepatic metastases. ABDOMEN:LIVER, BILIARY TRACT: There is no definite enhancing hepatic mass lesion identified. The large right renal mass causes extrinsic mass effect on the right hepatic lobe with adjacent heterogeneous enhancement in this region immediately adjacent to renal mass. The noncontrast coronal images suggest that the renal mass remains encapsulated and merely abutting liver but direct invasion cannot be excluded. There is a 1 cm flash filling hemangioma in segment II. There is no biliary ductal dilatation. The gallbladder appears normal.SPLEEN: No significant abnormality noted.PANCREAS: There is normal signal intensity in the pelvis. No focal pancreas lesion is identified. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a large, heterogeneous, enhancing mass extending from the right upper pole kidney which measures 6.6 x 6.4 x 7.4 cm, compatible with known renal malignancy. There is enhancing thrombus in the proximal right renal vein, concerning for direct invasion (series 803, image 194). This does not extend to the inferior vena cava. Left kidney is normal.RETROPERITONEUM, LYMPH NODES: No thrombus is identified in the IVC. There is no significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No discrete osseous lesion is identified.OTHER: No significant abnormality noted.", "output": "1.No discrete intrahepatic mass is identified.2.Heterogeneous enhancement in the right hepatic lobe adjacent to extrinsic compression from large right renal mass --- favored to be compression effect alone, but direct invasion cannot be excluded.3.Large right renal mass with tumor thrombus in the right renal vein."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female with degenerative disc disease. There is moderate dextroscoliosis. There is compression deformity of L1 with approximately 80% loss of height, left side greater than right. There is no associated hyperintense STIR signal abnormality to suggest acute compression fracture. There is a Schmorl node in the superior L5 endplate. There appear to be remote postoperative findings in the lower lumbar spine. There is extensive multilevel degenerative spondylosis with disc space narrowing and dessication, as well as endplate signal alterations at multiple levels. In particular, there is compression of multiple nerve roots. At T12-L1, there is mild diffuse disc bulge and moderate facet hypertrophy with mild effacement of the ventral thecal sac, as well as mild right and moderate left neural foramen narrowing. At L1-2, there is a disc bulge and facet hypertrophy with mild central canal stenosis, as well as mild right and moderate to severe left neural foramen compromise. At L2-3, there is a disc bulge, moderate facet hypertrophy, and ligamentum flavum hypertrophy with moderate to severe spinal canal stenosis and moderate bilateral neural foramen compromise. At L3-4, there is minimal anterolisthesis of L3 on L4, and a disc bulge and facet hypertrophy with moderate central canal stenosis and at least moderate bilateral neural foramen compromise. Indeed, there is associated flattening of the exiting left L4 nerve root. At L4-5, there is grade 1 anterolisthesis and a diffuse disc bulge and facet hypertrophy with mild to moderate spinal canal stenosis and bilateral moderate to severe neural foramen narrowing. At L5-S1, there is a disc bulge with moderate to severe canal stenosis and moderate neural foramen compromise. The paraspinal muscles demonstrate fatty atrophy.", "output": "1.Severe compression deformity of L1 vertebral body without evidence of associated edema.2.Extensive multilevel degenerative spondylosis of the lumbar spine with compression of multiple nerve roots, as described in the findings sections.3.Moderate dextroscoliosis of the lumbar spine. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: hx of peritoneal meso, pls compare to previous and measure History: none ABDOMEN:LIVER, BILIARY TRACT: Right hepatic T2 hyperintensity is unchanged. Scattered hypoattenuating lesions within the liver are unchanged. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a septated right upper pole lesion, the cystic component of which measures 5.4 x 4.8 cm (10/26), previously 5.7 x 4.8 cm. There is increased T1 signal within the cyst, with new ill-defined extension into the retroperitoneum posteriorly, likely representing hemorrhage with rupture. There is no enhancement on subtraction images.Additional bilateral simple and hemorrhagic cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference peritoneal nodule adjacent to the lesser curvature measures 2.2 x 1.6 cm (12/143), previously 2.5 x 1.8 cm upon remeasurement on post contrast images (10/215).Nodule adjacent to the left hepatic lobe measures 3.1 x 2.2 cm (12/145), previously 3.3 x 2.3 cm upon remeasurement on postcontrast images (10/221)BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Reference peritoneal nodules are not significantly changed.2.Mildly complex right upper pole cyst now contains hemorrhage with partial rupture posteriorly. No enhancement is evident."}
{"instruction": "Generate impression based on findings.", "input": " Again seen is mild dilatation of the lateral and third ventricles which is stable to minimally worse in the interval. For example the third ventricle measures up to 12 mm in the transverse plane, previously 11 mm. There is mild interval increase in dilatation of the infundibular recess of the third ventricle. Obstruction at the cerebral aqueduct is again suspected and better appreciated on prior sagittal FIESTA sequence on examination from 1/31/2013. Cerebellar tonsils have a pointed configuration and extend caudally up to 6 mm below the foramen magnum and to a lesser degree on the right. Retroflexed dens also contributes to fairly mild crowding at the foramen magnum.No evidence of acute infarct or intracranial hemorrhage. No extra-axial collections. There is minimal periventricular T2/FLAIR hyperintensity similar to prior with minimal if any evidence of transependymal flow of CSF. Brain parenchyma appears otherwise unremarkable. There is no intracranial mass, midline shift, or herniation. No abnormal enhancement. Pituitary gland is grossly unremarkable.Flow voids are present within the major vessels indicating patency. Paranasal sinuses are grossly clear. Minimal opacification of the left-sided mastoid air cells is present.", "output": "1. Findings compatible with mild chronic hydrocephalus with likely obstruction at the level cerebral aqueduct, which is better appreciated on prior high-resolution 3-D T2 sequence. Findings are stable to minimally worse since 1/31/2013. There is minimal if any evidence of transependymal flow of CSF.2. Findings of mild Chiari I malformation with fairly mild crowding at the foramen magnum related to low cerebellar tonsils and retroflexed dens similar to prior."}
{"instruction": "Generate impression based on findings.", "input": "Shunt, back pain, worsening. 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 normal in position. There is irregularity involving the contour of the thecal sac at the L2-L3 level, the dorsal epidural fat, and in the interspinous soft tissue region which is likely postsurgical. No obvious nerve root clumping to suggest arachnoiditis.Individual levels 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: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.", "output": "1. No significant disc disease or spinal canal or neural foraminal stenosis at any level.2. Mild distortion of the epidural fat, contour of the thecal sac, and soft tissues at the L2-L3 level is compatible with postsurgical change."}
{"instruction": "Generate impression based on findings.", "input": "Multiple recurrent oral cancer s/p two major resections with free flap reconstruction and XRT with dermal metastasis with good response clinically. There are postoperative findings, including right hemiglossectomy and floor of mouth dissection with soft tissue flap reconstruction, mandibular reconstruction, and bilateral neck dissection. There is marked interval decrease in size of the enhancing mass along the posterolateral margin of the flap in the right oral cavity, with erosion of the adjacent mandible. Indeed, the tumor now measures up to approximately 15 mm, previously 45 mm. There is no evidence of significant lymphadenopathy or evidence of new mass lesions in the neck. There is a small amount of fluid signal in the right mastoid air cells. The imaged intracranial structures and orbits are unremarkable. There is partially imaged thoracic scoliosis.", "output": "Extensive post-treatment findings in the oral cavity region with marked interval decrease in size of the recurrent tumor along the posterior margin of the surgical flap with adjacent right mandible erosion."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate right frontal lobe encephalomalacia, history of lung cancer. There is an unchanged heterogeneously enhancing, mildly expansile lesion in the occipital bone. There is an unchanged left parietal skull resection cavity without evidence of abnormal enhancement in this region. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged encephalomalacia in the right orbitofrontal gyri. There is also unchanged mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. 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. There is a left lens implant. The orbits are otherwise grossly unremarkable. There are mild ethmoid sinus secretions of mucosal thickening.", "output": "1. Unchanged encephalomalacia in the right orbitofrontal gyri, with no evidence of intracranial metastases or acute infarction. 2. Unchanged occipital skull metastasis and no evidence of recurrent left parietal skull metastasis. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Eval for osteomyelitis History: Deep ulcer of Left foot plantar, head of 1st metatarsal, plantar aspect, present for years There is ulceration of the ball of the foot beneath the first MTP joint. There is intermediate signal intensity on T1-weighted images replacing the underlying subcutaneous fat which is heterogeneous on T2-weighted images and extends to the head of the first metatarsal as well as the base of the great toe, likely reflecting a combination of granulation tissue, scarring, and edema. There is chronic erosion of the head of the first metatarsal that likely represents sequela of prior infection, but we see no edema within the marrow of the first metatarsal to indicate acute osteomyelitis. There is linear signal abnormality within the proximal diaphysis of the first metatarsal that may represent a small focus of bone infarction. The proximal phalanx is dorsally subluxed/dislocated relative to the first metatarsal. There is a defect within the base of the proximal phalanx, again, likely representing an erosion from prior osteomyelitis. However, we suspect that this is chronic as we see no edema within the adjacent marrow. The distal phalanx appears normal. There are small subcutaneous foci of signal void beneath the first metatarsal head which may represent gas or metal artifact. A small amount of fluid tracks along the inferior aspect of the distal diaphysis of the first metatarsal, but the clinical significance of this is uncertain, and there is little if any adjacent soft tissue inflammation. The sesamoid bones are not visualized and are presumably surgically absent or destroyed from prior infection. The flexor tendons of the great toe are not well visualized. There is diffuse atrophy of the imaged musculature of the foot. Mild osteoarthritis affects the midfoot.", "output": "1. Ulceration of the ball of the foot near the first metatarsal head with signal abnormality within the underlying soft tissues likely representing a combination of scarring and edema. There is a small collection of fluid along the undersurface of the first metatarsal. While we cannot exclude the possibility of a small abscess, this may not be of any clinical significance due to the lack of inflammation within the surrounding soft tissues and underlying bone.2. Absence of the sesamoid bones is presumably related to prior surgery or long-standing infection.3. Erosive deformity of the head of the first metatarsal and base of the proximal phalanx is likely due to infection, but we suspect that this is chronic as we see no edema within the adjacent bone marrow. Other findings as described above. Conventional radiographs may provide additional information and are recommended for initial evaluation for osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of cervix uteri, unspecified [C53.9], Reason for Study: ^Reason: hx of cervical cancer, new memory loss History: memory loss, insomnia No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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.2. No evidence of abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "Female, 62 years old, dizzy and not feeling well status post fall. Numerous punctate foci of T2 hyperintensity are present scattered through the cerebral hemispheres, a non-specific finding. No diffusion restricting lesions are seen. No evidence of edema or mass effect is detected. There are no findings to suggest acute or chronic hemorrhage. The lateral and third ventricles are normal in size and morphology.The cerebellar fissures are prominent, particularly along the vermis and upper cerebellar hemispheres, out of proportion to the cerebral sulci which are relatively normal. In addition, the pons and middle cerebellar peduncles appear subjectively small. The fourth ventricle is prominent.On DTI imaging, no gross diffusional asymmetries or obvious focal loss of anisotropy is detected.Although the temporal bone structures are not specifically evaluated on this study, the right superior semicircular canal may be dehiscent.", "output": "Findings are seen suggesting atrophy of the pons, middle cerebellar peduncles, cerebellar vermis and superior cerebellar hemispheres. These features, while not entirely specific, at least raise the possibility of an early manifestation of multiple system atrophy. Other degenerative processes, such as one of the spinocerebellar ataxia conditions, could be considered as well based on clinical symptomatology.No convincing findings of posttraumatic parenchymal injury are seen. Small foci of signal abnormality scattered through the cerebral hemispheres are nonspecific. Most commonly, these lesions reflect chronic microvascular ischemia, though the differential is broad and would include sequelae of prior inflammation, infection, demyelination, or migraine headache among many others.Incidentally noted is the appearance of possible dehiscence of the right superior semicircular canal. If vestibular symptoms are suspected, this potential finding can be better assessed with dedicated temporal bone CT."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old Reason: 64 yo male s/p whipple for IPMN in 4/14; please evaluate for abnormalities History: pancreas mass LUNG BASES: Right basal scarring/atelectasis.ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Subcentimeter T2 hyperintensity within the posterior right hepatic lobe is consistent with a hepatic cyst. SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple. There is marked dilatation of the pancreatic duct throughout its course, measuring up to 8 mm and increased compared to most recent CT abdomen 26/04/14. No definite enhancing mass is identified within the pancreas. Given the time interval, stricture is the most likely etiology.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Nonspecific mildly prominent portacaval lymph node.BOWEL, MESENTERY: Changes related to prior Roux-en-Y.BONES, SOFT TISSUES: T2 hyperintensities within the lower thoracic vertebral bodies are suggestive of hemangiomas.", "output": "1.Increased dilatation of the pancreatic duct in this patient who is status post Whipple. Given the time interval favor stricture as most likely etiology of the dilatation. While pancreatic mass or a main branch IPMN are differential considerations, there are no specific imaging findings to suggest these diagnoses which are therefore felt much less likely. 2.Hepatic steatosis. "}
{"instruction": "Generate impression based on findings.", "input": "Anterior right knee pain. Rule out chondral injury MENISCI: No evidence of meniscal injury.ARTICULAR CARTILAGE AND BONE: Articular cartilage appears normal.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism appears normal.ADDITIONAL", "output": "No chondral defect or other injury to account for the patient's knee pain."}
{"instruction": "Generate impression based on findings.", "input": "C5 -- C6, C6 -- C7 radiculopathy. History of C7 -- T1 herniated disk there Nonenhanced CT of the cervical spine:Routine nonenhanced CT of cervical spine the sagittal and coronal 2-D reformatted images were obtained.This is not an appropriate exam for detection of herniated disk. The CT examination of cervical spine cannot precisely evaluate the soft tissues of the cervical spine (disk material or hypertrophic changes of the ligamentum flavum).To evaluate for a herniated disk an MRI examination of cervical spine is the study of choice.Very advanced degenerative disease throughout the cervical spine is noted. There is exaggerated lordosis of cervical spine. The alignment the vertebral column is otherwise unremarkable.Foramen magnum.Examination at this level is unremarkable.C2 -- C3.Degenerative disk disease and hypertrophic changes of posterior elements. No bony central spinal stenosis or neural foramina compromise.C3 -- C4.Advanced degenerative disk disease with loss of intervertebral disk height. Moderate hypertrophic changes of posterior elements. Compromise of bilateral neural foramina secondary to bony hypertrophic changes (left greater than right). No central spinal stenosis.C4 -- C5.Moderate degenerative disk disease and extensive hypertrophic changes of posterior elements (left greater than right). Compromise of bilateral neural foramina secondary to a both changes. No central spinal stenosis.C5 -- C6.Moderate degenerative disk disease and exaggerated hypertrophic changes of posterior elements with resultant bilateral neural frontal compromise. No central spinal stenosis.C6 -- C7.Advanced degenerative disk disease and also disk height. Moderate hypertrophic changes of posterior elements. Mild to moderate compromise of the left neural foramina. Questionable minimal compromise the right neural foramina. No central spinal stenosis.C7 -- T1.Advanced degenerative disk disease and minimal hypertrophic changes of posterior elements. No central spinal stenosis. No definitive neural foramina compromise.Limited view of upper thoracic spine demonstrate no central spinal stenosis and no significant degenerative changes.", "output": "1.Extensive degenerative disk disease and hypertrophic changes of posterior element throughout the cervical spine as detailed.2.No central spinal stenosis at any level however multi-level bilateral neural foramina compromise secondary to degenerative changes is present as detailed per level above.3.This examination cannot assess for herniated disk as mentioned above. If concern for acute herniated disk exist a dedicated MRI of the cervical spine is recommended."}
{"instruction": "Generate impression based on findings.", "input": "History of pain. Evaluate for recurrent rotator cuff tear. There is a metallic susceptibility artifact within the posteromedial aspect of the humeral head as well as additional metallic susceptibility in the soft tissues of the shoulder indicating prior surgery. ROTATOR CUFF: There is perhaps mild irregularity of the bursal surface fibers of the supraspinatus tendon that may represent fraying but we see no discrete supraspinatus tear. The supraspinatus muscle appears normal. The infraspinatus tendon is normal. There is minimal fatty atrophy along the myotendinous junction of the infraspinatus. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: Minimal osteoarthritis affects the acromioclavicular joint. Trace fluid in the subacromial/subdeltoid bursa is of doubtful clinical significance. The coracoacromial and coracohumeral ligaments appear normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. We see no joint effusion. Mild intermediate signal intensity in the superior labrum is visualized and may reflect degeneration but we see no discrete fluid-filled labral tear. Small cysts are seen within the superior aspect of the humeral head. BICEPS TENDON: The tendon of the long head of the biceps is visualized within the intertubercular groove but not clearly seen within the rotator interval, perhaps due to prior tenotomy or tear.", "output": "1. Postoperative changes as described above2. Possible mild fraying of the supraspinatus tendon but no discrete tear3. Additional degenerative changes as described above."}
{"instruction": "Generate impression based on findings.", "input": "33 year old male with history of L frontal GBM. S/p surgery x2, RT/TMZ+TMZ. Patient off therapy since 1/2014. Again seen are postoperative findings related to left frontal craniotomy and resection. There is unchanged T2/FLAIR hyperintensity adjacent to the resection cavity extending across the genu of the corpus callosum into the right frontal white matter. There is linear enhancement along the posterior margin of the resection cavity which is unchanged from prior study. There are no new masses identified. There are no new areas of pathologic enhancement. There is no midline shift or mass effect. The imaged paranasal sinuses are clear. The imaged orbits are unremarkable. The mastoid air cells are clear.", "output": "Stable examination with no evidence of tumor progression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: stroke workup in patient with history of stroke presenting with worsening dysarthria and new onset dysphagia and ataxia. Mild asymmetry of the ventricles is again noted, felt to be within normal limits of anatomic variation, and unchanged. The basal cisterns remain patent. There is no midline shift or mass effect. There is mild volume loss involving the cerebellum. There are scattered punctate foci of increased T2/FLAIR signal within the periventricular white matter which are nonspecific and appear similar to the 4/9/2015 examination. There is also curvilinear focus of increased T2 signal within the left lower pons compatible with chronic infarction corresponding to the area of restricted diffusion seen on the 4/9/2015 examination. Previously seen increased T2 signal involving the middle cerebellar peduncles has improved, consistent with evolution of prior injury. There are numerous punctate foci of susceptibility in both the supratentorial and infratentorial compartments in a nonspecific distribution. Although some of these foci appear slightly more prominent or apparently new compared to the prior examination, this may at least in part reflect increased sensitivity of the technique. In the setting of renal insufficiency, these may reflect hemolytic microangiopathy. No pathological enhancement is identified. There is no diffusion abnormality currently. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The skull and scalp soft tissues are grossly unremarkable. There is mild patchy opacification of the paranasal sinuses. There is again volume loss and abnormal signal involving the left globe compatible with phthisis bulbi. Additional abnormal signal involving the right globe as seen on the prior studies is consistent with prior intraocular detachment.", "output": "1.No evidence of acute infarct.2.Chronic infarction involving the left pons. Additional nonspecific supratentorial white matter signal abnormality appearing similar to prior and favored to reflect chronic small vessel ischemic changes.3.Again seen are numerous foci of susceptibility compatible with chronic microhemorrhages. These are nonspecific but may reflect hemolytic microangiopathy in this patient with renal insufficiency."}
{"instruction": "Generate impression based on findings.", "input": " There is a mild dextrorotoscoliosis centered at approximately L1/2.Thoracic spine:There are no fractures. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.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 no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation and disc height loss are present throughout. Small Schmorl's nodes are noted along the inferior endplate of L1, and inferior endplate of L2. Modic type II degenerative reactive endplate changes are present at L2/3, L3/4, L4/5, and L5/S1.L1/2: No significant disc bulge or stenosis.L2/3: Diffuse annular disc bulge, slight ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is no significant stenosis.L3/4: Diffuse annular disc bulge, slight ligamentum flavum thickening, and mild bilateral facet hypertrophy. There are no significant stenoses.L4/5: Diffuse annular disc bulge, ligamentum flavum, and moderate bilateral facet hypertrophy. There is a 5 x 4 mm T2 hyperintense focus adjacent to the medial aspect the right facet joint most consistent with a small synovial cyst. There is mild bilateral lateral recess, mild to moderate left neural foraminal, and mild right neural foraminal stenosis.L5/S1:Mild disc bulge and mild bilateral facet hypertrophy without stenosis.", "output": "1.Negative noncontrast thoracic spine MRI.2.L4/5:Mild bilateral lateral recess, mild to moderate left neural foraminal, and mild right neural foraminal stenosis.3.Mild degenerative changes are noted elsewhere in the lumbar spine, without significant stenosis, as described in detail above."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with history of prostate cancer status post prostatectomy with elevated PSA. Evaluate for recurrence. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. No soft tissue in the surgical bed to suggest tumor recurrence.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Status post prostatectomy.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Minimally prominent nonspecific bilateral inguinal and left external iliac chain lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence of tumor recurrence."}
{"instruction": "Generate impression based on findings.", "input": "79 year old male with language disorder and mild cognitive decline No evidence of restricted diffusion to suggest acute ischemia or infarction. Redemonstrated are primarily periventricular foci of T2/FLAIR hyperintensity without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. Also redemonstrated is a punctate focus of increased T2/FLAIR hyperintensity in the right thalamus, which appears similar to the prior study and consistent with a remote lacunar infarction. The ventricles and sulci are slightly prominent, however unchanged. There is no evidence of pathologic intracranial enhancement. The visualized paranasal sinuses are aerated. Bilateral orbital contents are unremarkable. Proximal intracranial flow voids are identified apart from loss of the signal void in the distal left vertebral artery.", "output": "1.No acute ischemia or infarction. No pathologic intracranial enhancement.2.Loss of the signal void in the distal left vertebral artery is again noted.3.Stable chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "History of lipomatosis, new severe left lower leg pain and inability to walk TIBIA/FIBULA: No significant abnormality noted.BONE MARROW: No significant abnormality noted.MUSCULATURE: No significant abnormality noted.ADDITIONAL", "output": "Normal MRI exam of the left tibia and fibula. No acute abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Asymmetrical right sensorineural hearing loss with tinnitus. The bilateral labyrinthine structures, internal auditory canals, and cranial nerve 7 and 8 complexes appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is mild scattered paranasal sinus mucosal thickening.", "output": "No evidence of retrocochlear or inner ear lesions."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal head CT: newly diagnosed metastatic breast cancer. There is an infiltrative, enhancing mass within the left parietal calvarium that measures up to 50 mm with epidural and subgaleal extension. There is minimal associated mass effect upon the underlying left parietal lobe. There is no evidence of lesions with in the brain, brainstem, or cerebellum. There cerebellar tonsils extend up to 5 mm inferior to the foramen magnum. There is no evidence of acute intracranial hemorrhage or acute cerebral infarction. The orbits and paranasal sinuses are unremarkable.", "output": "A lesion in the left parietal bone with epidural and subgaleal extension is compatible with metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old with known left breast cancer on neoadjuvant chemotherapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, there has been interval decrease of the index mass, which now measures 24 x 27 x 33 mm, previously 102 x 86 x 98 mm (AP x LR x CC). This is peripherally enhancing with central signal compatible with necrosis. The posterior satellite now appears only as faint residual non-mass enhancement measuring 15 mm. The AP extent of the residual mass and non-mass enhancement measures 5.1 cm. Left axillary lymph nodes, including the biopsied node are decreased in size as well. The biopsied node is only 8 mm in short axis. The previously seem smaller suspicious nodes have normalized in morphology. No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in the right axillary region.", "output": "Response to therapy as above. Residual mass and non-mass enhancement measure up to 5.1 cm.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female, 30 years old, with neck spasm and left shoulder weakness. The normal cervical lordosis is slightly reversed which is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No concerning areas of marrow replacement, edema or pathologic marrow enhancement are observed.The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No focal lesions are seen. No pathologic parenchymal or leptomeningeal enhancement is observed. No epidural abnormalities are suspected.C2-3: Left facet arthropathy. No significant spinal canal or foraminal stenosis. C3-4: No significant spinal canal or foraminal stenosis. C4-5: Left uncovertebral hypertrophy with moderate left foraminal narrowing. No significant spinal canal stenosis. C5-6: Posterior disc-osteophyte complex formation with a small focal component centrally. No significant spinal canal stenosis or cord impingement. No significant foraminal narrowing. C6-7: No significant spinal canal stenosis or foraminal narrowing. C7-T1: No significant spinal canal stenosis or foraminal narrowing.", "output": "Relatively mild degenerative findings are seen at several levels as discussed above. Most notably, there is a moderate stenosis of the left neural foramen at C4-5. Otherwise, no high-grade spinal canal or foraminal stenosis is seen. No enhancing lesions are identified."}
{"instruction": "Generate impression based on findings.", "input": " There are a few scattered punctate foci of T2 hyperintensity within subcortical white matter locations without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. 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. Other than minimal sporadic foci mucosal thickening the paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.", "output": "Mild chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 91 years old; Reason: 91 Y old female with two decubitus ulcers on left hip with elevated CRP/ESR; eval for osteomyelitis History: decubitus ulcer, fever Nondiagnostic exam.", "output": "Nondiagnostic exam."}
{"instruction": "Generate impression based on findings.", "input": "47 years, Male, evaluate for tumor resection, word finding difficulty. There are postsurgical changes of left-sided craniotomy for resection of left temporal mass. There is a rind of restricted diffusion surrounding the resection cavity compatible with cytotoxic edema. No large infarct is evident. There are blood products within the resection cavity. There appears to be near total resection of the enhancing tumor with small residual enhancement suspected along the superior aspect of the resection cavity abutting the left temporal horn.Extensive surrounding T2/FLAIR hyperintensity in the left temporal lobe extending medially into the left thalamus and basal ganglia region as well as superiorly into the left parietal white matter is again seen. Mass effect including effacement of the left lateral ventricle is slightly improved. Uncal herniation with deformity of the midbrain and rightward displacement of the brainstem is slightly improved. Rightward midline shift measured at the foramen of Monro measures approximately 6 mm compared to 8 mm on the preoperative study. No hydrocephalus. Major flow-voids are maintained. There is diffuse opacification of the left mastoid air cell. Remainder of the brain parenchyma demonstrates few scattered nonspecific T2/FLAIR hyperintense foci but otherwise unremarkable.", "output": "Expected postsurgical changes of left temporal tumor resection. There is near total resection of the enhancing tumor with minimal residual enhancement suspected along the superior aspect of the resection cavity along the left temporal horn."}
{"instruction": "Generate impression based on findings.", "input": "14-year-old male with neurofibromatosis type II experiencing back pain. 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 and cauda equina display normal signal and morphology. The paravertebral soft tissues are unremarkable.Nerve root thickening associated with T2 hyperintensity and enhancement is present involving the:*Left L2 nerve roots, unchanged in appearance.*Left L4 nerve roots, unchanged in appearance.*Left L5 nerve roots, unchanged in appearance.*Bilateral S1 nerve roots (left greater than right), unchanged in appearance.*Left S2 nerve roots, unchanged in appearance.There are no degenerative changes or stenoses.", "output": "Stable L2, L4, L5, S1, S2 nerve root thickening, T2 hyperintensity, and enhancement."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with cavernous angioma, six-month follow-up. There is an unchanged cavernous malformation that measures up to 9 mm, with an associated developmental venous anomaly in the left frontal lobe, but no surrounding edema. There is also an unchanged focus of increased T2 signal in the posterior left frontal lobe without enhancement or susceptibility effect. There is no evidence of acute intracranial hemorrhage or 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.", "output": "1.Unchanged left frontal lobe cavernous malformation and associated developmental venous anomaly.A persistent small lesion in the posterior left frontal lobe remains nonspecific, but may represent a manifestation of endothelial abnormalities that can be associated with cavernous malformations, although other possibilities, such as gray matter heterotopia or low grade glial tumor, may be considered as well. "}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis B and family history of pancreatic cancer. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. Normal postcontrast enhancement. Punctate hepatic cysts are present. No suspicious liver lesion or vascular abnormality. Contracted gallbladder without biliary ductal dilatation.SPLEEN: Normal size spleen without focal lesion.PANCREAS: Normal variant ductal anatomy. No focal suspicious lesion. In the distal pancreatic tail there is a 1.7 x 1.7 cm lesion which matches splenic intensity on some but not all imaging sequences.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No suspicious liver. 1.7 cm distal pancreatic tail hyperenhancing lesion matches splenic intensity on some but not all imaging sequences. Although this likely represents a intrapancreatic accessory spleen this is not confirmed. A nuclear medicine damaged RBC scan is recommended to confirm that this is splenic tissue."}
{"instruction": "Generate impression based on findings.", "input": "20 year old male with Tetralogy of Fallot s/p repair, s/p pulmonary valve replacement. Referred for research cardiovascular MRI to evaluate right ventricular volume and function Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 173 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 119 g (normal range 164+/-36). There is systolic septal flattening, suggesting increased RV systolic pressure. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely enlarged with moderately reduced systolic function. The overall RV ejection fraction is 38%, the RV end diastolic volume index is 168 ml/m2 (normal range 82+/-16), the RVEDV is 309 ml (normal range 142+/-31), the RV end systolic volume index is 104 ml/m2 (normal range 31+/-9), and the RVESV is 192 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.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 ValveThere is a bioprosthetic pulmonary valve in place. There is moderate pulmonic valve regurgitation and moderate pulmonic valve stenosis.Regurgitant fraction 25%. Peak velocity 3.5 m/sTricuspid 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 ArteriesThe main pulmonary artery is moderately dilated (35mm). Right pulmonary artery has a diameter of 34mm and receives 53% of cardiac output. Left pulmonary artery has a diameter of 27mm and recieves 47% of the cardiac output.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": "This is a limited cardiac MRI without contrast performed for research purposes.1. Severe right ventricular dilation with moderately reduced systolic function (RVEF 38%, RVEDV indexed 168 mL/m2)2. A bioprosthic valve is noted in the pulmonic position. Moderate pulmonic valve insufficiency and stenosis are noted.3. Moderate dilation of pulmonary artery.4. Normal left ventricular size and systolic function (LVEF 63%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: rule out intracranial abnormality. CVA.signs and symptoms: History of cancer with brain metastases and after mental status Nonenhanced head CT:There is evidence of a right temporal craniotomy with focus of encephalomalacia under the craniotomy flap in the right anterior temporal lobe. There is no evidence of edema, hemorrhage or mass effect with this finding. The high convexity right frontal lobe there is a mass measuring approximately 11.9 x 8.4-mm on axial image 23. There is extensive surrounding vasogenic edema with resultant effacement of adjacent cortical sulci. This finding is believed to represent a metastatic focus.There are several small foci of low-attenuation in the subcortical white matter of left hemisphere which are not suggestive of metastatic disease and may represent small vessel disease ischemic stroke of indeterminate age. Follow-up with an MRI for detection of possible additional metastatic foci is recommended.There is no evidence of hemorrhage, midline shift or hydrocephalus.", "output": "1.Metastatic lesion in high convexity right frontal lobe with possible minimal hemorrhage measuring 8.4 x 11.9-mm in size.2.Ill-defined patchy areas of subcortical invagination suspected to small vessel ischemic stroke of indeterminate age.3.Evidence of a prior right-sided anterior temporal partial lobectomy as detailed above."}
{"instruction": "Generate impression based on findings.", "input": " The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. There is minimal loss of intervertebral disc space height at L4-5. Intervertebral disc space heights are otherwise well-maintained. There is disc desiccation at the L1-2 and L4-5 levels. Multilevel Schmorl nodes are noted. Heterogeneous bone marrow without evidence of marrow edema. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-2 intervertebral level.L1-2: New tiny central annular fissure is noted. No significant spinal canal or neural foraminal stenosis.L2-3: Minimal left foraminal shallow disc protrusion. No significant spinal canal or neural foraminal stenosis.L3-4: Mild disc bulge with biforaminal prominence. Mild facet joint hypertrophy. Mild bilateral neural foraminal stenosis, left greater than right. No significant spinal canal stenosis.L4-5: Mild disc bulge. Mild-to-moderate facet joint hypertrophy and ligamentum flavum thickening. Mild bilateral neural foraminal stenosis. No significant spinal canal stenosis.L5-S1: Mild facet joint hypertrophy. No significant spinal canal or neural foraminal stenosis.", "output": "1. Mild disc bulge at the L3-4 and L4-5 levels, with mild bilateral neural foraminal stenoses, without significant interval change. 2. New tiny central annular fissure at the L1-2 level. 3. Other mild degenerative changes of the lumbar spine as described above."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other specified diseases of inner ear, unspecified ear Other symptoms and signs involving the nervous systemClinical question: dizziness, balance difficulties, assess for acoustic neuroma, vascular abnormalities, masses/lesions The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the right maxillary sinus and a minor mucous retention cyst in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "MRI of the brain is within normal limits. No intracranial mass is appreciated. There is no evidence for cerebral infarction."}
{"instruction": "Generate impression based on findings.", "input": "Transient right-sided weakness. Rule out stroke. BRAIN MRI: There is an area of restricted diffusion along the left posterior frontal corona radiata adjacent to the left lateral ventricle. There is no significant associated FLAIR hyperintensity. There are multiple foci of T2/FLAIR hyperintensity involving the periventricular and subcortical white matter as well as the pons which are nonspecific but compatible with chronic small vessel ischemic disease. The ventricles and other CSF-containing spaces are mildly enlarged, reflecting mild underlying brain volume loss. There is no midline shift or herniation. There is trace mucosal thickening in the ethmoid sinuses. There is deformity involving the posterior aspect of the globes/staphylomas, which may be associated with axial myopia.CRANIAL MRA:The internal carotid arteries show preserved caliber and flow-related signal. There is moderate stenosis involving the distal left M1 segments with mild attenuation of the distal middle cerebral artery branches. Moderate stenoses also involves the proximal left and mid right P2 segments with attenuated distal right posterior cerebral artery branches. Other milder, scattered stenoses involve the intracranial arteries. There is no aneurysm.CERVICAL MRA: Aortic branching pattern is conventional. There is no significant stenosis involving the bilateral common or internal carotid arteries. The vertebral arteries arise conventionally from the respective subclavian arteries. No significant stenosis involving the vertebral arteries at their origins or their course in the neck.", "output": "1.Acute/hyperacute ischemia involving the left posterior frontal corona radiata. No significant associated T2/FLAIR signal which may be related to hyperacute timing.2.Mild to moderate chronic small vessel ischemic disease.3.Multifocal atherosclerotic stenoses of the intracranial arteries, with moderate focal stenoses involving the left lateral M1 segment and the bilateral posterior cerebral arteries. 4.There is no significant stenosis of the cervical arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "28 year old female with a history of non-ischemic cardiomyopathy who underwent heart transplant in 2007 referred for stress cardiac MRI to rule out coronary stenosis.MEDICATIONS: ASA, prednisone, Cellcept, tacrolimus. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no evidence of prior myocardial infarction. There is, however, a tiny focus of epicardial late gadolinium enhancement noted in the apical inferior wall which suggests the presence of fibrosis, inflammation, or infiltration, such as an old episode of rejection. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 121 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 44 ml (normal range 31+/-10), the LV mass index is 51 g/m2, and the LV mass is 92 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 131 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 52 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant morphology. 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 mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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. No perfusion defects/ \"ischemia\" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 64%) with evidence of a tiny focus of late gadolinium enhancement in the apical inferior wall. The pattern is not consistent with prior myocardial infarction and most likely represents an old episode of rejection. 4. Normal RV size and systolic function (RVEF 60%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Tib post tendinitis History: pain TENDONS: Small fluid around the posterior tibialis, flexor digitorum longus and flexor hallucis longus tendons, likely physiologic. No significant abnormality noted.LIGAMENTS: There is replacement of normal fat with low T1 signal and high T2 signal in the sinus tarsi, consistent with fluid or synovitis. ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL", "output": "MR findings representing sinus tarsi syndrome."}
{"instruction": "Generate impression based on findings.", "input": "Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Specifically, there is no evidence of an osteochondral defect or contusion.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: There is a small focus of increased signal within the lateral portion of the patellar tendon proximally. There is no evidence of discrete tear. Minimal signal changes are also noted in the inferior pole of the patella but there is no evidence of an sleeve avulsion or fracture.There is a small amount of increased signal within the anterolateral portion of Hoffa's fat pad.ADDITIONAL", "output": "1. Mild edema within Hoffa's fat pad which may reflect small component of patellar impingement.2. Mild patellar tendinosis."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female status post cerebral cavernous reformation resection. Redemonstrated are changes from left subtemporal approach for pontine cavernous reformation resection. Pneumocephalus has resolved. Redemonstrated is susceptibility hypointensity with associated T2 hypointensity within the left pons contain a few foci of internal T1 hyperintensity. Perilesional vasogenic edema has decreased, with a small amount of residual within the middle cerebellar peduncles bilaterally (left more than right). Compared to the presurgical images, there is now significantly less mass effect and anatomic deformation. Postprocedural dural enhancement is again noted.There is a small focus of ill-defined T2 hyperintensity with associated enhancement just anterior to the left precentral gyrus, in a subcortical location, most consistent with either a tiny developmental venous anomaly or a capillary telangiectasia.Ventricular sizes are normal. Expected vascular flow voids are demonstrated. The paranasal sinuses and right mastoid air cells are clear. Fat packing is now noted within the expected region of left mastoid air cells.", "output": "Susceptibility hypointensity with associated T2 hypointensity within the left pons contain a few foci of internal T1 hyperintensity. Perilesional vasogenic edema has decreased, with a small amount of residual within the middle cerebellar peduncles bilaterally (left more than right). Compared to the presurgical images, there is now significantly less mass effect and anatomic deformation. These findings are consistent with the postprocedural appearance of a cerebral cavernous reformation."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with unilateral posttraumatic osteoarthritis of the left hip. There is mild degeneration of the articular cartilage particularly along the posterosuperior aspect of the femoral head. Although evaluation of the acetabular labrum is limited due to the lack of intra-articular contrast, there is increased signal intensity throughout much of the labrum that likely represents degeneration and degenerative tearing. There is a small amount of fluid within the joint but no large effusion. There is fatty atrophy of the gluteus minimus muscle, but the remaining musculature of the left hip is unremarkable. Osteoarthritis also affects the right hip as seen on the large field-of-view images. There is also fatty atrophy of the right gluteus minimus muscle. Severe degenerative disc disease affects the level of L4/L5. Although incompletely imaged on this study, there appears to be focal disc protrusion, to the left of the midline at this level, which would be better evaluated with a dedicated lumbar spine MRI examination.", "output": "1. Osteoarthritis of the left hip.2. Severe degenerative disc disease at the level of L4/L5 with what we suspect is a protrusion of disc material at this level, however, this is incompletely imaged and could be better evaluated with a dedicated lumbar spine MRI exam if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Worsening back pain and lower extremity radiculopathy. Signs and symptoms: Same. Nonenhanced lumbar MRI:T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate moderate bilateral ligamentum flavum hypertrophy and unremarkable otherwise.L3 -- L4 demonstrate mild to moderate bilateral ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise or interval change.L4 -- L5 demonstrate bilateral transpedicular screw placement since prior exam. Mild to moderate disk disease and loss of disk height with mild interval progression. There is evidence of laminectomy with resultant expansion of thecal sac and no spinal stenosis or neural foraminal compromise. Tiny focus of T2 increase signal intensity within the annulus of the disk suspected of an annular fissure.L5 -- S1 demonstrate metallic hardware artifact posteriorly from prior fusion. There is moderate disk disease and loss of disk height with interval progression since prior exam. There is however no spinal stenosis or neural foraminal compromise. Bilateral transpedicular screws at S1 level is also noted.", "output": "1.Interval post operative changes of laminectomy at L4 -- L5 level, posterior fixating wires and bilateral transpedicular screws at L4 and S1 levels as detailed.2.Mild progression of degenerative disk disease at L4 -- 5 and L5 -- S1 levels and a tiny annular fissure at L4-L5 level.3.No spinal stenosis or neural foraminal compromise at any level."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old with anaplastic astrocytoma status post proton RT and on TMZ. Again seen are postoperative changes from left parietal craniotomy and remote ependymoma resection. Resection cavity is CSF filled and appears to communicate with the atrium of the left lateral ventricle. Again seen is a cystic focus anterior to the resection cavity related to recent biopsy with susceptibility artifact indicating postbiopsy blood products.Compared to most recent MRI from 1/17/2016 and dating back to 9/30/2015, there is slight further interval decrease in the extent of abnormal T2 signal within the white matter of the left parietal, temporal, and frontal lobes. The masslike thickening of the posterior corpus callosum and cingulate gyrus has resolved. Slight decrease in signal abnormality involving the left thalamus with T1 and T2 hyperintensity also noted. Slight decrease in signal abnormality involving the posterior callosum/splenium extending into the right also noted.A more nodular area of increased T2 signal in the subcortical white matter of the left inferior parietal lobule is not significantly changed. Most recent comparison study was obtained without gadolinium however when compared to MRI brain from 9/30/2015, there is interval development of nodular enhancement in the left inferior parietal lobule which measures 9 x 7 mm associated with the nodular T2 hyperintense focus mentioned above. Enhancement involving the left posterior thalamus is again seen. Punctate nodular enhancement more laterally in the subcortical left temporal white matter was also present previously. Punctate enhancement lateral to the left parietal resection cavity is no longer seen. Mild increase in enhancement medial and lateral to the posterior body of the left lateral ventricle also noted.A cavernous malformation within the central pons is not significantly changed from prior. There are additional punctate foci of susceptibility related to chronic microhemorrhages involving the left parietal, and temporal lobes.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. There has been significant increase in opacification of the left maxillary sinus as well as increased opacification of the right maxillary sinus. Right sphenoid sinus opacification appears improved. Opacification of the left greater than right ethmoid air cells is slightly worse. The visualized mastoid air cells are clear.", "output": "1. Compared to 1/7/2016 and 9/30/2015, there is continued decrease in T2/FLAIR signal abnormality within the white matter of the left temporal and parietal lobes, more noticeable when compared to study from 9/30/2015. There remain areas of abnormal increased T2/FLAIR signal centered within the left periatrial white matter and inferior parietal lobule related to known tumor. When compared with post gadolinium sequences from 9/30/2015, there is interval increase in nodular enhancement associated with the nodular lesion in the left inferior parietal lobule. Additional adjacent nodular areas of enhancement described above demonstrate stability, slightly increased, or slightly decreased compared to 9/30/2015. As such these findings may represent posttreatment changes but suggest attention on follow-up, particularly of the inferior parietal lobule lesion with nodular T2/FLAIR signal.2. Again seen is a separate left parietal resection cavity related to prior ependymoma resection without findings to suggest ependymoma recurrence.3. No significant change in pontine cavernous malformation.4. Increased paranasal sinus opacification."}
{"instruction": "Generate impression based on findings.", "input": "Headaches, ventricular shunt, hydrocephalus, and prior resection of a colloid cyst. There are postoperative findings related to right transfrontal resection of a colloid cyst with susceptibility from chronic blood products along the surgical approach, but no evidence of colloid cyst recurrence. There is a right transparietal ventricular catheter that termites in the posterior left lateral ventricle. The lateral ventricles remain disproportionately dilated with respect to the rest of the ventricular system. The brain parenchymal signal is otherwise unremarkable and there is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.", "output": "1. Persistent disproportionate dilatation of the shunted lateral ventricles. 2. No evidence of recurrent colloid cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Focal seizures with secondary generalization, most likely temporal semiology. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is no evidence of grey matter heterotopia. 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 are grossly unremarkable. There is a subcutaneous lipoma that measures up to 20 mm associated with the right lipoma. There is fluid and mucosal thickening in the bilateral maxillary, right ethmoid, and right frontal sinuses.", "output": "1. No gross structural intracranial abnormality.2. FIndings suggestive of acute sinusitis."}
{"instruction": "Generate impression based on findings.", "input": "Male, 68 years old, with weakness, hoarseness and dysphagia. Brain:No restricted diffusion is seen. Scattered foci of T2 hyperintensity are seen in the periventricular white matter bilaterally. No edema or mass effect is detected. No intracranial hemorrhage or abnormal extra-axial fluid is seen. Ventricular size and morphology are within normal limits.C-spine:The cervical lordosis is slightly exaggerated but sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or marrow replacement is seen. The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected. Minimal posterior disc-osteophyte complex formation is seen at C4-5, C5-6 and C6-7, without significant spinal canal stenosis. Likewise, no evidence of significant foraminal compromise is seen.L-spine:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or marrow replacement is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are seen. The intervertebral discs are preserved with no significant bulging or herniation. Mild facet arthropathy is seen at lower lumbar levels. No compromise of the spinal canal or neural foramina is detected.", "output": "1.Scattered nonspecific foci of T2 hyperintensity are seen in the brain. No findings are detected which could account for the patient's symptoms.2.Minimal degenerative disease in the cervical lumbar spine, without findings which would account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Persistent knee pain MENISCI: There is mild increased signal within the posterior horn of the medial meniscus without clear extension to either articular surface. There is otherwise no evidence of tear within the medial lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is mild signal heterogeneity and loss of the articular cartilage of the lateral patellar facet with with a small focus of marrow edema in the underlying patella. There is no discrete fracture line. Articular cartilage of the medial and lateral compartments is preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Intact ACL.2. Mildly increased signal within the posterior horn of the medial meniscus evidence of discrete tear.3. Articular cartilage loss with underlying marrow edema in the lateral patellar facet."}
{"instruction": "Generate impression based on findings.", "input": "64 years Female (DOB:8/5/1951)Reason: eval for brain lesion History: eval for brain lesionPROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE There is an extra-axial contrast enhancing mass present which abuts the falx and is medial to the right frontal lobe. It has a broad-based the dura and measures 46 x 39 mm axial dimensions. It is heterogeneous on signal intensity on all pulse sequences. It has a low signal center. There is susceptibility effect within much of the lesion. Within the white matter in the adjacent right frontal lobe there is T2 and FLAIR signal hyperintensity suggestive of vasogenic edema. There is mass effect present with distortion of the right lateral ventricle and corpus callosum. There is also shift of the falx to the left of midline x 10 mm. An 8 mm component of the mass protrudes across midline along the anterior and superior aspect of the mass.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "There is a large right parafalcine extra-axial mass present adjacent to the right frontal lobe associated with compression of adjacent brain parenchymal structures as well as some vasogenic edema. Most likely this represents a meningioma."}
{"instruction": "Generate impression based on findings.", "input": "Male 33 years old Reason: 32 yo with cirrhosis small perfusional defect on prior scans please evaluate History: none ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. There is a focal area of fatty deposition in segment 4 of the liver with associated perfusional changes. No hypervascular lesion is identified.A shunt connecting the right hepatic vein to the right portal vein is well opacified and is patent.Artifact from coils in the left upper abdomen possibly obscure the left hepatic lobe.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No focal lesion that meets criteria for HCC.2.Focal fatty deposition in segment 4 of the liver causing focal perfusional changes."}
{"instruction": "Generate impression based on findings.", "input": "Other alteration of consciousness [780.09], Reason for Study: ^Reason: Eval for ischemia, septic emboli, other acute abnormalities History: 5-6 days AMS-- waxing/waning alertness and orientation, transient aphasia Motion artifact degraded the examination quality.There is no evidence of acute ischemic or hemorrhagic lesion.Several localized tissue losses involving right external capsule, bilateral basal ganglia and mid Pons area indicating age indeterminate likely chronic lacunar infarcts.Minimal patch high signal intensities on periventricular white matter on FLAIR imaging indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "No evidence of acute ischemic or hemorrhagic lesion on the scan.Several chronic lacunar infarcts involving right external capsule, pons and bilateral basal ganglia as described above."}
{"instruction": "Generate impression based on findings.", "input": "Left thalamic hemorrhage. Also, history of fall with neck injury. BRAIN MRI:The left thalamic hematoma has not changed since the CT scan from yesterday, measures in the axial plane 2.1 cm x 1.3 cm. It shows signal characteristics that are compatible with its early subacute nature (peripherally T1-hyperintense and T2-hypointense). It is surrounded by moderate degree of vasogenic edema resulting in mass-effect on the third ventricle and the posterior limb of the left internal capsule as well as lentiform nucleus, which is not significantly changed also compared to the previous scan. Susceptibility weighted imaging shows multiple other scattered foci of hemosiderin staining in the cerebrum indicative of previous hemorrhages. Many of these are in periventricular and central in distribution.There is multifocal diffusion restriction involving the left external capsule, the parafalcine posterior frontal lobes (left more than right) as well as the right inferior frontal gyrus. In addition, there is diffusion restriction just deep to the posterior aspect of the right cingulate sulcus. There are foci of diffusion restriction in the left cerebellar hemisphere. A tiny focus of diffusion restriction is present in the left hemipons as well. There is diffusion restriction in the inferior fibers of the splenium of the corpus callosum, which likely reflects acute Wallerian generation. In addition, there is symmetric bright T2 and diffusion signal within the middle cerebellar peduncles which shows relatively isointense ADC signal. This may reflect metabolic injury or drug toxicity.Confluent cerebral white-matter T2/FLAIR hyperintense signal without diffusion restriction is compatible with chronic microvascular ischemia. Similar changes are present in the midbrain and pons. The right occipital chronic infarct and the associated leukomalacia as well as cortical laminar necrosis remain unchanged. Multiple scattered chronic lacunar infarcts involving the thalami, basal ganglia, and cerebellum are also not significantly changed. Accounting for mass effect caused by the left thalamic hematoma, the remainder of the ventricular system is mildly dilated reflective of diffuse brain volume loss. There is no brain herniation.There is mild mucosal thickening in the mastoid air cells and paranasal sinuses. There are secretions in the posterior nasopharynx. An esophagogastric tube traverses the right nasal cavity. There is an endotracheal tube through the oral cavity. There is bilateral proptosis without significant orbital abnormality otherwise.CRANIAL MRA:The intracranial internal carotid arteries become irregular in caliber and attenuated in their cavernous segments which probably reflects atherosclerotic involvement. This is more pronounced at the anterior genu of the cavernous segment of the right internal carotid artery which is significantly attenuated. Similar irregularity is present throughout the anterior and middle cerebral arteries and the major branches. This is most pronounced at the proximal A2 segment. A small anterior communicating artery is probably present.The left intradural vertebral artery is very attenuated with segmental complete loss of flow-related signal. The basilar artery and the right vertebral artery show irregularly narrowed caliber but no not flow limiting stenoses, reflective of atherosclerotic involvement. Both posterior-inferior cerebellar arteries are not definitively visualized. The anterior inferior and the superior cerebellar arteries are patent although atherosclerotically narrowed, especially the origin of the right anterior-inferior cerebellar artery. The posterior cerebral arteries are very small, more on the right. The left posterior communicating artery is larger than the associated P1 segment, with a fetal-type PCA. The right posterior communicating artery is not well visualized.Overall appearance has not significant change compared to the previous MRA.CERVICAL SPINE MRI:Alignment is notable for 2 mm of posterior subluxation of C5 relative to C6. The vertebral bodies are preserved in height. Anterior osteophytes are most pronounced at C5-C6 and C6-C7 levels. The intervertebral discs are unremarkable for mild height loss at C5-C6 and relative preservation of the other levels. The spinal canal is moderately to markedly narrowed at C4-C5 and C5-C6 levels. The spinal cord shows no abnormal signal although it is indented by the C5-C6 degenerative disc-osteophyte complex. There is increased T2 signal within and in between the paraspinal muscles along the cervical spines, which is more pronounced on the left, and may represent muscle sprain.C2-C3 and C3-C4: There is shallow anterior indentation of the thecal sac by degenerative disc-osteophyte complex but no significant spinal canal or foraminal stenosis.C4-C5: The disc-osteophyte complex partially effaces the CSF around the spinal cord resulting in mild spinal canal stenosis. There is no significant foraminal stenosis.C5-C6: Disc-osteophyte complex mildly deforms the spinal cord at this level causing moderate spinal canal stenosis. There is mild-to-moderate right and minimal left neuroforaminal stenoses by uncovertebral and to a lesser extent facet arthropathy. C6-C7 and C7-T1: There is no significant spinal canal or foraminal stenosis.There is an incidental finding of a 2.4 cm right thyroid lobe nodule which is heterogeneously T2-hyperintense. The endotracheal tube and esophagogastric catheter are included.", "output": "1.Stable appearance of evolving subacute left thalamic hematoma with surrounding vasogenic edema and localized mass-effect. Multiple other foci of hemosiderin staining are present centrally in the brain reflective of previous hemorrhage as, probably hypertensive in nature.2.Multiple scattered cerebral, left pontine and cerebellar recent infarcts, probably embolic given the multifactorial distribution. Diffusion restriction in the splenium of the corpus callosum is probably acute neuronal degeneration. 3.Symmetric T2 signal in the middle cerebellar peduncles is nonspecific and may reflect metabolic injury or drug toxicity. Alternatively, it may relate to chronic small vessel ischemia.4.Changes of chronic microvascular ischemia, chronic infarcts and global brain volume loss are unchanged.5.Essentially stable MRA head demonstrating multifocal attenuation of the intracranial arteries are reflective of atherosclerotic involvement. The diminutive left vertebral artery might be congenital variation or may reflect severe atherosclerosis.6.Disc-osteophyte complex at C5-C6 mildly deforms the spinal cord but without abnormal signal, reflecting moderate spinal canal stenosis.7.Right thyroid lobe nodule. If further assessment is clinically warranted, thyroid ultrasound is recommended.Dr. Monther Qandeel discussed the above findings with Dr. Tania Rebeiz over the phone on January 3, 2016 at 1505 hours. "}
{"instruction": "Generate impression based on findings.", "input": "Chiari malformation, thoracic lesion, syrinx, follow up. There is slight dilatation of the central canal in the thoracic spinal cord at T4 and T9 to T11, measuring up to 1 mm in diameter. 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 paravertebral soft tissues are unremarkable. The cerebellar tonsils appear to be mildly low-lying on the localizer images.", "output": "Minimal syringohydromyelia in the thoracic spinal cord. "}
{"instruction": "Generate impression based on findings.", "input": "43 years Female (DOB: 7/19/1972)Reason: Please do CSF flow study at foramen magnum, s/p Chiari Decompression Jan 7th History: follow up s/p Chiari DecompressionPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is disc desiccation present at multiple levels.The patient is status post decompression for Chiari I malformation. There is no obstruction at the foramen magnum. There is normal biphasic flow at the level of foramen magnum.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.", "output": "Status post surgery for Chiari decompression. There is no obstruction to CSF flow at the level of the foramen magnum appreciated."}
{"instruction": "Generate impression based on findings.", "input": "Right hand weakness which started 2 weeks ago with prior history of stroke. There is interval appearance of a punctate T2 hyperintense lesion in the left precentral gyrus involving the putative hand center without discernible restricted diffusion. There is unchanged encephalomalacia in the right middle cerebral artery territory involving the frontal, parietal, and temporal lobes. There is also encephalomalacia within the bilateral cerebellar hemispheres, left larger than right. There is scattered patchy high T2 signal in the cerebral and pontine white matter. There are probable enlarged perivascular space in the bilateral basal ganglia. There is no evidence of an acute infarct. There is ex vacuo dilatation of the lateral ventricles superimposed on a background of diffuse cerebral volume loss. There is unchanged susceptibility effect in the left superior frontal gyrus, which is compatible with chronic hemorrhage. There is no evidence of mass, midline shift or mass effect. The imaged paranasal sinuses and mastoid air cells are unremarkable. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "Interval appearance of a punctate lesion in the left precentral gyrus involving the putative hand center may represent a subacute infarct. Otherwise, extensive areas of chronic infarcts in multiple vascular territories."}
{"instruction": "Generate impression based on findings.", "input": "8 days, Male, Reason: is there intracranial hemorrhage? white matter injury? is structure WNL? History: 36 4/7 week with H/O perinatal depression S/P whole body cooling.. Examination is nondiagnostic as only sagittal T1-weighted sequence was obtained. No obvious intracranial mass effect, hydrocephalus, or herniation is appreciated.", "output": "Examination was prematurely terminated after a single sagittal T1-weighted sequence as patient could not tolerate the study. No obvious intracranial mass effect, hydrocephalus, or herniation is appreciated. If clinically indicated suggest obtaining complete study with sedation. "}
{"instruction": "Generate impression based on findings.", "input": "History of meningioma, status post resection. There are stable postoperative findings related to right parietal craniotomy. There is unchanged encephalomalacia in the right parietal lobe along the margins of the resection cavity. There is no evidence of intracranial hemorrhage, mass, or 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 appaer grossly unchanged.", "output": "Stable post-treatment findings without evidence of tumor recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Female, 21 years old, history of GBM. A right parietal resection cavity is again seen without significant change in size or morphology. Mild T2 hyperintensity within the tissues surrounding cavity is unchanged. No pathologic enhancement is seen adjacent to the cavity or elsewhere intracranially. A few scattered small foci of T2 hyperintensity are seen in the cerebral white matter without significant interval change. A small suspected arachnoid cyst is redemonstrated along the left inferior frontal lobe. Ventricular size and morphology are within normal limits.", "output": "Stable postoperative findings with no evidence of tumor recurrence."}
{"instruction": "Generate impression based on findings.", "input": "L knee pain, evaluate for MPFL disruption or other intra-articular pathology, meniscal tear, ACL tear. BONES: The osseous alignment is within normal limits. There is no acute fracture. There is increased bone marrow signal in the lateral femoral condyle compatible with contusion (series 6 image 12).MENISCI: The medial and lateral menisci are normal in morphology and signal.ARTICULAR CARTILAGE AND BONE: Deep fissuring of the medial facet of the patellar cartilage (series 4 image 7), new from prior study. Grade 2/3 chondromalacia of the lateral compartment.LIGAMENTS: The cruciate ligaments and collateral ligaments are unremarkable. There is mildly increased signal on the medial patellofemoral ligament suggestive of sprain (series 4 image 12). The lateral patellofemoral ligament is within normal limits. EXTENSOR MECHANISM: Quadriceps mechanism and patellar ligament are within normal limits.ADDITIONAL", "output": "Deep fissuring of the medial facet of the patellar cartilage, new from prior study.Mild medial patellofemoral ligament sprain.Small joint effusion.Lateral femoral condyle bone contusion."}
{"instruction": "Generate impression based on findings.", "input": "Female, 4 years old. Sickle cell disease with osteomyelitis of the sacrum, 6 week therapy repeat scan. Edema and enhancement of the right sacral ala and right aspect of the sacral promontory are again seen, compatible with osteomyelitis, appearing slightly decreased in this area from the prior study. The right lateral sacrum and vertebral body at the S2 level are homogeneously involved, with decreased involvement on the left at S2. Additional involvement of the bilateral lateral aspects of the sacrum at the S3 level appears similar to prior. Persistent enhancement of the right sacroiliac joint.Edema and enhancement of the medial aspect of the right iliac bone adjacent to the sacroiliac joint.Small volume free pelvic fluid. No discrete fluid collection within the pelvis or soft tissues", "output": "Sacral osteomyelitis with decreased involvement on the left at the S2 level, but otherwise grossly unchanged sacral involvement. New involvement of a small area of the right iliac bone adjacent to the SI joint. Persistent right sacroiliitis."}
{"instruction": "Generate impression based on findings.", "input": "Numbness in feet. 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 a perineural cyst in the left C7-T1 neural foramen that measures up to 9 mm with mild indentation upon the thecal sac. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.", "output": "1. Subcentimeter perineural cyst in the left C7-T1 neural foramen.2. No evidence of significant spinal canal stenosis.3. No evidence of cervical spinal cord lesions."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female with cavernous malformation. Redemonstrated is a patchy subcentimeter area of enhancement in the lateral right putamen associated with a small anomalous vein. There is also a nonenhancing focus of 4 mm susceptibility effect in the medial right putamen. There is no evidence of acute intracranial hemorrhage or acute infarct. As before, there are a few scattered punctate to small foci of T2 hyperintensity within subcortical white matter locations without susceptibility abnormality. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.", "output": "1.Findings suggestive of a subcentimeter right putamen cavernous malformation and associated developmental venous anomaly which are unchanged in appearance. 2.Probable minimal chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o retear ACL graft History: pain and instability Exam is slightly limited secondary to artifact from femoral and tibial tunnels.MENISCI: There is evidence of prior partial medial meniscectomy. There is superimposed abnormal proton density and T2 signal hyperintensity signal in the anterior aspect of the posterior horn of the medial meniscus, which is more pronounced than on the prior study, suggesting a more acute oblique tear, which contacts the inferior articular surface (series 6, image 25). There is persistent abnormal signal hyperintensity in the anterior horn of the lateral meniscus, which was also seen previously, compatible with fibrosis.ARTICULAR CARTILAGE AND BONE: There is grade II chondromalacia in the posterior aspect of the medial femoral condyle. Otherwise, the articular cartilage is intact.There is a 14 x 13 mm osteochondral defect in the posterior aspect of the medial femoral condyle with near complete underlying T2 signal hyperintensity, and evidence of previous repair.LIGAMENTS: There is indistinctness of the anterior cruciate ligament graft along its midportion, which suggests at least partial tear (series 5, image 17).The posterior cruciate ligament is intact. The medial collateral ligament and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1.Indistinctness of the ACL graft along its midportion suggesting at least partial tearing.2.Status post repair of an osteochondral defect in the medial femoral condyle with near complete underlying T2 signal abnormality which suggests there may be a component of partial instability.3.Prior partial medial meniscectomy with evidence of superimposed tear."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old with two recent right breast biopsies showing invasive mammary carcinoma and invasive lobular carcinoma. A patient submitted outside study for review. Submitted for review are breast MRI (7/20/2015) performed at Valparaiso Medical Center. For comparison,standard mammogram (6/29/2015 and 7/8/2015) and ultrasound (7/8/2015) are available. MRI", "output": "Nondiagnostic exam due to artifact resulting in loss of signal in large portions of each breast. A repeat MRI is recommended as clinically indicated.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "64 year old male. Chronic hepatitis C. HCC status post resection. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Cholelithiasis.No suspicious hepatic mass. Previously noted segment 8 arterially enhancing lesion is no longer visualized.Patent hepatic vasculature with a replaced right hepatic artery, representing normal variant anatomy. No biliary ductal dilatation.Small perigastric varices, similar to prior.SPLEEN: Mild splenomegaly measuring 13.8 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney.RETROPERITONEUM, LYMPH NODES: Calcific atherosclerotic disease of the abdominal aorta with an ectatic distal aorta that measures 2.3 cm in AP dimension, similar to prior.Mildly enlarged left periaortic lymph nodes and multiple small gastrohepatic ligament lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel small perineural cysts at neural foramina in the thoracic spine. Mild degenerative changes of the lumbar spine with rightward curve.Post-surgical findings in the anterior abdominal wall.OTHER: No significant abnormality noted.", "output": "Cirrhotic liver morphology with no evidence of recurrence or new suspicious lesion."}
{"instruction": "Generate impression based on findings.", "input": "Male, 62 years old, history of nasopharyngeal carcinoma status post CRT with cranial nerve 12 palsy. Concern for recurrence. Brain:Two or three scattered small foci of nonspecific T2 hyperintensity are evident within the cerebral hemispheres.No restricted diffusion is seen. No evidence of parenchymal edema or mass effect is detected. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is observed.No significant intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits.Neck:Imaging of the neck is somewhat degraded by motion artifact. Within this limitation, the following observations are made.Mild pooling secretions are evident in the nasopharynx, but no mucosal lesion is seen.Mild atrophy of the intrinsic tongue and floor of mouth muscles is suspected on the left. No tongue or tongue base mass is demonstrated. No clear evidence of any focal lesion is seen along the expected course of the hypoglossal nerves.Volume loss in the left neck is likely related to prior therapy, as is infiltration of the fascial planes and scarring, particularly along the left carotid space.No pathologic adenopathy is detected by size criteria. No mass lesion is seen. The visualized salivary glands and thyroid are free of focal lesions.Vertebral body marrow signal characteristics are unremarkable. Mild cervical spondylosis is evident without significant spinal canal stenosis. The visualized spinal cord is unremarkable.", "output": "1.No evidence of intracranial metastases.2.Mild atrophy of the left tongue is suspected.3.No evidence of tumor recurrence, pathologic adenopathy, or any other specific findings are seen in the neck to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Benign neoplasm of brain, unspecified [D33.2], Reason for Study: ^Reason: follow up meningioma resection History: routine imaging following meningioma resection. Post left fronto temporal craniotomy status.Rim enhancing lesions on the left middle cranial fossa with restricted diffusion are again demonstrated. Measured size of each lesion on Gad enhanced axial scan are 14mm x 12mm and 9.9mm x 10.7mm, certainly there is no evidence of growth but no significant interval change since prior scan. Diagnostic possibilities include organized blood products, post-operative changes and the possibility of residual or regrowth of tumor is less likely. High signal intensity lesion on FLAIR/T2 at the right cingulate gyrus with subtle enhancement most evident on sagittal post enhancement scan appears to be stable, no change since prior scan.Encephalomalacia of the left lateral orbital gyrus and the left temporal lobe tip also appear to be stable, no change since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no evidence of acute ischemic or hemorrhagic lesion. 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. Re-demonstration of the left middle cranial fossa rim enhancing lesions. No significant interval change of their size and MR signal characteristics since prior scan. Differential diagnosis include organizing and evolving hematoma, postoperative changes. Possibility of residual or regrowth of tumor would be slim.2. No change of FLAIR/T2 high signal intensity lesion with subtle enhancement on the right cingulate gyrus since prior scan.3. No change of left lateral orbital gyrus and left temporal tip encephalomalacia since prior scan.4. No evidence of acute ischemic or hemorrhagic lesion. "}
{"instruction": "Generate impression based on findings.", "input": "History of brain biopsy, third ventricle and removal of EVD 3/31. Evaluate ventricles. Interval removal of right-sided ventricular catheter. A defect in the right calvarium from prior catheter placement is noted. There is stable enlargement of the lateral, third and fourth ventricles. The previously described mass in the pineal gland is of increased attenuation and measures 2.4 x 2 cm (image 13/36, series 2). When accounting for differences in technique, there is no significant change compared to the prior MRI. Calcification is seen along the superior and left anterolateral aspect of the mass.No evidence of intracranial hemorrhage or edema. No midline shift.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Pineal region mass with associated hydrocephalus. Size of ventricles appears stable compared to the prior MRI."}
{"instruction": "Generate impression based on findings.", "input": "62 year old who is BRCA mutation carrier, with family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old man with left shoulder pain, history of rotator cuff repair in 2008 ROTATOR CUFF: There is a full-thickness tear of the supraspinatus with at least 3 cm of retraction. There is at least a partial, and likely full-thickness, tear of the subscapularis tendon with mild retraction and thickening at the attachment, although a few fibers may remain attached. A small amount of fluid tracks along the infraspinatus tendon, which may relate to the injection of contrast material prior to the MRI. No definite abnormality of the infraspinatus is identified. The teres minor is unremarkable.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Globular signal abnormality in the superior and anterior aspect of the labrum is seen, with an associated linear SLAP tear.BICEPS TENDON: Degenerative changes affect the biceps tendon with internal fluid signal.ADDITIONAL", "output": "Probable SLAP tear and degenerative changes of the labrum. Complete tear of the supraspinatus and subscapularis as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Hip pain, evaluate for labral tear. ACETABULAR LABRUM: There is an abnormal focus of increased signal within the anterior superior aspect of the labrum compatible with a small tear (series 1201, image 3). The remainder of the labrum is intact.ARTICULAR CARTILAGE AND BONE: The bone marrow signal intensity is within normal limits. A small defect within the acetabular articular cartilage at approximately the 3:00 position is thought to represent a pseudodefect rather than a true defect. The remaining acetabular cartilage is intact.SOFT TISSUES: The visualized musculature and soft tissues are within normal limits. ADDITIONAL", "output": "Small tear of the anterior superior labrum."}
{"instruction": "Generate impression based on findings.", "input": "4-year-old male status post chiari decompression January 2016 with syrinx. BRAIN: Postsurgical changes of the posterior suboccipital craniectomy compatible with a Chiari decompression and left cerebellar tonsillar resection. There is now ample CSF space in the neo-foramen magnum. There is now biphasic CSF flow across the ventral and dorsal aspect of the neo-foramen magnum, as well as along the dorsal upper cervical canal.There is no evidence of intracranial hemorrhage, mass, or acute infarct. Focus of asymmetric T2/FLAIR signal abnormality in the periventricular white matter along the posterior body the right lateral ventricle region of the right lateral ventricle, in the area of a terminal zone of myelination, may represent asymmetric variation of myelination versus more likely gliosis given the possible mild volume loss. 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.CERVICAL SPINE: A syrinx is noted at the C5-C7 levels slightly decreased craniocaudal extent now measuring 1.5 cm and measuring 3 mm in AP dimension, previously 8 mm AP. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE: Trace residual prominence of the central spinal canal is noted at the T8 level measuring 1.0 mm in diameter, significantly improved since the prior exam, where the thoracic syringohydromyelia was only partially visualized.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is otherwise of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.", "output": "1.Expected postoperative changes following Chiari decompression, with patent neoforamen magnum and restoration of dorsal biphasic CSF flow at this level.2.Interval decrease in size and craniocaudal extent of a cervical spine syrinx.3.Significant interval improvement of previously partially visualized lower thoracic syringohydromyelia, with trace prominence of the canal at the T8 level."}
{"instruction": "Generate impression based on findings.", "input": "Male, 12 years old, with involuntary abnormal movement. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.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. An incidental developmental venous anomaly is present within the right centrum semiovale.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.", "output": "Unremarkable evaluation with no specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Cervical spine disease. Signs and symptoms: Left facial numbness. Pre and post enhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with mild straightening of lordosis without change since prior exam.There is normal signal intensity and caliber of the cervical cord and upper most visualized thoracic cord.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes and unremarkable otherwise.C4-C5 demonstrate mild degenerative changes with resultant moderate left neural foraminal compromise with subtle interlobar progression and no central spinal stenosis.C5-C6 demonstrate mild to moderate disc disease and loss of disc height, asymmetric left-sided uncovertebral hypertrophy, mild facet and ligamentum flavum hypertrophy. There is no spinal stenosis or neural foraminal compromise and no significant change since prior exam. There is tortuosity of the left dominant vertebral artery which abuts the left neural foraminal at this level similar to prior exam.C6-C7 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. No change since prior exam.C7-T1 is unremarkable.Post enhanced images demonstrate no detectable abnormal enhancement of the vertebral column, cervical and upper visualized thoracic cord or the leptomeninges.", "output": "1.Mild degenerative changes of cervical spine with minimal progression since prior exam as detailed.2.No evidence of central spinal stenosis and single level neural foraminal compromise on the left at C5-C6 as detailed.3.Normal signal intensity and caliber of cervical and upper most visualized thoracic cord without abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: 62-year-old female with metastatic Phyllodes tumor to spine. Signs and symptoms: Back pain. Non-enhanced CT lumbar spine:Examination demonstrate a large destructive lytic lesion involving the vertebral body of L5 on the right with involvement and extension across the right pedicle into the right facet complex and transverse process of L5 vertebrae. The overall length of this lesion measures 56-mm in transverse axis and 37-mm in AP axis. This lesion also partially involve the right lamina. There is partial extra osseous extension of tumor into the right neural foramina at L5 -- S1 and minimally at L4 -- L5. There is no distinct evidence of extension of mass into the spinal canal. For detailed evaluation an MRI is significantly more sensitive for detection of extent of tumor. Minimal bulge of disk, degenerative change and vacuum phenomenon of L4 -- L5 disk is noted. The a small additional separate foci of low-attenuation in the left paramedian of L5 vertebrae is also present. This finding also could represent a small additional metastatic lesion and measures 7-mm times 11-mm in size. Minimal sclerotic changes along the inferior endplate of L2 is believed to be secondary to degenerative changes. No additional lytic or sclerotic metastatic lesions are identified. The alignment of the lumbosacral spine remains within normal.CT of cervical spine:A large lytic / sclerotic destructive bony lesion is noted involving the left aspect of vertebral body of C6 with involvement of left transverse process, pedicle, facet complex and left lamina. The overall transverse axis of this tumor measures 34-mm and 22.5-mm in AP axis. There is small extra osseous spread of tumor into the left paraspinal space. There is shallow epidural spread of tumor along the ventral aspect of the canal on the left and along the lamina on the left. This tumor also appears to involve the left foramina transversarium. The normal alignment of vertebral column is maintained. A very small entirely intraosseous a foci of low density within the anterior aspect of body of C4 vertebrae may also in indicate a second metastatic foci. This lesion measures on the 3.5 x 2.5-mm in size.", "output": "1.Large destructive lytic metastatic lesions of vertebral bodis, pedicles, transverse process and lamina of C6 and L5 as detailed above. There is a small extra osseous spread of tumor into the soft tissues of cervical spine and epidural space of the lumbar spine. Please see above detailed report.2.Possible two very small entirely intraosseous additional metastatic foci.3.The alignment of vertebral column and cervical and lumbosacral spine remains within normal."}
{"instruction": "Generate impression based on findings.", "input": "Male, 37 years old, history of MS, with new right face weakness, left third nerve palsy, left ptosis and bilateral internuclear ophthalmoplegia for two days. Brain:Scattered T2 hyperintense lesions are redemonstrated within the white matter of the bilateral cerebral hemispheres. As before, the largest lesion is present in the right parietal periatrial white matter. There has been no significant interval change in the size and number of these lesions when compared to the prior exams.As before, a very small focus of T2 hyperintensity and questionable restricted diffusion is again seen within the dorsal pons, just to the right of midline along the floor of the fourth ventricle. No significant interval change is seen.No evidence of parenchymal edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is observed. There are no abnormal extra axial fluid collections or evidence of intracranial hemorrhage. The ventricular system remains normal in size and morphology.IACs:The visualized cranial nerves demonstrate normal morphology and are free of pathologic enhancement. The fluid-filled structures of the inner ears demonstrate normal morphology.Orbits:The globes are round and symmetric. The extraocular muscles demonstrate normal morphology and signal characteristics. The optic nerves are normal in course morphology and show no evidence of pathologic focal signal abnormality. Postcontrast images are motion degraded, but within this limitation, no definite pathologic intraorbital enhancement is seen.", "output": "1.Multiple scattered cerebral white matter lesions are redemonstrated, appearing similar to prior examinations and consistent with demyelinating disease.2.A small area of T2 and diffusion signal abnormality is redemonstrated along the dorsal pons, in the location of the medial longitudinal fasciculus. Given the history of MS, this may represent a small demyelinating lesion which could potentially account for the patient's internuclear ophthalmoplegia.3.Within the limitations of imaging artifact, no definite abnormalities of the cranial nerves or orbits are seen."}
{"instruction": "Generate impression based on findings.", "input": "28 year old with history of left ventricular systolic dysfunction and hypertension presenting for evaluation of cardiac function and scar. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVEDV is 193 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19), the LV mass index is 59 g/m2 (normal range 85+/-15), and the LV mass is 132 g (normal range 164+/-36). The left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 90 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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.OtherIn some views, there appears to be a small patent ductus arteriosus but it is not well visualized. Of note, no PDA flow is noted on his echocardiograms. Correlation with physical exam suggested.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. Mildly reduced left ventricular systolic dysfunction (LVEF 52%) without evidence of scar, infarct or inflammation. The LV dysfunction is global. 2. Normal right ventricular size and function (RVEF 51%)3. There is mild mitral and tricuspid regurgitation. 4. In some views, there appears to be a small patent ductus arteriosus but it is not well visualized. Of note, no PDA flow is noted on his echocardiograms. Correlation with physical exam suggested."}
{"instruction": "Generate impression based on findings.", "input": "71 years Male (DOB:11/1/1944)Reason: persistent headache History: headachePROVIDER/ATTENDING NAME: HALINA BRUKNER HALINA BRUKNER The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The patient status post paranasal sinus and nasal cavity surgery with removal of middle turbinates. The maxillary sinuses are relatively small. There is some mucosal thickening present within the maxillary sinuses and ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There is no evidence for intracranial mass lesion or intracranial hemorrhage. 2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Patient status post paranasal sinus surgery."}
{"instruction": "Generate impression based on findings.", "input": "History of prostate cancer. 3+3 right mid medial, 3+3 right Apex medial dated 6/25/2013. PELVIS:PROSTATE:Prostate Size: 2.8 x 5.3 x 5.0 cmPeripheral Zone: No discrete T2-weighted hypointense or restricting lesion to suggest neoplasm. Non-specific linear foci of T2-weighted and ADC hypointensity.Central Gland: There is a large T2 hypointense lesion in the transition zone extending from the apex to the base with abnormal restricted diffusion and avid enhancement with washout. The lesion is best delineated on the restricted diffusion images were measures 2.0 x 2.6 cm (series 604/284). Using similar measurement technique the lesion previously measured 1.7 x 2.6 cm (series 902/324). The lesion appears to extend into a prominent median lobe.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The lesion bulges the anterior margin of the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific external iliac lymph nodes measuring less than 1 cm in short axis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Large transition zone lesion has not demonstrated significant interval change. Carcinoma cannot be ruled out. This lesion would be amenable to MRI/TRUS fusion biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Traumatic hemorrhage of left cerebrum with loss of consciousness of unspecified duration, initial encounter [S06.359A], Reason for Study: ^Reason: eval vasculature History: likely traumatic left splenium ICH Brain MRIThere is linear T1 high signal intensity lesion at the left corpus callosum splenium which is corresponding to the CT high attenuation lesion. The lesion does not show evidence of enhancement and does not show significant susceptibility artifacts either. Surrounding edema cannot be evaluated due to limited image sequences. There is no other hemorrhagic lesion on this scan. Constellation of above findings indicate early subacute parenchymal hemorrhage.There is no evidence of acute ischemic infarction.There is no evidence of abnormal enhancement.The left cerebellar hemispheric DVA is again seen, unchanged since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.No evidence of intracranial arterial aneurysm. No arterial stenosis.Brain MRV3D Phase contrast MRV brain with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.", "output": "1. Linear left corpus callosum splenium lesion most likely represent early subacute parenchymal hemorrhage. No other hemorrhagic lesion is seen.2. No evidence of acute ischemic lesion.3. Normal brain MRA and MRV.Comment: unusual location, unusual shape parenchymal hemorrhage may need further imaging investigation such as catheter angiography. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 4 years old, with tongue fasciculations and left leg weakness status post gunshot wound to the abdomen with extensive blood loss. Concern for hypoperfusion of the medulla. No diffusion restriction is seen. No evidence of edema or mass effect is detected. There are no findings to suggest acute or chronic intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles are normal in size and morphology. The brainstem shows normal signal intensity and morphology.", "output": "Unremarkable evaluation with no specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "bilateral sensorineural hearing loss, developmental delay, and OSA, presenting with a shaking episode. There are multiple scattered foci of T2 hyperintensity in the bilateral cerebral white matter, predominantly in periventricular and subcortical distributions. There is no evidence of intracranial hemorrhage, mass, 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.", "output": "Multiple scattered foci of T2 hyperintensity in the bilateral cerebral white matter are nonspecific, but may represent a sequela of prior ischemia, a demyelinating process, sequela of prior infection, or vasculitis process, for example. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female with personal history of left breast cancer, status post lumpectomy and radiation and hormonal therapy in 2008. Benign right breast biopsy in 2011 with pathology of PASH. There are moderate parenchymal enhancement in right breast and mild in the left breast.RIGHT BREAST:There is no new or abnormal enhancement. There is redemonstration of multiple cysts scattered throughout the right breast. Biopsy clip in the upper inner right breast is again noted. A few nonspecific enhancing foci in the right breast are stable. LEFT BREAST:There is no suspicious enhancement. Postsurgical changes from prior lumpectomy are noted in the left breast. Decreased background parenchymal enhancement is likely from prior radiation therapy.Prominent right axillary lymph nodes are stable. No abnormal lymph nodes are identified in the left axillary region.", "output": "No MRI evidence for malignancy. Postsurgical changes of the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Elevated PSA. Additional history per EMR: PSA 4.1 in April of 2015 and it was 4.6 in June of 2015. It has varied between 2.5 and 3.5 over the last few years. No prior biopsy. PELVIS:PROSTATE:Prostate Size: 5.5 x 4.2 cm.Peripheral Zone: There is a 11 x 5 mm focus of decreased T2 and ADC signal demonstrating mild early enhancement, located in the mid to apical medial portion of the right peripheral zone (series 1201, image 12). No evidence of extracapsular extension.Central Gland: Hypertrophy of the median zone is noted. There are few well-defined nodules, some of which demonstrate decreased ADC and enhancement on postcontrast images, though given well-circumscribed morphology with smooth, round margins, would favor benign nodules (series 1201, image 14). Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: Few prominent subcentimeter right external iliac and inguinal lymph nodes are nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "11 mm right peripheral zone lesion suspicious for neoplasm as described above.Benign prostatic hypertrophy with associated nodules."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are digital mammographic images (5/24/16), images from ultrasound guided biopsy of right breast with specimen radiograph and postprocedural right mammographic images (5/27/2016), breast MRI (6/3/16), ultrasound images (6/9/16) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (5/24/16):The breast parenchyma is extremely dense (BiRADS Density Category D), which limits the sensitivity of the mammogram . A BB marker is placed at upper outer quadrant of right breast, denoting the area of palpable lump.There is a cluster of pleomorphic calcifications at the site of palpable lump in the right breast at upper outer quadrant. The cluster measures approximately 18 mm in AP dimension.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (5/27/2016):An irregularly-shaped, ill-defined hypoechoic mass is detected at 11:00 position in the right breast, measuring 21 x 11 mm. This lesion likely corresponds to the area of pleomorphic calcifications on the mammogram., In addition, there is an ill-defined hypoechoic mass measuring 12 x 7 mm at 10:00 position. This mass is annotated as \"area of pain/area of palp.\" There are a few benign-appearing lymph nodes in the right axilla.Ultrasound guided biopsy for the mass at 11:00 position and 10:00 position in the right breast were performed with an appropriate needle placement. Specimen radiograph demonstrates a single calcification within one of the cores.Postprocedural mammographic images demonstrate a coil clip at 11:00 position, near the cluster of calcifications, and a ribbon clip at 10:00 position in the right breast. Distance between these 2 clips is 23 mm on CC view, and 17 mm on ML view.Per outside radiology report, the pathology results for both sites were malignant.BREAST MRI (6/3/16):MR images were submitted with non-DICOM format, and this could not be processed at our workstation. We tried to upload the images from the original DVD, but again images could not be uploaded to our workstation.Pre and post contrast MR images uploaded to PACS are not interpretable, because only axial images are available and no subtraction images are available. On T2 weighted images and non-contrast T1 weighted images, there are two metallic artifacts, at posterior upper outer quadrant, corresponding to the biopsy clips. There are a few small cysts in the right breast.ULTRASOUND IMAGES (6/9/16):This study was performed for MR directed ultrasound after abnormal findings on the MRI performed 6/3/2016. Per outside radiology report, there was a small focal area of masslike enhancement in the retroareolar region in the right breast. On the provided ultrasound images, there is a simple cyst at retroareolar region, and a complicated cyst next to it. There are no suspicious findings in the ultrasound images.", "output": "Biopsy proven malignancy in the right breast at upper outer quadrant. MRI provided from outside institution is not interpretable. MR directed ultrasound for the right retroareolar region demonstrated a simple cyst with a complicated cyst.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Left shoulder pain. ROTATOR CUFF: There is increased signal intensity within the distal fibers of the supraspinatus muscle compatible with mild tendinopathy. The rotator cuff tendons are otherwise intact. There is no muscle atrophy.SUPRASPINATUS OUTLET: There is minimal osteoarthritis of the acromioclavicular joint. No fluid is noted in the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There are mild degenerative changes of the glenohumeral joint with subchondral cyst formation in the humeral head.The labrum is grossly intact on this non-augmented examination.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL", "output": "Mild supraspinatus tendinopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: h/o lumbar stenosis History: back pain, leg pain, leg numbness Five lumbar type vertebral bodies are presumed to be present. The conus medullaris on sagittal imaging is grossly intact. There is approximate 25% loss of vertebral body height at L2 related to superior endplate compression with a mild retropulsion and there is mild intra-subluxation of L4 on L5. There is multilevel disk desiccation isAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level associated with mild ligamentum flavum and facet hypertrophy.At L4-5 there is diffuse disk bulge associated marked bilateral facet and ligamentum flavum hypertrophy with associated effacement of the fat at the lateral recesses and a moderate to severe degree of spinal stenosis. There is associated narrowing of the neural foramina bilaterally are partial effacement of the fat surrounding the exiting nerve roots within the neural foramina. There is associated mild anterior subluxation of L4 on L5.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level and a minor disk bulge.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a small cyst present in the right kidney measuring 6 mm in diameter.", "output": "1.There is moderate to severe spinal stenosis at L4-5 related to degenerative changes.2.There is a benign-appearing chronic compression fracture at L2."}
{"instruction": "Generate impression based on findings.", "input": "90 year-old female with acute mental status changes. Diffuse periventricular and subcortical white matter hypodensity indicates diffuse small vessel ischemic disease. Prominence of the sulci and ex vacuo dilatation of the ventricles indicates moderate to severe corticomedullary volume loss.Hypodense focus in the left cerebellar hemisphere with an adjacent area of increased attenuation is nonspecific but could represent infarction, tumor, or even blood. A contrast-enhanced CT or preferably an MRI is indicated for further evaluation of this area.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. Hypodense left cerebellar focus with adjacent area of increased attenuation is nonspecific. A contrast enhanced CT or preferably an MRI is indicated for further evaluation of this lesion.2. Diffuse small vessel ischemic disease and volume loss."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female with a history of transverse myelitis, presenting with back pain, numbness/tingling in left leg, imbalance. Assess for demyelination. MRI Brain:Since the prior exam there has been development of multiple new foci of T2/FLAIR signal abnormality in the bilateral subcortical and periventricular white matter, including periventricular lesions perpendicular to the callosum highly suggestive of demyelinating disease. There is no evidence of brain parenchymal enhancement, intracranial hemorrhage, mass, acute infarct, midline shift or herniation. The ventricles and basal cisterns are unchanged in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI T-Spine:The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is a subtle T2/FLAIR signal abnormality involving the posterior aspect of the spinal cord at the T11-12 level which was present previously. There are no new lesions and no pathological enhancement in the thoracic cord. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.", "output": "1.Interval increase in the number of foci of T2/FLAIR signal abnormality in the subcortical and periventricular brain parenchymal white matter including lesions with morphology and distribution highly suspicious for demyelinating disease. 2.Subtle T2/FLAIR signal abnormality within the posterior aspect of the spinal cord at the T11-12 level, most compatible with a chronic demyelinating plaque. No new lesions in the thoracic cord are appreciated.3.No abnormal enhancement in the brain or thoracic cord to suggest active demyelination."}
{"instruction": "Generate impression based on findings.", "input": "A 76 year old male with history of hypertension, hyperlipidemia and coronary artery disease: in a recent hospitalization a left cath showed chronic total occlusion of the left circumflex and 95% of the right coronary artery, a stent was implanted to the RCA. The echocardiography showed normal left ventricular function. Now referred to stress cardiac MRI for further evaluation due to fatigue.MEDICATIONS: aspirin, ticagrelor, metoprolol, ramipril, atorvastatin, tamsulosin. First Pass PerfusionDuring hyperemia, a moderate perfusion defects was present at the base and mid level of the lateral, inferolateral and inferior walls and within the apical lateral wall. The ischemia score is 4/32 (12.5%). Viability/ Myocardial ScarThere was late gadolinium enhancement at the base and mid level of the inferolateral walls, suggesting a prior myocardial infarction. This finding affects more than 50% of the thickness of the myocardium suggesting that is a transmural defect. The rest of the myocardium is viable.Left VentricleThe left ventricle is normal size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 59 ml/m2 (normal range: 74+/-15), the LVEDV is 129 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 43 ml (normal range 47+/-19), the LV mass index is 52 g/m2, and the LV mass is 112 g. There is mild hypokinesis of the basal and mid segments of the inferolateral wall. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 162 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 73 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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. During hyperemia, a moderate perfusion defects was present at the base and mid level of the lateral, inferolateral and inferior walls and within the apical lateral wall. The ischemia score is 4/32 (12.5%). 2. There was late gadolinium enhancement at the base and mid level of the inferolateral wall, suggesting a prior myocardial infarction. This finding affects more than 50% of the thickness of the myocardium suggesting that is a transmural defect. The rest of the myocardium is viable.3. Normal LV size and systolic function (LVEF 67%).4. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Seizure, etiology seen? Signs and symptoms: Seizure. Pre and post enhanced brain MRI:Diffusion weighted images are negative.Examination demonstrates scattered tiny nonspecific foci of FLAIR hyperintensity only in the subcortical and periventricular white matter of the lateral cerebral hemispheres. Findings demonstrate no evidence of hemorrhagic changes or abnormal enhancement and considering patient's stated age of 61 could represent mild chronic nonhemorrhagic small vessel ischemic strokes.The anatomical morphology and the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination of the brain.There is no detectable abnormal parenchymal or meningeal enhancement.Unremarkable images through the orbits and calvarium without abnormal enhancement.All the paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.", "output": "1.Negative diffusion weighted series.2.Scattered tiny nonspecific foci of FLAIR hyperintensity only in the subcortical and periventricular white matter which could represent mild chronic small vessel ischemic strokes.3.Unremarkable pre and post enhanced brain MRI otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Please evaluate for basal ganglia or temporal lesion: Tics and episodes of somatosensory hallucinations. There is no evidence of intracranial hemorrhage, mass, or acute infarct. However, there are multiple punctate scattered cerebral white matter T2 hyperintense foci, with relative sparing of the temporal lobes. The basal ganglia are unremarkable. There is mild cavum septum pellucidum. The ventricles and basal cisterns are otherwise 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": "1. Multiple scattered cerebral white matter T2 hyperintense foci are nonspecific, but may represent sequela of prior infection, vasculitis, toxic substance exposure, or perhaps demyelinating lesions, for example.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct."}
{"instruction": "Generate impression based on findings.", "input": "39 year old male with an atrial septal defect and pulmonary hypertension, referred for cardiovascular MRI to evaluate shunt, Qp:Qs, and possible anomalous pulmonary venous return. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. There is global hypokinesis, and diastolic septal flattening suggestive of volume overload. The overall LV ejection fraction is 28%, the LV end diastolic volume index is 125 ml/m2 (normal range: 74+/-15), the LVEDV is 227 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 165 ml (normal range 47+/-19), the LV mass index is 70 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). There is no late gadolinium enhancement to suggest inflammatory or infiltrative disorder.Coronary ArteriesRight and left coronary artery origins are normal.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 277 ml/m2 (normal range 82+/-16), the RVEDV is 504 ml (normal range 142+/-31), the RV end systolic volume index is 230 ml/m2 (normal range 31+/-9), and the RVESV is 417 ml (normal range 54+/-17).Right AtriumThe right atrium is severely enlarged.Atrial SeptumThere is a large secundum atrial septal defect (30mm x 40mm). There is predominantly left-to-right shunting seen on the first pass perfusion imaging. Velocity-encoded imaging suggestive of bidirectional shunting although net shunt flow could not be reliably quantified. Of note, patient was on supplemental home oxygen. ASD rims: SVC rim = 12 mmIVC rim = 0-1 mmAortic rim = 11 mmPosterior rim = 11 mmAortic ValveThe aortic valve is trileaflet, opens widely, and there is trace aortic regurgitation. Aortic forward flow is 46 mL.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. It is trileaflet. There is mild pulmonic regurgitation. Pulmonary forward flow is 75 mL.Tricuspid ValveThe tricuspid valve opens widely. There is at least 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. No anomalous pulmonary venous drainage noted.Pulmonary ArteryThe main pulmonary artery is severely dilated.MPA measures 38 x 40 mmRPA measures 41 x 42 mmLPA measures 32 x 32 mmVenous 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. Left ventricle is moderately enlarged with severely reduced systolic function (LVEF 28%). There is septal flattening in diastole suggestive of RV volume overload2. Right ventricle is severely enlarged with severely reduced systolic function (RVEF 14%)3. Large secundum atrial septal defect measuring 30mm x 40mm with rims as specified above. 4. Predominantly left to right shunting seen. Qp:Qs = 1.6:15. There is at least moderate tricuspid regurgitation6. No anomalous pulmonary venous drainage appreciated. 7. The main pulmonary artery and both branch PAs were severely dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are breast MRI dated 6/27/2016 performed at Palos community Hospital. Outside hospital MRI uploaded to Dyna CAD for postprocessing and interpretation. As per the report from outside hospital 20 cc of MultiHance was administered intravenously.Fatty breast tissue noted bilaterally. Mild parenchymal enhancement is present.Lobulated enhancing mass at the site of proven right central breast malignancy measures 2.1 x 1.1 cm. Clip artifact is identified within the lobulated mass. Predominantly superior to the enhancing mass, there is an area of fat density with peripheral thin enhancement, compatible with postbiopsy fat necrosis/hematoma. A somewhat nodular area of enhancement at the superior aspect of the fat necrosis is seen though this may represent post biopsy changes rather than tumor. Additionally, about 3 cm lateral and posterior to the known malignancy is a 6 mm intramammary lymph node, with a normal fatty hilum on the fat sensitive sequence and expected enhancement. Within the inferior breast, there are 2 several millimeter sized foci of enhancement that do not meet threshold for kinetic analysis on our system. No suspicious axillary lymph node in either axilla. Normal parenchymal enhancement is noted in the left breast.", "output": "1. Biopsy-proven malignancy in the right breast measures up to 2.1 cm. Adjacent hematoma/fat necrosis is noted.2. Normal sized intramammary lymph node in the right upper outer quadrant has expected MRI appearance on contrast enhanced and fat sensitive sequences.3. A few scattered foci in the inferior right breast do not meet threshold for kinetic analysis and are probably benign. Suggest a 6 month MRI and mammogram follow-up to ensure stability.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Right lower extremity focal seizure and left paracentral lesion on imaging. Preoperative planning. There is no significant interval change in the extent of gyriform and subcortical swelling of the left paracentral lobe without abnormal intracranial enhancement. 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.", "output": "Preoperative planning MRI for a left paracentral lobe lesion."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: eval for vascular abnormality History: syncope, gait instability Brain MRIMotion artifacts degraded exam quality.Especially gradient echo images (venbold) are non diagnostic/There is no evidence of acute ischemic lesion.Patchy FLAIR high signal intensity lesions on bilateral periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRAMotion artifacts significantly degraded image quality.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate patent ICAs, MCAs and ACAs. Vertebrobasilar system appears to be patent.Due to significant motion artifacts, precise evaluation of intracranial arterial system for atherosclerotic changes, mild to moderate luminal stenosis or arterial aneurysm cannot be evaluated.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 80% or higher degree of luminal stenosis on the left carotid bulb and distal left CCA.Bilateral distal vertebral arteries at the level of C1 show about 50% luminal stenosis.Left vertebral artery ostium appears to have more than 70% luminal stenosis. The right CCA and extracranial ICA do not show any significant luminal stenosis.", "output": "1. Motion artifacts degraded exam quality.2. No evidence of acute ischemic lesion. 3. Non specific small vessel ischemic disease.4. More than 80% stenosis of the distal left CCA and left CCA bulb as described above.5. Various degree luminal stenosis of bilateral distal vertebral arteries and left vertebral artery ostium as described above. "}
{"instruction": "Generate impression based on findings.", "input": "65 years, Male, ataxia, rule out new ischemic event.. No restricted diffusion to suggest acute ischemia. No evidence of acute intracranial hemorrhage. No intracranial mass or mass-effect. There is extensive encephalomalacia involving the right frontal lobe extending into the right anterior temporal lobe. Minimal encephalomalacia involving the left inferior frontal lobe also noted. There is mild ex vacuo dilatation of the right lateral ventricle. No hydrocephalus. Minimal foci of susceptibility compatible with chronic blood products are noted in the right frontal and anterior temporal lobes. There are foci of T2 hyperintensity with volume loss involving the globi pallidi which may be related to prior ischemic or metabolic injury. Additional scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There is cystic change/volume loss involving the left lateral aspect of the cervicomedullary junction compatible with prior injury. There is also mild to moderate generalized volume loss involving the cerebral hemispheres as well as of the cerebellar vermis and hemispheres.Paranasal sinuses are grossly clear. There is minimal opacification involving the bilateral mastoid air cells. Major flow-voids are preserved. There is mild deformity involving the bilateral medial orbital walls with medial herniation of fat and slight contour deformity involving the medial recti muscles which is suspected to be related to remote trauma.", "output": "1. No evidence of acute infarct.2. Extensive encephalomalacia in the right frontotemporal lobes favored to be related to prior trauma. Additional foci of signal abnormality and volume loss are seen in the bilateral globi pallidi which may be related to prior ischemic or toxic-metabolic injury. Additional focus of volume loss is seen involving the left lateral medulla/upper cervical cord junction also likely related to remote injury.3. Mild to moderate volume loss involving the cerebellar vermis and hemispheres and to a lesser degree the bilateral cerebral hemispheres. Finding is nonspecific and may be related to antiepileptic medications and/or chronic alcohol use, for example."}
{"instruction": "Generate impression based on findings.", "input": "63 year old male with medial sided left knee pain. MENISCI: There is attenuation of the body and most of the posterior horn of the medial meniscus presumably reflecting changes related to the patient's history of partial meniscectomy. Best seen on coronal image 22 of series 1001, is linear increased signal intensity within the body of the medial meniscus extending to the tibial articular surface, suspicious for a tear. There is also globular increased signal intensity more anteriorly within the body of the medial meniscus that extends to the tibial articular surface, suggestive of degenerative tearing/fraying. Please note, however, it is difficult to determine whether or not these represent tears that existed prior to the patient's surgery without prior imaging for comparison. There is also diffuse signal abnormality within the remainder of the truncated posterior horn with extension to the femoral and tibial articular surfaces. Once again we cannot determine if this represents new or pre-existing tearing, but we see no fluid signal intensity within this portion of the posterior horn to indicate a large unstable tear. Finally, there is a relatively abrupt contour change between the truncated posterior horn and the remainder of the posterior horn near its root, as seen on images 21 and 22 of series 601. While we suspect this is postoperative in etiology , we cannot exclude a tear. There is mild medial extrusion of the body of the medial meniscus. There are parameniscal cysts seen along the posterior aspect of the meniscal body. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is moderate diffuse degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle with several superimposed small near full-thickness and full-thickness articular cartilage defects. There is also mild to moderate thinning of the articular cartilage of the medial aspect of the tibial plateau. There is a subchondral cyst situated centrally and inferiorly within the femoral trochlea with associated near full-thickness degeneration of the overlying articular cartilage. Articular cartilage of the patella appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Abnormalities of the medial meniscus as described above in large part likely reflect postoperative changes, however, there is signal abnormality within the body of the meniscus that extends to the tibial articular surface which is suspicious for tearing. Other findings as described above.2. Degeneration of the articular cartilage of the medial compartment and femoral trochlea.3. Subcutaneous mass along the lateral aspect of the distal thigh that is incompletely imaged on this study and could be further evaluated with a contrast-enhanced MRI."}
{"instruction": "Generate impression based on findings.", "input": "History of inflammatory pseudotumor: worsening headache. There is no significant interval change in the high T2 signal lesion involving the periaqueductal portion of the midbrain, with extension into the bilateral posterior thalami. There is no associated abnormal enhancement. There is a right transfrontal ventricular catheter with mild surrounding gliosis. The ventricles and basal cisterns are unchanged in size and configuration. There are scattered punctate foci of susceptibility effect in the ventricles, which may be related to prior hemorrhage. There is no evidence of acute infarction. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable. There is a left maxillary sinus retention cyst.", "output": "1. No significant interval change in the lesion involving the periaqueductal portion of the midbrain, with extension into the bilateral posterior thalami.2. Unchanged appearance of the shunted ventricular system. "}
{"instruction": "Generate impression based on findings.", "input": "Renal mass. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild diffuse thickening of the adrenal glands bilaterally, without focal masses.KIDNEYS, URETERS: Unchanged size of the 2.1 x 1.5 cm complex T1 hyperintense, T2 hyperintense lesion (series 801, image 15) in the midpole of the left kidney. The multiple thick enhancing septations are unchanged. Additional subcentimeter simple and hemorrhagic cysts are noted in both kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "Unchanged appearance of the complex cystic lesion in the left midpole kidney, again suspicious for a cystic renal cell carcinoma. "}
{"instruction": "Generate impression based on findings.", "input": "History of thoracic astrocytoma treated with chemotherapy: off therapy evaluation. There are postoperative findings in the lower thoracic and upper lumbar spine. There unchanged diffuse expansion and T2 hyperintensity without corresponding abnormal enlacement. There is also persistent significant narrowing of the lower thoracic spinal canal with flattening of the lower thoracic spinal cord. There is unchanged considerable thoracolumbar levoscoliosis and exaggerated kyphosis in the lower thoracic region related to mild wedging of the T7 through T12 vertebral bodies.", "output": "1. Unchanged post-treatment findings and tumor involving the lower thoracic spinal cord.2. Severe stenosis of the lower thoracic spinal canal.3. Unchanged considerable thoracolumbar levoscoliosis."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Metastatic thyroid cancer to bone, brain and lung. Pre-chemotherapy. Signs and symptoms: metastatic thyroid cancer. Enhanced CT of soft tissues of neck:Limited view of intracranial content demonstrates small enhancing metastatic lesion in the left frontal lobe measuring 7-mm times 10-mm. This could be further evaluated on dedicated CT of brain.Images through the skull base demonstrate a lytic lesion in the clivus with no change since prior exam. This lesion has a sclerotic rim. This is believed to represent postoperative changes of the sphenoid sinus with packing material.Cavernous sinuses and bilateral Petrus bones remain within normal limits.Images through the neck and demonstrate no evidence of a mass or pathologic adenopathy. No evidence of residual enhancing thyroid tissue. The esophagus appears dilated and contains air. This may represent reflux. Trachea appears ectatic.CT of brain with enhancement: Lytic changes of clivus with a sclerotic rim and internal calcific fragments remains stable since prior CT of head and neck study and MRI of brain. This lesion believed to represent non-pneumatized sphenoid sinus or may be result of prior surgical inflammation (transphenoidal hypophysectomy) and with packing of the sinus. There is no interval change since prior exams and there is no abnormal enhancement of this finding on MRI examination. Please correlate with patient's past history.Images through the posterior fossa demonstrate a well demarcated low-attenuation within the vermis with no enhancement at the site of previously noted metastatic lesion. Surrounding vasogenic edema still is present. The finding may represent post treated metastatic lesion. This lesion measures approximately 16.2 mm in transverse axis and 14.4-mm in AP axis. This is a smaller than prior measurements of the enhancing mass in this location which measured 21 mm times 18-mm.At enhancing tumor measuring approximately 9 mm times 7-mm in the inferior left frontal lobe with surrounding vasogenic edema is again identified. This mass on prior MRI examination measured 5-mm x 4.5-mm. there is no evidence of any new additional metastatic lesions to the brain or leptomeninges.Calvarium is intact. 65 cc of Omnipaque 350 was utilized for the above studies.", "output": "1.Stable CT of soft tissues of neck with no evidence of recurrence of tumor or pathologic adenopathy in neck.2.Minimally larger left inferior frontal metastatic focus with surrounding vasogenic edema. This lesion measures 7 mm times 9-mm on current exam.3.Patient is known enhancing metastatic lesion in the vermis demonstrates no enhancement on the current exam and measures smaller than prior exam.4.No evidence of new additional metastatic lesion to the brain or calvarium."}
{"instruction": "Generate impression based on findings.", "input": "25 years Female (DOB:6/15/1991)Reason: 3 t scanner ccm protocol, qsm/permiablility assess for cavernomas History: assess for cavernomasPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 3 mm signal hypointense focus present in the right lateral pontine tegmentum adjacent to the origin of the right superior cerebellar peduncle. It is in the expected locations of the right lateral meniscus, spinothalamic tract and central tegmental tract This is associated with a developmental venous anomaly. It has blooming effect on the susceptibility images. No associated lesions are appreciatedNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "Findings are compatible with a small cavernoma located along the right pontine tegmentum near the superior cerebellar peduncle."}
{"instruction": "Generate impression based on findings.", "input": "History of renal cancer status post left nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity without a focal lesion or biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. In the adjacent dorsolateral retroperitoneal space there are several soft tissue nodules that demonstrate postcontrast enhancement, the largest conglomeration of which measures 2.4 x 1.4 cm (series 12 101/2024), slightly increased in size when measured on the prior outside hospital study where it measured approximately 2.2 x 1.1 cm (series 12 image 31). Another discrete nodule more inferiorly measures 8 mm (series 12 101/154), compared to 6 mm previously (series 12 image 41). There is a discrete parasplenic implant on the left lateral transversalis fascia (series 1201/324), increased in size. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: In the lower left lateral abdominal wall musculature there is a 1.8 x 1.0 cm enhancing nodule (series 1201/4), unchanged.OTHER: No significant abnormality noted.", "output": "Status post left nephrectomy with enhancing soft tissue nodularity in the left retroperitoneal compartment along the fascial planes suspicious for residual or locally recurrent disease, slightly increased in size compared to the prior. Nonspecific enhancing soft tissue nodule in the left lateral abdominal wall musculature may represent a site of metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": " There is no evidence of cord compression.There is straightening of the entire spine in the sagittal plane with dextroscoliosis of the lower thoracic spine.Conus terminates at approximate mid-L1 level. There is a diffuse plaque-like T1 hyperintensity along the dorsal thecal sac from the level of L1-L2 that becomes thicker caudally to the end of the thecal sac. The maximal thickness is 9 mm. At the level of L5 there is additional ventral thecal sac T1 hyperintensity. There is corresponding drop out of signal on STIR, suggesting that the intrathecal finding is fat. There does not appear to be true layering of the abnormal signal in the thecal sac to suggest blood products, although axial images are not available.Annular fissure is seen at L4-L5. There is desiccation of the L4-L5 disc. Diffuse desiccation is seen in the cervical disks.", "output": "1. No evidence of cord compression.2. Probably fatty filum/lipoma in the lower lumbar spine. Recommend dedicated lumbar spine MRI on nonurgent basis to include prone imaging for further evaluation.3. Mild spondylotic change of L4-L5."}
{"instruction": "Generate impression based on findings.", "input": "Acute stroke status post TPA. History of well-differentiated colonic adenocarcinoma. There are few punctate foci of restricted diffusion along the medial margin of the otherwise chronic right lateral temporal and inferior parietal infarct, where there is also diffuse susceptibility effect. There are also numerous scattered punctate foci of susceptibility effect in the cerebellum, brainstem, and bilateral thalami. There is diffuse cerebral white matter T2 hyperintensity. There is ex vacuo dilatation of the right lateral ventricle superimposed upon diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a T1 hypointense lesion in the right frontal bone that measures up to 20 mm.", "output": "1. Acute punctate infarcts along the medial margin of the otherwise chronic right middle cerebral artery territory infarct, where diffuse susceptibility effect may represent prior petechial hemorrhages and/or cortical laminar necrosis.2. Diffuse background of what likely represents chronic small vessel disease and scattered chronic hypertensive microhemorrhages.3. A T1 hypointense lesion in the right frontal bone is nonspecific, but may represent metastatic disease. Follow up via MRI with contrast may be useful."}
{"instruction": "Generate impression based on findings.", "input": "44 years, Female, Reason: evaluate uterine fibroids History: heavy periods. PELVIS: FemaleUTERUS, ADNEXA: Uterus is anteverted. There are hypoechoic, enhancing lesions within the uterus which likely represent fibroids including a posterior body lesion measuring 4.3 x 3.1 cm (501/22), posterior body lesion measuring 1.3 x 0.9 cm (501/24), anterior body lesion measuring 4.5 x 2.5 cm (501/23) and anterior body lesion measuring 1.7 x 1.2 cm (501/20). An ill-defined hypoechoic lesion in the fundus measuring 3.1 x 2.5 cm (501/20) likely represents a focal adenomyoma.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Multiple uterine fibroids as above."}
{"instruction": "Generate impression based on findings.", "input": "The patient is a 13-year-old female with history of neurofibromatosis. Cerebellar tumor resection in June 2005. Tinnitus, vertigo, ear pain and decreased hearing. Again seen is hypodensity in the left cerebellar hemisphere partially surrounded by calcified rim which appears unchanged from the prior study. Midline posterior craniectomy defect and postoperative changes in posterior fossa appear similar to the prior study.Ventricular shunt catheter tubing enters the a right frontal approach with tip terminating near midline, also unchanged from the comparison study.There is no evidence of intracranial hemorrhage, mass or edema. The internal auditory canals are normal in caliber and symmetric. However, for evaluation of tumor at this site, MRI is recommended. The cerebral hemispheres, brainstem and remainder of the cerebellum are normal in morphology and attenuation.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": "1. Normal caliber internal auditory canals. For evaluation for possible tumor at this location, we recommend MRI.2. Stable postoperative findings."}
{"instruction": "Generate impression based on findings.", "input": "Female, 67 years old, status post transphenoidal resection of a pituitary tumor in December 2011, yearly surveillance to ensure stability. Redemonstrated is deformity of the pituitary gland associated with low parenchymal volume compatible with surgical alteration, unchanged in appearance. As before. the pattern of glandular enhancement remains somewhat heterogeneous, but again without discrete mass, which is unchanged and likely attributable to surgery. No new or developing lesions are seen. The pituitary stalk sits at midline and enhances normally. Right maxillary sinus inflammation is demonstrated with mucosal thickening and fluid, similar to the prior exam.", "output": "Stable postsurgical appearance of the postoperative pituitary gland without evidence of recurrent lesion."}
{"instruction": "Generate impression based on findings.", "input": "39 year old BRCA mutation with strong family history of breast cancer in maternal grandmother, maternal cousin, paternal grandmother, and paternal aunt. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: h/o newly diagnosed small cell lung cancer; eval for mets prior to beginning urgent chemotherapy History: see above Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Patchy scattered FLAIR/T2 high signal intensities on periventricular white matter and bilateral centrum semiovale indicate nonspecific small vessel ischemic disease.There are several lacunar infarcts seen on bilateral basal ganglia and left side anterior pons.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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 are clear. Left mastoid air cells show fluid collections.Cervical and Thoracic Spine MRIThere are multifocal vertebral body lesions which replacing normal fatty marrow on both cervical and thoracic vertebral bodies including C7, T1, T2, T3, T5, T10, T11 and T12 indicating multifocal metastatic lesions.Specifically, there are associated soft tissue mass left side neural foramen at the level of C7T1 and T12 with large paravertebral likely extrapleural soft tissue mass.There are also multilevel bilateral pleural thickening on thoracic vertebral levels as well as right posterior lobe of the liver indicating possible metastatic lesions.There is no evidence of vertebral body compression fracture on this scan. Cervical spine shows straightening with degenerative changes of cervical spine. In particular, there are disc dessication with disc height decrease at C45, C56 and C67.There is broad based a bit irregular disc protrusion which abuts thecal sac at the level of C34, however, no evidence of bilateral neuroforamen stenosis.Spinal cord signal intensity is normal.There is no evidence of spinal canal stenosis or neuroforaminal narrowing on thoracic spine.", "output": "1. No evidence of metastatic lesion intracranially.2. Multiple vertebral body metastatic lesions involving both cervical and thoracic vertebral bodies with paravertebral soft tissue mass formation at T1 and T2 level as described above.3. Multifocal extra vertebral metastatic lesions including bilateral extrapleural or pleural spaces and right lobe of the liver.4. Degenerative changes of cervical spine C45 to C67."}
{"instruction": "Generate impression based on findings.", "input": "40 year old with history of left modified radical mastectomy in January 2015 for left breast IDC with DCIS and metastatic left axillary lymph node, presents for MRI study. Status post left mastectomy.There is extreme amount of fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in right breast or in the left mastectomy bed. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old man with history of rectal cancer status post resection of left lobe hepatic metastasis, now with new lesions seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Patient is status post partial left hepatectomy. In comparison to 6/2016, there are two new hepatic parenchymal lesions identified. A segment 4 lesion (13/17) measures 17 x 13 mm, has increased peripheral T2 signal, and enhances. In segment 6 at the site of previously seen hypoattenuating liver lesion (13/30) there is a 19 x 13 mm subcapsular T2 hyperintense area which retracts the capsule and does not enhance. No additional focal hepatic lesions are identified.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: Accessory splenule noted, the spleen is otherwise unremarkable.PANCREAS: A few punctate foci of T2 hyperintensity along the pancreatic duct probably represent small sidebranch IPMNs. The pancreatic parenchyma otherwise appears normal. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left renal cysts, the kidneys are otherwise unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: Scarring in the right lower quadrant anterior abdominal soft tissues likely from prior ostomy.OTHER: Along the surgical margin (13/27) there is minimally increased, amorphous T2 and diffusion signal. There is no evidence of enhancement.", "output": "1.Segment 4 lesion suspicious for metastasis.2.Segment 6 surgical defect without evidence of enhancing tumor.3.Signal along the left lobe resection margin nonspecific but may represent postoperative inflammation/scarring."}
{"instruction": "Generate impression based on findings.", "input": " The ventricles and sulci are normal in size. 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. Scattered foci of mucosal thickening can be found throughout the paranasal sinuses, and there is engorgement of the mucosal surfaces in the left nasal vault. The Mastoid air cells are clear. There is no abnormal enhancement within the brain.", "output": "Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's tremor."}
{"instruction": "Generate impression based on findings.", "input": "Male, 12 days old, with left frontal encephalomalacia, IUGR. The ICAs demonstrate relatively normal and symmetric caliber. The right A1 segment is not visualized and may be congenitally hypoplastic or absent. The ACAs and MCAs are visualized to approximately the level of the third order branches and are free of significant focal stenosis or occlusion. Beyond this point, image quality does not permit accurate assessment. The vertebrobasilar system appears within normal limits. The PCAs are not well visualized but this is felt to be technical in nature.", "output": "The proximal intracranial vessels demonstrate a relatively normal and symmetric caliber. The more distal vessels also appear relatively normal to the level of the third order branches. Beyond this point, image quality does not allow for accurate assessment."}
{"instruction": "Generate impression based on findings.", "input": "History of metastatic renal cell cancer, uncontrolled nausea/vomiting, evaluate for intracranial metastases No intracranial mass or abnormal parenchymal or meningeal enhancement is seen to suggest metastatic disease. No diffusion restriction is seen to suggest acute ischemia. Periventricular white matter T2/FLAIR hyperintense foci are compatible with mild small vessel ischemic disease, unchanged from the prior study. Additional T2/FLAIR hyperintense areas are seen in the right putamen/head of caudate and right post central gyrus are likely from prior infarction. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. A small lesion is seen in the right prepontine cistern which follows CSF signal and likely represents an arachnoid cyst, unchanged from the prior study. There is no significant mass effect from this lesion. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the major intracranial vasculature. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Nonspecific enhancing scalp foci are seen in the left parietal and right frontal scalp. This may be secondary to prior inflammation/infection and are unchanged from the prior study. Given their stability, dermal metastases are considered unlikely.A subcentimeter right parotid nodule is present, likely representing a lymph node.", "output": "1. No evidence of intracranial metastatic disease.2. Chronic infarcts involving the right basal ganglia and right post central gyrus. Mild chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with significant ecchymosis and hemarthrosis. Evaluate MCL, ACL, MPFL, patellofemoral articulation. Due to patient's body habitus, the high-definition coil could not be utilized resulting in slightly suboptimal image quality. MENISCI: There is globular signal abnormality within the body and posterior horn of the medial meniscus that appears to extend to the free edge, indicating intrasubstance degeneration with degenerative tearing. The anterior horn appears spared. There is globular signal abnormality within the body of the lateral meniscus, which extends to the free edge, indicating intrasubstance degeneration and degenerative tearing. There is intrasubstance degeneration affecting the posterior horn of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is focal discontinuity of the cortex along the medial aspect of the patella which we suspect represents an avulsion fracture at the site of attachment of the medial patellofemoral ligament. There is mild edema within the underlying medial aspect of the patella as well as mild edema within the anterior aspect of the lateral femoral condyle likely reflecting prior transient patellar dislocation. There is full-thickness cartilage loss along portions of the lateral facet of the patella. The medial facet of the femoral trochlea appears abnormally small relative to the lateral facet, likely representing dysplasia. The trochlear depth appears shallow. There is focal depression of the articular surface of the medial femoral condyle just above the posterior horn of the medial meniscus that may represent an old impaction injury, but this is not associated with edema on this examination. There are small tricompartmental osteophytes.LIGAMENTS: The ACL, PCL, and LCL appear intact. There is a small amount of edema along the medial collateral ligament which may represent a mild sprain, but the ligament itself appears intact. EXTENSOR MECHANISM: The quadriceps tendon appears intact. There is mild increased signal intensity within the medial fibers of the patellar tendon at its patellar attachment, suggesting a sprain injury. The medial retinacular structures are ill-defined with adjacent edema indicating injury. As stated previously, we suspect there is an avulsion fracture of the medial aspect of the patella at the attachment of the medial patellofemoral ligament. The ligament, including its femoral attachment, is not well visualized. There is also slight thickening and edema along the lateral retinacular structures, although we see no gross disruption.ADDITIONAL", "output": "1. Findings indicating prior transient lateral dislocation of the patella, including disruption of the medial patellofemoral ligament and probable medial patellofemoral ligament avulsion fracture at the medial aspect of the patella. There are also findings of femoral trochlear dysplasia.2. Possible mild sprain of the MCL which otherwise appears intact. The ACL appears intact.3. Full-thickness cartilage loss along the lateral facet of the patella.4. Degeneration and degenerative tearing of the menisci.5. Joint effusion and Baker's cyst."}
{"instruction": "Generate impression based on findings.", "input": "History of cavernous hemangioma with recurrent right peripheral blurry vision. There are postoperative findings related to right orbital tumor resection, without evidence of gross tumor recurrence. There is redemonstration of a lamina papyracea fracture with orbital frat herniation and deformity of the medial and inferior rectus muscles. The rest of the right orbital and the left orbital contents are unremarkable. There is a nonspecific punctate focus of T2 hyperintensity in the frontal lobe white matter bilaterally. There are small left maxillary and ethmoid sinus retention cysts.", "output": "1. No evidence of gross tumor recurrence in the right orbit.2. Redemonstration of a lamina papyracea fracture with orbital frat herniation and deformity of the medial and inferior rectus muscles."}
{"instruction": "Generate impression based on findings.", "input": " There are unchanged findings related to left-sided craniotomy with a similar extent of susceptibility effect surrounding the posterior left temporal lobe resection cavity, which likely represents hemosiderin deposition. There is persistent linear branching enhancement in the region of the resection cavity, which likely represents a residual developmental venous anomaly. There is no evidence of acute infarction or hemorrhage. The ventricles and sulci are unchanged in size and configuration. There is no midline shift or mass effect. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.", "output": "Unchanged postoperative findings related to left temporal lobe cavernous malformation resection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "40 year old male patient with abnormal LFTs. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion is identified. No intra- or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable. The hepatic vasculature is patent.SPLEEN: There is an accessory splenule. 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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Unremarkable examination of the upper abdomen."}
{"instruction": "Generate impression based on findings.", "input": "Shoulder pain ROTATOR CUFF: There is mild increased signal intensity of the supraspinatus and infraspinatus tendons indicating tendinosis however there is no discrete fluid-filled rotator cuff tear identified. The supraspinatus muscle is normal in caliber and signal but there is moderate fatty atrophy of the infraspinatus muscle. An ovoid focus of intermediate to low signal is noted within the myotendinous junction of the infraspinatus which may represent old hematoma or heterotopic ossification from an old/chronic tear. The teres minor muscle and tendon are intact. There is mild thickening of the subscapularis tendon reflecting mild tendinosis but there is no evidence of tear. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: There is minimal osteoarthritis of the acromioclavicular joint. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is severe osteoarthritis of the glenohumeral joint with diffuse loss of the articular cartilage of the glenoid. Marrow edema and cystic changes of the glenoid and humeral head are likely degenerative in nature. There is degenerative tearing of the labrum. There is a moderate-sized joint effusion which contains areas of intermediate signal intensity indicating synovitis. There are multiple loose bodies seen anterior to the neck of the scapula. BICEPS TENDON: There is thickening of the biceps tendon at its transition from the rotator interval to the intertubercular groove which indicates tendinosis.", "output": "Severe osteoarthritis of the glenohumeral joint with synovitis and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "56 year old woman with history of palpitations, 1st degree AV block and likely scleroderma, referred for cardiac MRI for further evaluation of possible underlying infiltrative disease. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 70 ml/m2 (normal range: 65+/-11), the LVEDV is 101 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 36 ml (normal range 31+/-10), the LV mass index is 24 g/m2 (normal range 67+/-11), and the LV mass is 24 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying focal or replacement fibrosis, infiltration, or obvious inflammation. Her native myocardial T1-times are borderline elevated (1050-1100ms), which could represent low grade inflammation or fibrosis; however, very little is published about native myocardial T1 times in scleroderma patients and the clinical relevance of this finding is unknown.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 70%, the RV end diastolic volume index is 67 ml/m2 (normal range 69+/-14), the RVEDV is 97 ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). 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. Normal LV size and systolic function (LVEF 65%) without underlying late gadolinium enhancement (i.e. replacement/ focal myocardial fibrosis, obvious inflammation, or infiltration). The native myocardial T1-times are borderline elevated (1050-1100ms), which could represent low grade inflammation or fibrosis; however, very little is published about native myocardial T1 times in scleroderma patients and the clinical relevance of this finding is unknown.2. Normal RV size and systolic function (RVEF 70%).3. Normal pulmonary artery size. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "CNS nocardia, now with numbness and tingling in fingers and visual change. There is an unchanged avidly enhancing mass with susceptibility effect in the splenium of the corpus callosum, which measures up to approximately 25 mm. There is unchanged associated extensive vasogenic edema that extends into the bilateral posterior cerebral hemispheres. There are multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral and cerebellar hemispheres. There is also an unchanged branching area of susceptibility effect in the right pons with associated patchy enhancement and corresponding calcifications depicted on CT. There are unchanged scattered foci of T2 hyperintensity in the cerebral white matter, which may represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. No significant interval change in the lesion within the splenium of the corpus callosum with associated extensive surrounding vasogenic edema may represent stigmata of alleged central nervous system nocardiosis, although other infectious or inflammatory processes versus neoplasm are alternative considerations. MR perfusion and spectroscopy may be useful for further evaluation.2. Unchanged punctate foci of susceptibility effect in the bilateral cerebral and cerebellar hemispheres may also represent stigmata of nocardiosis, but are nonspecific and could alternatively represent chronic microhemorrhages related to amyloid angiopathy, for example. "}
{"instruction": "Generate impression based on findings.", "input": "Male 5 years old Reason: s/p Fontan operation Systemic venous return is into the pulmonary artery. SVC and IVC caliber are normal. There is a functional single ventricle with small, and slightly hypoplastic left posterior ventricle. The apex is forming right ventricle. Right and left AV valves are normal with no significant regurgitation. There is a left aortic arch and aortic arch vessels are branching normally. The ascending aorta is anterior and quite large (25 mm). The main pulmonary artery valve is atretic. Complete Fontan pathway is unobstructed. IVC extracardiac conduit and the SVC connected to the right main pulmonary artery. The SVC is connection is directed towards the left pulmonary artery whereas the SVC connection is more directed towards the right pulmonary artery.No evidence of venous-venous or arteriovenous collaterals.Extracardiac Findings Partial view of the hollow viscus and solid organs of the upper abdomen are normal.", "output": "1. Completely patent Fontan pathway with no evidence of venous or arterial collateralsDr. Peter Varga was present during the elaboration of this report and agrees with the findings. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Assess for cause of severe bilateral leg pain involving calves, thighs, groin. 65-year-old female with metastatic pancreatic cancer. Signs and symptoms: As above. Pre- and post enhanced lumbar MRI:Examination demonstrates multiple osseous metastatic lesion of the thoracolumbar and sacral spine without intravenous fracture or malalignment and without evidence of epidural or paraspinal soft tissue is present. Metastatic lesions are noted in the partially visualized anterior body of and the left pars articularis of T11, large metastatic lesion involving nearly entire vertebral body of L2 and the base of the base of the spinous process, small metastatic lesion in the dorsal inferior midline body of L4, large metastatic lesion involving vertebral body of L5 and extending into the left pedicle, left articulating facet and left transverse process and a large metastatic lesion involving extensively the vertebral body of S1. The lesions demonstrate T1 hypointensity, T2 hyperintensity and with enhancement.Visualized lower thoracic cord, conus and cauda equina demonstrate no detectable abnormal enhancement to suggest metastases.Moderate degenerative changes at L4-L5 and mild bilateral facet and ligamentum flavum hypertrophy as well as bilateral facet effusion results in moderate central spinal stenosis without neural foraminal compromise.No evidence of spinal stenosis at any other level. Degenerative changes at L5-S1 however results in significant bilateral neural foraminal compromise. Partially visualized iliac wings also demonstrate a metastatic lesion on the left measuring approximately at 10 x 15 mm in transaxial dimensions.Findings on this exam were discussed with the clinical service Kwang Jin Choi # 5662 at the time of review of exam.", "output": "1.Multiple intraosseous metastatic lesions involving lower most visualized thoracic spine, lumbar spine and sacral spine as well as left iliac wing detailed above. No evidence of extraosseous spread of tumor.2.No detectable leptomeningeal enhancement.3.Extensive degenerative changes at L4-L5 results in moderate central spinal stenosis without neural foraminal compromise.4.Degenerative changes at L5-S1 results in significant bilateral neural foraminal compromise and without central spinal stenosis.5.No spinal stenosis or neural foraminal compromise at any other level."}
{"instruction": "Generate impression based on findings.", "input": "Assess for cervical spondylosis. Neck pain and stiffness. There is partial fusion of the C6 and C7 vertebrae. Otherwise, the vertebral column alignment is within normal limits and the vertebral body heights are preserved. There are multilevel degenerative changes in the cervical spine with endplate edema and small posterior disc-osteophyte complexes. There is associated mild neural foramen stenosis at C2-3 and C3-4, eccentric to the left. There also appears to be mild left C3-4, right C4-5, and right C5-6 neural foramen stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.", "output": "1. Multilevel degenerative changes in the cervical spine with endplate edema and small posterior disc-osteophyte complexes with associated mild neural foramen stenosis at C2-3 and C3-4 and what appears to be mild left C3-4, right C4-5, and right C5-6 neural foramen stenosis. 2. Partial fusion of the C6 and C7 vertebrae may be congenital in nature. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 22 years old, with seizures, concern for HSV encephalitis. No definite restricted diffusion is seen. A few scattered small foci of FLAIR hyperintensity and questionable DWI hyperintensity within the sulci, including one within the posterior right sylvian fissure, are nonspecific and could potentially be artifactual. Two or three additional punctate foci of parenchymal FLAIR hyperintensity are nonspecific as well.No evidence of edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is observed. No intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. Ventricular size and morphology are within normal limits. The mesial temporal lobes are normally formed, symmetric and free of focal signal abnormality.", "output": "No definite findings are seen to account for the patient's symptoms. A few foci of hyperintense signal involving scattered cerebral sulci are nonspecific and could potentially be artifactual. While a subtle infectious process cannot be entirely excluded, no findings characteristic of an HSV encephalitis are seen on this exam."}
{"instruction": "Generate impression based on findings.", "input": "64 years Female (DOB:7/8/1951)Reason: new right precentral gyrus stroke History: left sided paresis and sensory deficitsPROVIDER/ATTENDING NAME: DAVID A HARTER RICHARD KRAIG MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The MRA exam is mildly degraded due to patient motion.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are small to medium sized. The vertebral arteries are similar in size.", "output": "1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Exam is somewhat degraded due to patient motion artifact which may obscure more subtle abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for effusion vs lipoma at the left knee History: pain, swelling at left knee There is intrasubstance degeneration of the posterior horn of the medial meniscus. Some of the signal extends to the tibial articular surface with associated deformity of the posterior horn indicating degenerative tearing. The lateral meniscus appears intact. No full-thickness or near full-thickness articular cartilage defects are identified. There is a large fluid collection anterior to the patella with foci of low signal intensity internally which likely represents a prepatellar bursitis although a hematoma could be considered, particularly if there is a history of trauma. There are multiple internal septations. There is a small amount of fluid within the deep infrapatellar bursa which is not necessarily of any clinical significance.", "output": "Findings indicating a prepatellar bursitis. Other findings as described."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Unspecified convulsionsClinical question: etiology of new onset seizures The CSF spaces are appropriate for the patient's stated age with no midline shift. There is mild cerebellar atrophy present.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "Mild cerebellar atrophy is a nonspecific finding. There are no intracranial mass lesions or other abnormalities to account for the patient's seizures."}
{"instruction": "Generate impression based on findings.", "input": "Reason: quad tendon rupture. Had prior surgery History: right quad tendon pain MENISCI: There is distorted morphology and abnormal signal morphology of the body of the medial meniscus, best seen on coronal proton density fat saturated images, representing complex tearing. This tearing also extends into the posterior horn, which is attenuated and shows increased undersurface signal intensity. The anterior horn of the medial meniscus appears relatively intact. There is also increased signal intensity along the undersurface of the posterior horn of the lateral meniscus, suggesting undersurface fraying/tearing. ARTICULAR CARTILAGE AND BONE: There is moderate osteoarthritis of the knee, particularly affecting the patellofemoral and medial tibiofemoral compartments, with areas of near-full thickness cartilage loss. There is also delamination of the articular cartilage anterior to the posterior horn of the medial meniscus. There are tricompartmental osteophytes. We see no bone marrow edema. LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral complex are intact. EXTENSOR MECHANISM: There are vertically oriented linear bands of abnormal signal within the patella, which likely represent surgical fixation tracts from prior quadriceps tendon repair. The distal quadriceps tendon is thickened with abnormally increased signal intensity, likely representing a combination of tendinosis and scarring, but we see no fluid signal intensity within the tendon to indicate rupture. Small foci of ossification are noted along the tendon, as seen in prior radiographs. There is linear increased signal intensity within the proximal fibers of the patellar tendon laterally, with edema in the adjacent soft tissues, suggesting a focal tear, that extends from the anterior to the posterior margins of the tendon. We see no rupture of the patellar tendon. ADDITIONAL", "output": "1.Findings of quadriceps tendon repair with tendinosis and scarring of the quadriceps tendon but no evidence of acute rupture. 2.Focal incomplete tear of the proximal fibers of the patellar tendon. 3.Osteoarthritis with medial and lateral meniscal tears. "}
{"instruction": "Generate impression based on findings.", "input": "74 year old woman with AF, referred for evaluation of function prior to ablation. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 25%, the LV end diastolic volume index is 98 ml/m2 (normal range: 65+/-11), the LVEDV is 186 ml (normal range 109+/-23), the LV end systolic volume index is 74 ml/m2 (normal range 18+/-5), the LVESV is 139 ml (normal range 31+/-10), the LV mass index is 53 g/m2 (normal range 67+/-11), and the LV mass is 100 g (normal range 114+/-24). There is global hypokinesis with regional variation. No evidence of myocardial iron overload. There is a moderately increased native myocardial T1 relaxation time along the mid and apical septum, suggesting the presence of fibrosis in these regions. Left AtriumThe left atrium is severely dilated. The LA volume is 219 ml.Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 26%, the RV end diastolic volume index is 121 ml/m2 (normal range 69+/-14), the RVEDV is 223 ml (normal range 110+/-24), the RV end systolic volume index is 90 ml/m2 (normal range 22+/-8), and the RVESV is 170 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Mild aortic valve sclerosis is noted.Mitral ValveThe mitral valve leaflets are thickened and calcified with changes consistent with rheumatic mitral valve disease. The leaflet excursion is significantly restricted and suggestive of at least moderate mitral stenosis. There is additionally at least moderate mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe 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. Small pericardial effusion.Extracardiac FindingsModerate right pleural effusion, small left pleural effusion. Small (<1cm) bilateral axillary lymph nodes. 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. Moderate LV dilation with severely reduced systolic function (LVEF 25%). The native myocardial T1 relaxation time is moderately elevated in the mid to apical septum suggesting the presence of fibrosis in this territory. Late gadolinium enhancement imaging was not performed given patient's renal function. 2. Moderate RV dilation with severely reduced systolic function (RVEF 26%).3. Mitral valve is thickened and calcified with changes suggestive of rheumatic mitral valve disease. The opening of the valve is restricted suggestive of at least moderate mitral stenosis. There is additionally at least moderate mitral regurgitation.4. Severe tricuspid valve regurgitation. 5. Severe biatrial dilation. 6. See extra-cardiac findings. 7. Suggest quantification of severity of valvular heart disease using echo; however, if that is not feasible for some reason, she can be brought back for additional CMR images at no charge to get extra-images needed for quantification of mitral regurgitation and mitral stenosis (Q-flow of aorta, mitral inflow, pulmonary, and planimetry of mitral orifice area at leaflet tips).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " The comparison is limited due to motion on the previous comparison study.Extensive confluent T2 hyperintensity is again evident within the periventricular white matter bilaterally and throughout the thinned corpus callosum. Extensive white matter signal abnormality is also evident within the midbrain, pons, bilateral middle cerebellar peduncles, and medulla. Most of these lesions seem not to have significantly changed, with the exception of an area of FLAIR hyperintensity in the posterior right parietal lobe white matter which appears to be new with associated enhancement along the posterior medial aspect of the lesion (47/11 and 801/52). There is also a ring enhancing lesion in the right frontal lobe (801/61). An additional enhancing punctate lesion is seen in the left corona radiata. Many of the lesions demonstrate T1 hypointensity.", "output": "Extensive white matter lesions consistent with known demyelinating disease, with a new area of FLAIR hyperintensity seen in the right parietal lobe white matter with minimal associated enhancement, consistent with a new area of demyelination. Additional enhancing lesions in the right frontal lobe and left corona radiata consistent with active plaques. Overall, moderate T1 and moderate-severe T2 burden of disease, including infratentorial lesions."}
{"instruction": "Generate impression based on findings.", "input": "64 year old male with a history of coronary artery disease, myocardial infarction, and new onset systolic heart failure who presents today for a second opinion regarding heart failure management. First Pass PerfusionDuring hyperemia, there were perfusion defects in the basal inferior, inferolateral, and inferoseptal walls; the mid inferoseptal, inferolateral, and anteroseptal walls; and in the apical inferior and septal walls.  Viability/ Myocardial ScarThere was transmural myocardial infarction involving the basal anteroseptal wall, mid anterior, anteroseptal, and inferoseptal walls, and the apical anterior and septal walls. The segments are unlikely to be viable. The remainder of the myocardium is viable. Left VentricleThe left ventricle is severely dilated with severely systolic function. The overall LV ejection fraction is 18%, the LV end diastolic volume index is 159 ml/m2 (normal range: 74+/-15), the LVEDV is 343 ml (normal range 142+/-34), the LV end systolic volume index is 130 ml/m2 (normal range 25+/-9), the LVESV is 281 ml (normal range 47+/-19), the LV mass index is 54 g/m2, and the LV mass is 116 g. There is thinning and akinesis of the LAD territory. There is hypokinesis of the remainder of the other other coronary territories. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 53 ml/m2 (normal range 82+/-16), the RVEDV is 115 ml (normal range 142+/-31), the RV end systolic volume index is 21 ml/m2 (normal range 31+/-9), and the RVESV is 44 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 mild 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 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.There is significant amount of ischemia and viability in the RCA and LCx territories.2.There is a very large myocardial infarction in the LAD territory which is not viable. 3.Severely dilated LV with severe systolic dysfunction (LVEF 18%). There is a large akinetic region involving much of the LAD territory.4.Normal RV size and systolic function (RVEF 62%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "55 years, Female, multiple sclerosis, follow-up progression. Paresthesias. Leg weakness. Brain: There are greater than 20 T2/FLAIR hyperintense lesions involving the periventricular and subcortical white matter with a distribution and morphology consistent with known demyelinating disease. Compared to outside MRI from 8/6/2014, no new lesion is demonstrated. Multiple foci of T1 hyperintensity also noted, particularly associated with a periventricular/pericallosal lesions. Multiple infratentorial lesions are also seen including the right dorsal and left lateral pons as well as few foci in the bilateral cerebellar hemispheres. Motion artifact limits evaluation. There is new enhancing focus involving the right parietal lobe, series 4801, image 50, with surrounding confluent FLAIR hyperintensity in the right parietal white matter not significantly changed since prior. Apparent enhancement involving the suprasellar cistern is most likely artifactual. No intracranial mass or mass effect. No hydrocephalus. No midline shift or herniation. There is an enhancing focus involving the right parietal calvarium with intrinsic T1 hyperintensity, likely representing a hemangioma. Bone marrow signal is otherwise within normal limits.Cervical Spine: Multiple T2 hyperintense lesions are seen throughout the cervical cord consistent with demyelinating plaques. There is a relatively large lesion at the C2 level, a small right C2-C3, dorsal C3-C4, ventral C4, left C4-C5, and right C6-C7 lesions. No new lesions within the cervical spine or evidence of pathologic enhancement in the cervical spine is appreciated.Vertebral body heights and alignment are within normal limits. Bone marrow signal is benign. Mild degenerative changes are seen without significant spinal canal or neural foraminal stenosis.Thoracic Spine: There are multiple T2 hyperintense lesions throughout the thoracic cord as seen before. There are more prominent lesions at the right dorsal T2-T3 level with mild volume loss ventral T4-T5, right lateral T7-T8, right dorsal T8, left ventrolateral T8-T9, and right lateral T12. Some of these lesions appear more prominent on the current study which is favored to be related to differences in technique.There is mild loss of height involving the T9 vertebral body compatible with chronic compression fracture similar to prior. Vertebral body heights and alignment are otherwise maintained. No significant spinal canal or foraminal stenosis is appreciated.No significant change in appearance of subcentimeter enhancing lesion involving the T7 vertebral body favored to represent an atypical hemangioma but is nonspecific.", "output": "1. Numerous foci and confluent regions of T2/FLAIR hyperintensity in the supratentorial and infratentorial white matter are consistent with known demyelinating disease and not significant changed since prior. There is a new enhancing focus involving the right parietal lobe, series 4801, image 50, with surrounding confluent FLAIR hyperintensity in the right parietal white matter not significantly changed since prior. 2. Multiple T2 hyperintense lesions throughout the cervical and thoracic cord which allowing for differences in technique are not appreciably changed in the interval. No abnormal enhancement to suggest active demyelination in the spinal cord."}
{"instruction": "Generate impression based on findings.", "input": "62 year old female patient with PSC. Cholangiocarcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Multifocal, irregular stricturing within the intrahepatic right and left biliary ducts is not significantly changed. The common bile duct is irregular with a long segment stricture distally, appearing similar to the prior study. There is mild intrahepatic biliary ductal dilatation. Peripheral T2 hyperintensity in the right hepatic lobe with delayed enhancement likely represents confluent fibrosis. There is mild delayed enhancement of scattered biliary ducts, which is compatible with primary sclerosing cholangitis. No suspicious hepatic lesion is identified to suggest cholangiocarcinoma. The hepatic vasculature is patent.SPLEEN: There is an accessory splenule. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple right renal cysts, including one with a septation, are stable.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.Grossly stable intra- and extrahepatic biliary stricturing compatible with primary sclerosing cholangitis.2.No suspicious hepatic lesion to suggest cholangiocarcinoma. "}
{"instruction": "Generate impression based on findings.", "input": "C5-6 partial laminectomy for cervical decompression and tumor resection. There are postoperative findings related to recent C5-6 partial laminectomy for cervical decompression and tumor resection, with a drain in the right posterior paraspinal surgical bed. There is no longer compression of the spinal cord, although mild deformity and signal abnormality persist. There appears to be residual tumor in the right paraspinal region and within the C5 and C6 vertebrae, which overall measures up to approximately 45 mm and abuts and possibly encases the right vertebral artery, although the flow void remains intact. There is also a residual posterior disc-osteophyte complex at C5-6. There is no vertebral subluxation and the vertebral body heights are essentially intact. There is a bosselated T2 hyperintense mass in the right parotid gland, which measures up to 25 mm. There is a partially imaged posterior mediastinal tumor.", "output": "1. Postoperative findings related to recent C5-6 partial laminectomy for cervical decompression and tumor resection, without residual compression of the spinal cord, although mild deformity and signal abnormality persist. Residual tumor is present in the right paraspinal region and within the C5 and C6 vertebrae, with possible encasement of the right vertebral artery.2. A partially imaged posterior mediastinal tumor likely represents metastatic disease. Please refer to the recent chest CT report for additional details.3. A mass in the right parotid gland, which measures up to 25 mm, may represent a pleomorphic adenoma, although additional metastatic disease is a consideration."}
{"instruction": "Generate impression based on findings.", "input": "Parietal craniotomy for repeat resection of atypical meningioma on 3/8/16. There are interval postoperative findings related to posterior parietal cranioplasty for resection of recurrent meningioma. There is nodular enhancement that measures up to 20 mm in the left posterolateral aspect of the resection cavity and persistent extensive vasogenic edema in the surrounding brain parenchyma. There is mild susceptibility effect and areas of restricted diffusion along portions of the surgical margins related to blood products, as well as regional prominent leptomeningeal enhancement. There is also sulcal prominent susceptibility effect in the right frontal and left parietal lobes, which may represent hemorrhage or cortical vein thrombosis. There is swelling and fluid in the overlying scalp. There are unchanged scattered foci of nonspecific cerebral white matter T2 hyperintensity in the anterior frontal lobes. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are bilateral lens implants. There are persistent secretions in the left frontal sinus.", "output": "Postoperative findings related to repeat parietal convexity meningioma resection with what appears to be residual tumor that measures up to 20 mm in the left posterolateral aspect of the resection cavity and persistent extensive vasogenic edema in the surrounding brain parenchyma."}
{"instruction": "Generate impression based on findings.", "input": "History of metastatic GYN adenocarcinoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. There is susceptibility artifact within the bilateral basal ganglia, likely reflecting mineralization. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. Incidental note is made of cavum septum pellucidum and cavum vergae. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild vessel thickening and fluid signal in bilateral mastoid air cells. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. No evidence of intracranial mass.2. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "29 years, Female, status post trans-sphenoidal hypophysectomy. Examination is mildly motion degraded. Interval postsurgical changes of transsphenoidal hypophysectomy are seen. There appears to be near total resection involving the sellar and right suprasellar mass. There is residual mildly enhancing soft tissue along the right cavernous sinus wall compatible with small amount of residual tumor, with partial encasement of the right cavernous ICA suspected. This tissue measures approximately 6 mm in thickness in the transverse dimension. There is also more avidly enhancing soft tissue along the left lateral aspect of the resection cavity measuring approximately 3 to 4 mm in thickness also compatible with residual tumor, adjacent to normal pituitary tissue. Infundibulum is leftward displaced but improved in the interval. Optic chiasm is well decompressed. Paranasal sinus opacification, particularly the sphenoid sinuses compatible with postoperative change. Brain parenchyma is within normal limits for age. No restricted diffusion to suggest acute ischemia. No other 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. There is edema and enhancement involving the left frontotemporal as well as left lateral suboccipital scalp which may postsurgical.", "output": "Interval postsurgical changes of transsphenoidal hypophysectomy with near total resection of the sellar and suprasellar tumor. Residual tumor is noted in the sella along the lateral aspects of the resection cavity bilaterally with suspected invasion of the right cavernous sinus. The right-sided residual tumor enhances to a lesser degree than on the left which may be related to prior necrosis. Optic chiasm is well decompressed."}
{"instruction": "Generate impression based on findings.", "input": "T4N2c squamous cell carcinoma of the floor of the mouth and ventral tongue status post induction chemotherapy and radiotherapy. There is diffuse edema involving the soft tissues of the lower face/upper neck, including the larynx, which is likely treatment-related. The midline enhancing, infiltrative mass involving the floor of the mouth and the ventral aspect of the tongue has decreased in size, measuring approximately 20 x 25 mm in axial cross-section, previously 25 x 30 mm, and is more necrotic. The associated reference left level 1B pathologic lymph node is also not significantly changed in size, measuring 15 x 19 mm compared to 14 x 20 mm previously. The reference right level 3 lymph node measures 12 mm x 14 mm, previously also 12 mm x 14 mm. The submandibular glands, parotid glands, and thyroid are unchanged. The osseous structures are unchanged. There is a right internal jugular venous catheter.", "output": "The infiltrative tumor involving the floor of the mouth and the ventral tongue has decreased in size. However, the associated cervical lymphadenopathy has not significantly changed in size."}
{"instruction": "Generate impression based on findings.", "input": "Incidental finding of parotid mass seen on sinus CT. There is a well-defined, lobulated cystic lesion with multiple septations in the deep lobe of the left parotid gland, which measures up to 16 mm. The rest of the left parotid gland and other salivary glands are unremarkable. There is no significant lymphadenopathy in the imaged portions of the neck. There is scattered mucosal thickening in the ethmoid sinuses. There is partially-imaged periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is a partially-empty sella. The orbits are unremarkable. There is degenerative spondylosis of the imaged portions of the cervical spine.", "output": "A well-defined cystic lesion with multiple septations in the deep lobe of the left parotid gland, which measures up to 16 mm, may be nonneoplastic versus cystic degeneration of a benign tumor."}
{"instruction": "Generate impression based on findings.", "input": "History of fistulous small bowel Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: The liver dome is not included in the coronal field-of-view. The visualized liver is unremarkable.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: Post-surgical changes from an ileocecectomy with neo-terminal ileum formation. The small bowel is normal in caliber without wall thickening or abnormal enhancement or adjacent inflammatory changes. The bowel demonstrates normal peristalsis on dynamic imaging without any fixed stricture evident. There is no abnormal restricted diffusion. BONES, SOFT TISSUES: Mild rectus muscle diastases. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.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": "No evidence of active inflammation or significant stricture. No fluid collections."}
{"instruction": "Generate impression based on findings.", "input": "Female, 53 years old, with worsening neck pain and history of cervical disc herniation seen in 2009. The cervical lordosis is straightened. Vertebral body heights are preserved. No evidence of pathologic marrow replacement or edema is seen. Signal alteration compatible with the presence of a hemangioma is seen within the T1 vertebral body and right pedicle, unchanged.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural lesions are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Loss of disc height with posterior disc-osteophyte complex formation slightly improved from prior. Minimal flattening of the ventral cord. No significant spinal canal stenosis. No foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation with a small superimposed left paracentral protrusion, slightly increased in size from prior. However, there is no clear impingement of the spinal cord and no significant canal stenosis. The neural foramina are patent. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.", "output": "1.Minimal increase in size of a left paracentral protrusion at C6-7. However, there is no evidence of spinal cord impingement or significant canal stenosis at this level.2.Improvement in the size of a disc osteophyte at the C5-6 level, again without significant spinal canal stenosis.3.The neural foramina are patent throughout.4.No other significant interval changes are seen to account for the patient's worsening pain."}
{"instruction": "Generate impression based on findings.", "input": "Paresthesias. Evaluate for demyelinating disease. There are foci of T2 hyperintensity involving the right dorsal cord at C6-7 and medial dorsal cord at C7-T1. There is an additional, more subtle area of T2 hyperintensity involving the dorsal midline cord at C2. On the sagittal images, there is also subtle signal abnormality involving the T2 level. The cord volume appears maintained. The craniocervical junction is normal. There is kyphotic angulation of the cervical spine at C4-5. The vertebral body heights are preserved. Bone marrow signal is benign. There is disc desiccation from C2 to C5, consistent with disc dessication. There is no spinal canal or neural foraminal stenosis. The paraspinal soft tissues are unremarkable.", "output": "Multiple small lesions in the cervical and partially imaged upper thoracic cord are highly suspicious for demyelinating disease. No comparison studies are available."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Mantle cell lymphoma, lymph nodes of multiple sitesClinical question: assess for leptomeningeal lymphoma The CSF spaces are appropriate for the patient's stated age with no midline shift. There several subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some enlarged perivascular spaces are present in the region of the basal gangliaNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a couple minor opacities The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.", "output": "1.There is no evidence for intracranial lymphoma or leptomeningeal disease.2.There are several subcortical white matter lesions present which are nonspecific and likely of little clinical significance as they are most likely simply age related."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: eval for septic emboli, stroke History: few days ago patient became acutely unresponsive and hypercarbic No evidence of acute ischemic or hemorrhagic lesion.Previously seen middle cranial fossa extra-axial lesion located anterior inferior aspect of the left inferior temporal gyrus is not as conspicuous as it was before due to lack of contrast infusion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. Due to lack of contrast infusion, previously seen left middle cranial fossa extra-axial lesion is not as conspicuous as it was before."}
{"instruction": "Generate impression based on findings.", "input": "24 years, Male, vision loss. There is diminished parenchymal volume centered in the right occipital lobe which is replaced with a cystic cavity that communicates with the right lateral ventricle most suggestive of porencephaly. There is however mild FLAIR hyperintensity within this region suggesting gliosis/encephalomalacia. There is deformity of the overlying gyri favored to represent volume loss related to same injury. There is irregularity involving the cortex of the superior frontal gyrus abutting the superior frontal sulcus, axial T2 image 28, suggesting polymicrogyria but can be better assessed with high-resolution 3-D T1 sequences on 3 Tesla.The splenium of the corpus callosum is small favored to represent Wallerian degeneration. There is mild nonspecific T2/FLAIR hyperintensity involving the periventricular white matter. No evidence of intracranial mass effect, midline shift, or herniation. No hydrocephalus. No evidence of acute ischemia or recent hemorrhage. No abnormal enhancement. Major flow-voids are preserved. Pituitary gland and infundibulum are grossly unremarkable. Extracranial soft tissues are also grossly unremarkable.The optic nerves and chiasm appear small in volume without focal signal abnormalities. Bilateral orbits appear otherwise unremarkable. No masses or abnormal enhancement within the orbits.", "output": "1. Findings are most compatible with sequela of prenatal injury centered in the right occipital lobe where there is a porencephalic cavity communicating with the lateral ventricle.2. Question of polymicrogyria adjacent to the right superior frontal sulcus. Suggest high resolution 3D T1 sequence at 3 Tesla to better assess cortical abnormalities.3. Diminutive caliber of the bilateral optic nerves and chiasm."}
{"instruction": "Generate impression based on findings.", "input": "66 year old female, evaluation for cardiac sarcoidosis Left VentricleThe left ventricle is normal in size with mildly decreased systolic function. The overall LV ejection fraction is 50%. The LVEDV is 148 ml (normal range 109+/-23), LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), LVESV is 74 ml (normal range 31+/-10), and LV end systolic volume index is 33 ml/m2 (normal range 18+/-5). The LV mass is 178 g (normal range 114+/-24) and the LV mass index is 78 g/m2 (normal range 67+/-11). There is presence of concentric hypertrophy, more severe in the lateral wall (measured up to 20mm in end diastole). There are no regional wall motion abnormalities present. There is no convincing evidence of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process on current scanner (3T).The native T1 myocardial relaxation time is not obtainable due to patient movement artifact. Left AtriumThe left atrium is normal.Right VentricleThe right ventricle is normal in size with mildly decreased systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 138 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve is trileaflet, 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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsHepatic and renal lesions are present, as described on prior abdominal CT imaging. Upper lung pulmonary fibrosis and left lung effusion are present, as noted on prior chest CT imaging. 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. Left ventricle is normal in size with mildly decreased systolic function. The overall LV ejection fraction is 50%. There are no regional wall motion abnormalities present. 2. There is no convincing evidence of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process on current scanner (3T).3. There is presence of concentric hypertrophy, more severe in the lateral wall (measured up to 20mm in end diastole). Therefore, an infiltrative process cannot be completely excluded even given absence of delayed hyperenhancement. 4. Right ventricle is normal in size with mildly decreased systolic function. The overall RV ejection fraction is 44%.5. See extracardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "History of Guillain Barre with unilateral right-sided retroorbital headache (sharp pain without radiation) gradual onset, with visual disturbance. There appears to be mildly elevated T2 hyperintensity and perhaps minimal swelling of the left hippocampus. 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, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the left sphenoid sinus.", "output": "1. Incompletely characterized apparent abnormality in the left hippocampus, which may represent encephalitis or perhaps less likely a neoplastic process, for example. Further evaluation via a seizure protocol MRI with contrast may be useful.2. Mild mucosal thickening in the left sphenoid sinus."}
{"instruction": "Generate impression based on findings.", "input": "78 years Female (DOB:5/16/1937)Reason: symptoms consistent with glossopharyngeal neuralgia; please assess CN; RT planning History: RT planningPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The eyeball lenses are thin.At C3-4 there is a disc bulge present associated with posterior ligamentous hypertrophy and spinal stenosis.", "output": "1.No intracranial mass lesion is appreciated. The T2 exam is mildly degraded due to patient motion and the exam is limited for the purposes of treatment planning.2.Findings are suggestive of spinal stenosis at the C3-4 level. If clinically appropriate. Imaging of the cervical spine may be of further benefit."}
{"instruction": "Generate impression based on findings.", "input": "History of Crohn's disease and nausea vomiting and diarrhea. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. The liver is normal in morphology, size and signal intensity. No suspicious lesion or biliary ductal dilatation.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: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained. The terminal ileum is well seen.The small bowel is normal in caliber and wall thickness without abnormal signal intensity, restricted diffusion, postcontrast enhancement or adjacent inflammatory changes such as mesenteric vessel engorgement or fibrofatty perforation.No fixed luminal narrowing or associated prestenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.No free fluid or loculated fluid collection.The colon is normal in caliber and wall thickness without adjacent inflammatory changes, improved from prior.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained. The terminal ileum is well seen.The small bowel is normal in caliber and wall thickness without abnormal signal intensity, restricted diffusion, postcontrast enhancement or adjacent inflammatory changes such as mesenteric vessel engorgement or fibrofatty perforation.No fixed luminal narrowing or associated prestenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.No free fluid or loculated fluid collection.The colon is normal in caliber and wall thickness without adjacent inflammatory changes, improved from prior.BONES, SOFT TISSUES: Demonstrated again is a transsphincteric fistula extending from the 4 o'clock position into the left ischioanal fossa associated with a small subcentimeter collection. It splits anterolaterally towards the left obturator muscle and posteromedially to the skin in the midline, unchanged from the prior. There is minimal thickening of the rectum compatible with mild active disease.OTHER: No significant abnormality noted.", "output": "1.Previously improved descending/sigmoid colon wall thickening and enhancement has improved. No specific evidence of active bowel inflammation, fibrostenotic or sinus/fistulous disease. 2.No significant change in the left ischioanal fistula with a small abscess as described above."}
{"instruction": "Generate impression based on findings.", "input": "44 year old woman with NICM, referred for evaluation of underlying scar. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 6%, the LV end diastolic volume index is 130 ml/m2 (normal range: 65+/-11), the LVEDV is 328 ml (normal range 109+/-23), the LV end systolic volume index is 123 ml/m2 (normal range 18+/-5), the LVESV is 309 ml (normal range 31+/-10). LV dysfunction is global with regional variation. The delayed enhancement images are non-diagnostic, thus determination of late gadolinium enhancement is not possible on this study. Morphology of the left ventricle myocardium is sugegstive of LV non-compaction. There is an extensive LV thrombus present in the apex as, but also extending up the walls of the LV to the mid LV cavity.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 10%, the RV end diastolic volume index is 87 ml/m2 (normal range 69+/-14), the RVEDV is 219 ml (normal range 110+/-24), the RV end systolic volume index is 79 ml/m2 (normal range 22+/-8), and the RVESV is 197 ml (normal range 35+/-13). Right AtriumThe right atrium is mild-moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve is not well visualized.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is not well visualized.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is not well visualizedVenous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLeft chest ICD present. 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. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 6%. LV dysfunction is global with regional variation. 2. The right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 10%. 3. There is an extensive LV thrombus present in the apex as, but also extending up the walls of the LV to the mid LV cavity.4. Morphology of the left ventricle myocardium is suggestive of LV non-compaction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with widespread Gleason 3+4 = 7 prostate cancer. Evaluate for surgical planning.Per pathology report: Prostate, left lateral mid; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+3=6.Prostate, left lateral apex; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+3=6.Prostate, left medial base; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+3=6.Prostate, left medial mid; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+4=7.Prostate, right lateral base; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+4=7.Prostate, left base lateral; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+4=7.Prostate, right medial base; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+3=6.Prostate, right medial mid; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+4=7. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.3 cm.Peripheral Zone: There are multiple lesions demonstrating T2 hypointensity with corresponding low ADC signal and enhancement consistent with patient's known adenocarcinoma. Left base lesion measures 0.8 x 0.8 cm (series 1601, image 18). Midline mid gland lesion measures 1.2 x 0.8 cm with mild capsular bulging (series 1061, image 17). Right apex lesion measures 0.5 x 0.4 cm (series 1601, image 12). Additionally, there are regions of T1 hyperintensity in the peripheral zone consistent with post-biopsy hemorrhage.Central Gland: The central gland is mildly heterogeneous consistent with benign nodules.Seminal Vesicles: The seminal vesicles are unremarkable.Extracapsular Extension: No evidence of extracapsular extension or perineural spread.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple prostatic lesions as above consistent with known adenocarcinoma without evidence of extracapsular extension."}
{"instruction": "Generate impression based on findings.", "input": "T4aN2cMx cancer of the oral cavity. There is an infiltrative oral tongue mass that spans the midline and measures up to approximately 5 cm. The tumor extends along the anterior floor of mouth and gingiva, with invasion of the mandible. The tumor does not invade the masticator space, pterygoid plates, or skull base. There is no evidence of internal carotid artery encasement. There are multiple abnormal suprahyoid lymph nodes bilaterally. For example, a right level 1 lymph node measures 29 x 49 mm in axial cross-section and a left level1 lymph node measures 11 x 20 mm in axial cross-section. The right submandibular gland is compressed and perhaps even invaded by the adjacent lymphadenopathy. The other salivary glands are intact. The thyroid gland is unremarkable. There is multilevel degenerative cervical spondylosis. The imaged intracranial structures are unremarkable.", "output": "1. The oral cavity squamous cell carcinoma measures up to 5 cm and involves the oral tongue, the anterior floor of mouth, and gingiva, with invasion of the mandible. 2. Multiple bilateral suprahyoid lymph nodes are compatible with metastases."}
{"instruction": "Generate impression based on findings.", "input": "History of tuberous sclerosis and seizures of increased frequency. There is a unchanged 7 mm avidly enhancing lesion at the grey-white matter junction along the anterior right superior frontal sulcus with associated surrounding T2 hyperintensity. There are postoperative findings in the right parietal lobe with unchanged associated scattered punctate foci of susceptibility effect and linear T2 signal abnormality surrounding the resection cavity, which likely represents gliosis and encephalomalacia. There is also unchanged linear T2 hyperintensity in the right forceps minor region. 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 unchanged.", "output": "1. Unchanged enhancing lesion in the right superior frontal sulcus grey-white matter junction, which may represent a hamartoma or perhaps a neoplasm associated with underlying transmantle dysplasia.2. Unchanged postoperative findings in the right parietal lobe.3. Unchanged signal abnormality in the right right forceps minor region, which likely represents transmantle dysplasia with radial migration band."}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old Reason: eval for lesions, assess hepatic vessel patency History: cirrhosis, s/p liver and kidney transplant 4/05 ABDOMEN:LIVER, BILIARY TRACT: Allograft liver with lobulated contour and heterogenous signal intensity consistent with chronic liver disease. No focal hepatic lesions are identified. There is no significant biliary ductal dilatation, decreased from prior. The common bile duct measures up to 5 mm in diameter. The hepatic vasculature appears patent. There is once again mild narrowing at the portal vein and hepatic artery anastomoses appearing similar to prior.SPLEEN: The spleen is normal in size measuring up to 11.0 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Severely atrophic kidneys with multiple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the spine.OTHER: Transplant kidney is partially visualized in the right iliac fossa.", "output": "1.Allograft liver with signs of chronic liver disease without focal lesion. 2.Patent hepatic vasculature with mild anastomotic narrowing appearing similar to prior. 3.No significant biliary ductal dilatation, improved from prior. "}
{"instruction": "Generate impression based on findings.", "input": "20 year-old female with pain status post fall and trauma to head and positive loss of consciousness. There is no evidence of intracranial hemorrhage, mass or edema. A nonspecific focus of low attenuation is present within the white matter just adjacent to the right frontal horn which appears to represent encephalomalacia. This is nonspecific and of unknown etiology. Correlation with clinical history and possibly further evaluation with MRI as clinically indicated to further determine etiology.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.CERVICAL SPINE: There is minimal straightening of the visualized cervical spine secondary to positioning for the examination. Cervical spine alignment is within normal limits without evidence of spondylolysis or spondylolisthesis. Vertebral body heights and intervertebral disk spaces are within normal limits. The pre-and paravertebral soft tissues are within normal limits. The airway is patent.Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no evidence of spinal canal stenosis. If there is clinical concern for spinal cord or ligamentous injury, an MRI may be considered.", "output": "1. No evidence of fracture or intracranial hemorrhage.2. Normal cervical spine without evidence of fracture or malalignment.3. Focus of low attenuation adjacent to right frontal horn appears to represent encephalomalacia. This is nonspecific and of unknown etiology. Correlation with clinical history and possibly further evaluation with MRI as clinically indicated to further determine etiology."}
{"instruction": "Generate impression based on findings.", "input": "65 years Female (DOB:12/5/1950)Reason: hx cervical fusion. eval for stenosis above/below or abnormality History: neck spasms, shooting neck pain to occiputPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. The patient status post anterior fusion from C4 through C7 using anterior plate and screws. This partially obscures visualization from C4 through C7 especially the neural foramina.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a disc bulge present associated with some endplate and uncovertebral osteophytes and effacement of spinal fluid anterior and posterior the spinal cord. There is narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots bilaterally within the neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal .At C5-6 there is no significant compromise to the spinal canal .At C6-7 there is no significant compromise to the spinal canal .At C7-T1 there is no significant compromise to the spinal canal or neural foramina.Some T2 signal hyperintensity is present within the brainstem on T2 imaging. The right vertebral artery flow voids very small and not readily perceptible distally. There is also on MRI internal auditory canals from 4/11/2016 which also demonstrates loss of the vertebral artery flow-void proximal to the right posterior inferior cerebellar artery origin.", "output": "1.Status post cervical spine anterior fusion from C4 through C7. There is a mild to moderate degree of spinal stenosis present at C3-4 associated with encroachment of the exiting nerve roots within the neural foramina bilaterally at this level.2.Findings are suspicious for occlusive disease involving the right vertebral artery. If clinically appropriate additional imaging of the right vertebral artery may be of benefit. Please note that there is a prior MRI of the internal auditory canals which also demonstrates right vertebral artery occlusive disease3.There are T2 signal changes within the brainstem which are suspected to be vascular related."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Secondary malignant neoplasm of brainClinical question: 61 yo M with metastatic thyroid cancer to brain s/p SRS to L putamen and L posterior parietal resection cavity, known R frontal lesion; eval for progression and new mets The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left parietal craniotomy for left parietal lobe surgery. There is redemonstration of some susceptibility effect along the medial aspect of the left parietal lobe within the precuneus where there was previously a mass. There is no evidence for local recurrence at this time.There is a punctate focus of enhancement present along the anterior aspect of the left putamen. It measures currently 3 mm in diameter and previously measured 5 mm in diameter. It is associated with susceptibility effect. There was also identified in the 7/13/2015 exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.The patient status post left-sided craniotomy for removal of a left precuneus mass. There is no evidence for local.2.There is redemonstration of a tiny lesion in the left putamen which appears smaller on the current exam and is now associated with susceptibility effect. This susceptibility effect is likely treatment related.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Novack is a 47 year old female with a strong family history of breast cancer in mother (diagnosed at the age of 42) and maternal grandmother (diagnosed at the age of 43). There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable intramammary lymph node of the left medial breast, far posterior depth. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram. "}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with known degenerative disc disease presents with arm and leg weakness. Evaluate for cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is multi-level degenerative disc disease with associated narrowing of the central spinal canal, most pronounced at C7-T1. However, there is no evidence of acute cord compression.", "output": "1. No acute cord compression. Please note that this is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. 2. Multi-level degenerative disc disease, most severe at C7-T1."}
{"instruction": "Generate impression based on findings.", "input": "Small cell lung cancer, restaging and consideration of prophylactic cranial radiation . There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse cerebral white matter T2 hyperintensity bilaterally. There are also small areas of encephalomalacia in the bilateral cerebellar hemispheres. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The right internal carotid artery aneurysm is better depicted on the prior MRA. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. No evidence of intracranial metastases.2. Chronic small vessel ischemic white matter disease and chronic bilateral cerebellar hemisphere lacunar infarcts.3. The right internal carotid artery aneurysm is better depicted on the prior MRA. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable."}
{"instruction": "Generate impression based on findings.", "input": " Brain MRI:The ventricles and sulci are normal in size. 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. The paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions, arteriovenous reformations, or aneurysms are identified. Incidental note is made of a tiny fenestration involving the proximal basilar artery. The right superior cerebellar artery appears diminutive and irregular with time-of-flight technique, however it normally fills with contrast and has a normal appearance on subsequent contrast enhanced neck MRA.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified. There is irregularity of the right subclavian artery distal to the right vertebral artery origin.", "output": "1.Negative MRI of the brain including gadolinium enhancement.2.Negative MRA of the brain.3.There is irregularity of the right subclavian artery distal to the right vertebral artery origin. Dedicated subclavian artery CT angiography is recommended to better characterize this finding, in this location, as well as to assess the adjacent soft tissues for possible impingement."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral lower extremity weakness, left more than right. Back pain and history of L4-L5 disc herniation. There is also currently suspicion of ALS. At L4-L5, a disc bulge with a right paracentral protrusion mildly narrows the right subarticular recess. The disc bulge and moderate facet arthropathy also result in mild-to-moderate right and mild left neural foraminal stenosis. The right facet arthropathy is associated with minimal fluid and synovial contrast enhancement. There is no significant spinal canal or foraminal stenosis at T12-L1, L1-L2, L2-L3, L3-L4, and L5-S1. The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is no abnormal spinal cord or nerve root contrast enhancement.", "output": "Mild L4-L5 degenerative spondylosis is associated with right paracentral disc protrusion and mild-to-moderate right and mild left neural foraminal 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": "Female; 61 years old. Reason: 61 yo with cirrhosis please screen for HCC ABDOMEN:LIVER, BILIARY TRACT: Diffuse nodular surface contour, compatible with cirrhosis. No suspicious hepatic lesions. No biliary ductal dilatation. Hepatic and portal veins are patent.SPLEEN: Splenomegaly. Thin, curvilinear area of increased delayed enhancement at the anteroinferior aspect of the spleen (series 10/52) with no restricted diffusion, suggestive of benign etiology such as scar tissue and similar to prior studies dating back to 9/18/13.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left midpole renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Stable mild gastrohepatic lymphadenopathy, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of abdominal ascites.", "output": "1.Cirrhotic liver sequela of portal hypertension including splenomegaly and mild ascites. 2.No suspicious hepatic lesion. 3.Probable scar tissue adjacent to the spleen."}
{"instruction": "Generate impression based on findings.", "input": "History of prostate cancer. PELVIS:PROSTATE:Prostate Size: 3.4 x 5.1 x 4.7 cmPeripheral Zone: In the left medial base there is a 5 x 5 mm focus of T2 weighted hypointensity (series 901/18) with associated restricted diffusion (series 704/344) and equivocal arterial enhancement suspicious for a site of prostatic adenocarcinoma. No additional suspicious lesion. The peripheral zone is somewhat heterogeneous on T2-weighted imaging.Central Gland: Mild changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic tumor extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific left obturator 6 mm lymph node. Nonspecific subcentimeter inguinal lymph nodes. BONES, SOFT TISSUES: Fat containing left greater than right inguinal hernia.OTHER: No significant abnormality noted.", "output": "1.5 x 5 mm focus in the left medial base peripheral zone suspicious for site of prostatic adenocarcinoma. No additional suspicious lesion.2. No evidence of seminal vesicle invasion or extraprostatic tumor extension. Nonspecific 6 mm left obturator lymph node."}
{"instruction": "Generate impression based on findings.", "input": "Right hip pain. No improvement with injection. Evaluate for AVN. ACETABULAR LABRUM: There is increased signal intensity within the superior labrum suggestive of a tear.ARTICULAR CARTILAGE AND BONE: There is superior and medial joint space narrowing of the right hip joint. There is near complete loss of the articular cartilage with underlying acetabular reactive edema.Bone marrow signal within the right femur is within normal limits.Metal artifact from a left total hip arthroplasty device obscures visualization of the left hip.SOFT TISSUES: No significant abnormality noted. ADDITIONAL", "output": "1. Moderate to severe right hip osteoarthritis without evidence of AVN. 2. Probable superior labrum tear. "}
{"instruction": "Generate impression based on findings.", "input": "Gross hematuria. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in contour and morphology. No biliary ductal dilatation. Cholelithiasis, without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The bilateral kidneys are atrophic and contain multiple simple cysts. No suspicious lesion identified. No filling defect identified within the ureters. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Residual thoracoabdominal aneurysm, incompletely imaged. Status post abdominal aortic aneurysm measuring up to 4.6 cm, with iliac grafts. Persistent occlusion of the internal mesenteric artery.PELVIS:Motion artifact limits evaluation of the pelvis.PROSTATE/SEMINAL VESICLES: The prostate is enlarged measuring 5.5 x 5.2 cm. Canal prosthesis.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Avascular necrosis of the right femoral head.OTHER: Left inguinal inflammatory changes.", "output": "1.No renal or bladder mass identified. No filling defect identified within the ureters. Etiology of hematuria not evident.2.Enlarged prostate.3.Patent iliac grafts. Residual abdominal aortic and thoracoabdominal aortic aneurysms.4.Avascular necrosis of the right femoral head."}
{"instruction": "Generate impression based on findings.", "input": " There is mild scoliosis of the thoracic spine, otherwise alignment is within normal limits. There is mild concavity at the superior endplate of T4 vertebral body, likely chronic given lack of edema. Otherwise, the vertebral body and disk heights are well-maintained. The scout image demonstrates endplate degenerative marrow signal changes at L4-L5 level which is better visualized in the prior lumbar spine MRI.There are T1 hypointense foci adjacent to the superior endplate of T8 and T11 vertebral bodies, which demonstrate slightly increased T2 signal and associated enhancement, compatible with recent or developing Schmorl's nodes. No worrisome focal marrow signal abnormalities appreciated. The spinal cord is of normal caliber and signal. There is no pathological intraspinal enhancement .There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.", "output": "1. Evidence of possible acute Schmorl's nodes adjacent to superior endplates of the T8 and T11 vertebrae, which could potentially account for patient's symptoms.2. Mild concavity of the superior T4 endplate which appears to be chronic in nature. No other significant abnormalities in the thoracic spine."}
{"instruction": "Generate impression based on findings.", "input": "83 year old female status post partial simple mastectomy, stage V chronic kidney disease on dialysis and diabetes, hypertension and anemia. Evaluate for possible CVA. There is no evidence of intracranial hemorrhage, mass or edema. Note is made of bilateral basal ganglia calcifications. Diffuse hyperdensity in the periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.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": "Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: Eval GBM. 1 mo post-RT MRI.Signs and Symptoms: GBM.Comments: GBM. 1 mo post RT. | There is an 80 by the 2 mm mm sagittal dimension heterogenously enhancing mass in involving the deep white matter of the right frontal lobe and the adjacent subcortical white matter of the right parietal lobe . This previously measured 61 x 40 mm sagittal dimensions. There is adjacentT2/FLAIR signal hyperintensity compatible with vasogenic edema in an area measuring 118 x 59 mm mm axial dimensions. This previously measured 97 x 62 mm axial dimensions. There are satellite foci of enhancement in the adjacent brain. There is susceptibility effect within the mass. There is T2 signal hyperintensity present in the right midbrain and pons on the current exam which was not clearly present on the prior. There is associated mass effect with approximately 13 mm shift of the midline towards the left on the current exam which was approximately 11 mm on the prior exam. There is associated uncal herniation which was also previously present. There is also associated dilation of the left lateral ventricle associated with subfalcine herniation and there is a mild degree of transtentorial herniation also present.The patient is status post recent right sided craniotomy. There is an underlying subdural collection measuring up to 5mm thickness.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The distal right vertebral artery appears to be hypoplasticThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Since the prior exam the patient's right hemispheric mass consistent with glioblastoma has enlarged and is associated with more mass effect on the current exam versus the prior exam. There is associated uncal, transtentorial and subfalcine herniation present. There appears to be some infiltration into the right upper brainstem on the current exam which was not previously present.2.A right-sided subdural collection is now smaller on the current exam."}
{"instruction": "Generate impression based on findings.", "input": " The previously demonstrated focus of restricted diffusion in the left corona radiata has resolved. The focus along the right posterior body of the corpus callosum has decreased in conspicuity. There may be subtle FLAIR hyperintensity in these locations. In addition, there is stable minimal nodularity along the left lateral atrial margin, also without corresponding enhancement or susceptibility (1101/80). Diffusion-weighted images do not demonstrate T2 shine through in this location. There are numerous foci of punctate susceptibility scattered throughout the brain parenchyma, most conspicuous along the right greater than left temporal and right occipital lobes peripherally, which are unchanged indicating prior microscopic hemorrhage.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. Extensive patchy abnormal T2/FLAIR hyperintensity is again seen throughout the periventricular and subcortical white matter, including anterior temporal tips, as well as the brainstem. Evidence of chronic lacunar infarcts are present along the basal ganglia bilaterally. No extra-axial fluid collection is identified.The right vertebral artery flow-void remains absent. Normal flow-voids are otherwise demonstrated in the major intracranial vascular structures. Incidental partially empty sella is again noted. The remainder of the midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening throughout the paranasal sinuses. There is at least moderate narrowing of the upper cervical spinal canal", "output": "1.No evidence of acute infarct. Normalized diffusion restriction in the left corona radiata and reduced diffusion hyperintensity in the right corpus callosum since 10/27/2016. 2.Persistent minimal nodularity along the left lateral atrial margin that demonstrates gray matter signal on all sequences may represent a small area of subependymal heterotopia.3.Redemonstration of extensive white matter disease with multiple areas of prominent chronic lacunar infarct. Findings again may represent advanced small vessel ischemic changes, although other possibilities such as CADASIL remain within the differential."}
{"instruction": "Generate impression based on findings.", "input": "Disorientation, unspecified [R41.0] / Other abnormalities of gait and mobility [R26.89], Reason for Study: ^Reason: eval for interval change, ischemic disease, mass, NPH History: loss of time, confusion, gait impairment No evidence of acute ischemic or hemorrhagic lesion on this scan.Patchy confluent FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating likely non specific small vessel ischemic disease are seen with more involved of the left hemisphere comparing to those of the right, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "1. Extensive confluent white matter lesions of bilateral hemispheres (left worse than right) likely indicating non specific small vessel ischemic disease, unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Known basilar stenosis and right pontine lacunar infarct presenting with headache, vertigo and worsened left sided weakness and slurred speech. There is moderate cerebral white matter T2 hyperintensity bilaterally, particularly in a periventricular distribution. There is also encephalomalacia in the right pons with Wallerian degeneration in the right medulla. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits are grossly unremarkable. The skull appears to be intact. There is a 6 mm thick left temporal scalp lipoma.", "output": "Findings suggestive of chronic small vessel ischemic disease and chronic right pons lacunar infarct, but no evidence of acute intracranial hemorrhage, mass, or acute infarct. Please refer to the prior CTA for details regarding the cerebral vasculature."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified dementia without behavioral disturbance [F03.90], Reason for Study: ^Reason: small vessel disease extent History: memory changes No evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal scattered FLAIR/T2 high signal intensity lesions involving bilateral periventricular white matter, centrum semiovale as well as pons are seen, indicating nonspecific small vessel ischemic disease.There are localized round susceptibility lesions on the right side centrum semiovale without evidence of surrounding edema or mass effects indicating possible chronic petechial hemorrhage or calcifications on Gradient echo images.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Fluid collection seen on the right side sphenoid sinus.Bilateral lens are not seen indicating postoperative status.", "output": "1. Nonspecific small vessel ischemic disease as described above.2. No evidence of acute ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": "57 year old man with a history of COPD and newly diagnosed heart failure. He is referred to evaluate etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 21%, the LV end diastolic volume index is 143 ml/m2 (normal range: 74+/-15), the LVEDV is 236 ml (normal range 142+/-34), the LV end systolic volume index is 113 ml/m2 (normal range 25+/-9), the LVESV is 186 ml (normal range 47+/-19), the LV mass index is 79 g/m2 (normal range 85+/-15), and the LV mass is 130 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 moderately dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 157 ml (normal range 142+/-31), the RV end systolic volume index is 66 ml/m2 (normal range 31+/-9), and the RVESV is 108 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 at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 FindingsThere is proximal esophageal dilation. 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. Severe LV dilation with severely reduced systolic function (LVEF 21%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size with moderately reduced systolic function (RVEF 31%).3. At least moderate mitral regurgitation.4. Moderate left atrial dilation.5. See extra-cardiac findings."}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval for left hip labral pathology History: left groin pain ACETABULAR LABRUM: There is increased signal intensity within the undersurface of the anterior labrum at approximately the 2 o 'clock position indicating a partial thickness tear. There is mild increased signal intensity within the substance of the posterior labrum suggesting degeneration, but we see no discrete posterior labral tear.ARTICULAR CARTILAGE AND BONE: There is slight prominence of the anterolateral aspect of the femoral head/neck junction suggesting a borderline CAM deformity of approximately 55 degrees. There is a small synovial herniation pit within the anterolateral aspect of the femoral head/neck junction. The articular cartilage appears intact.SOFT TISSUES: The musculature of the hip is normal in appearance. ADDITIONAL", "output": "Labral tear as described above."}
{"instruction": "Generate impression based on findings.", "input": "Lung cancer. There are a few subcentimeter intrinsically T1 hyperintense lesions at the grey-white matter interfaces of the left frontal and right occipital lobes, which may demonstrate minimal superimposed enhancement and are perhaps slightly larger in size than in February 2016. There is a background of mild nonspecific cerebral white matter T2 hyperintensity. There is no evidence of 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. However, there is a partially imaged hypointense lesion in the C2 vertebra.", "output": "1. Subcentimeter metastases in the left frontal and right occipital lobes are perhaps slightly larger in size than in February 2016. 2. Partially imaged metastasis in the C2 vertebra."}
{"instruction": "Generate impression based on findings.", "input": "Reason: right hip pain History: pain Surgical clips overlie the right hip and groin region. We see no cam deformity. The coronal center edge angle is 33 degrees. The anterior center edge angle is 42 degrees. The femoral neck shaft angle is 132 degrees. There is perhaps minimal osteoarthritis of the hip, which otherwise appears normal. There is also perhaps mild osteoarthritis of the left sacroiliac joint and left hip.", "output": "Minimal osteoarthritis with measurements as above. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 4 years old, with stable urinary incontinence. Evaluate for tethered cord. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. There is a normal complement of lumbar vertebral bodies. No pathologic marrow replacement or marrow edema is seen.The distal spinal cord, conus and cauda equina are all within normal limits. The conus tip terminates at the L1 level which is normal. No evidence of a fatty filum terminale or other intraspinal fatty lesion is seen. On prone imaging, there is clear evidence of anterior displacement of the conus and cauda equina.The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is noted.", "output": "Unremarkable evaluation with no evidence of tethered cord."}
{"instruction": "Generate impression based on findings.", "input": "Left shoulder pain and instability for several months. ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact.SUPRASPINATUS OUTLET: No significant degenerative changes of the acromioclavicular joint. No fluid is present within the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is irregularity of the anterior inferior labrum consistent with a cartilaginous Bankart lesion. The remainder of the labrum appears intact. There are no associated osseous fractures or deformities.BICEPS TENDON: Long head of the biceps tendon appears intact. ADDITIONAL", "output": "Cartilaginous Bankart lesion. Rotator cuff is intact."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate left knee for healing, changes, loose body since MRI in 7/15 History: Recurrent left knee pain. MENISCI: The medial and lateral menisci appear intact. ARTICULAR CARTILAGE AND BONE: There is slight lateral translation of the patella relative to the femoral trochlea. There is convexity of the femoral trochlea superiorly indicating dysplasia. Again seen is a full thickness defect of the articular cartilage of the medial facet of the patella, with what appears to be degeneration and delamination of the adjacent articular cartilage as well as superficial defects of the articular cartilage of the lateral facet of the patella. This appears similar or perhaps slightly progressed when compared to the prior study, although the bone marrow edema within the underlying patella has resolved. The tibiofemoral articular cartilage appears intact. We see no bone marrow signal abnormalities. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact. The tibial tuberosity trochlear groove distance is approximately 17 mm, which is borderline abnormal.ADDITIONAL", "output": "1.Femoral trochlear dysplasia with slight lateral translation of the patella. Full thickness cartilage loss along the medial facet of the patella is again noted. Overall, the patellofemoral cartilage degeneration has perhaps progressed slightly when compared to the prior study. Small foci of low signal intensity within the joint anteriorly may represent loose cartilage fragments as suggested on the prior study. "}
{"instruction": "Generate impression based on findings.", "input": "Other visual disturbances [H53.8], Reason for Study: ^Reason: rule out mets History: rule out mets There is a rim-enhancing nodular intra-axial lesion measured about 5.5 mm on the left anterior-inferior cerebellar hemisphere, the size and signal characteristics do not show any interval change since prior scan performed on October 24, 2015 orbit MRI. This lesion is consistent with metastatic nodule.Redemonstration of a 7 x 14 mm sized left intraorbital enhancing lesion, no change since prior scan.Choroidal detachment and orbital enhancement are again demonstrated, no change since prior scan. However, perirectal soft tissue enhancement appears to be slightly lessened than prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cyst on the left maxillary sinus.", "output": "1. About 5 mm sized brain enhancing intra-axial lesion on the left inferior anterior aspect of cerebellar hemisphere, consistent with metastatic lesion.2. No interval change of left orbit enhancing lesion with choroidal detachment since prior scan. However, periorbital soft tissue enhancement appear to be slightly lessen since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old male with left hip pain with sitting and stairs for many years. Had 1 prior dislocation. There is a linear band of gadolinium that separates the anterosuperior labrum from the underlying acetabulum at approximately the 1 to 3 o'clock position. We see no fluid-filled articular cartilage defects. There is a dysplastic \"bump\" along the lateral aspect of the femoral head, as seen on prior radiographs, which results in an alpha angle of 65 degrees on MRI, which was previously measured at 70 degrees on prior radiographs. There is also slight prominence along the anterior aspect of the femoral head/neck junction with the borderline alpha angle of 55 degrees. The ligamentum teres appears intact. The sacroiliac joints are within normal limits. A similar morphology affects the right femoral head/neck as seen on the large field-of-view images. The imaged musculature is normal in appearance.", "output": "1. Tear of the left acetabular labrum.2. Mild CAM deformities as described above. Please refer to the CT examination report for additional measurements."}
{"instruction": "Generate impression based on findings.", "input": "Possible right L5 herniated disc 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. Low T1 and T2 signal focus at the right S2 level may represent a sclerotic lesion such as bone island. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc desiccation and mild bulge. No significant spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation and mild bulge, eccentric to the left. There is mild narrowing of the neural foramina, left relatively greater than right. There is contact of the extraforaminal left L3 nerve root. No spinal canal stenosis.L4-L5: There is a disc bulge with a central protrusion. There is no significant spinal canal or neural foraminal stenosis.L5-S1: There is a relatively large right paracentral disc protrusion which contacts the descending right S1 nerve root. The neural foramina and central canal remain patent. Paraspinous soft tissues are within normal limits.", "output": "Mild degenerative changes in the lumbar spine. There is a right paracentral disc protrusion at the L5-S1 level which may be impinging on the right S1 nerve root. Additional levels of degenerative disease as described above."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain and CVA tenderness. RIGHT KIDNEY: The right kidney measures 8.8 cm with minimal hydronephrosis, similar to prior MRI. No shadowing nephrolithiasis. Minimal perinephric fluid as seen on MRI.LEFT KIDNEY: The left kidney measures 9.7 cm without hydronephrosis or shadowing nephrolithiasis.URINARY BLADDER: Normally distended urinary bladder. A right ureteral jet was noted.OTHER: No significant abnormalities noted.", "output": "Minimal right sided hydronephrosis is similar to the prior MRI and may be physiologic given the patient's gravid state. No shadowing nephrolithiasis. "}
{"instruction": "Generate impression based on findings.", "input": " There are post-surgical findings related to prior lipomyelomeningocele repair and laminectomies of the lower lumbar spine. The vertebral column alignment is unchanged in alignment. There is unchanged minimal anterior wedge deformities of the L1 and L2 vertebral bodies. There is mild to moderate loss of disc height at the T12-L1, L1-2, and L2-3 levels. There are scattered T1 hyperintense foci in the lumbar spine, which are consistent with focal fatty replacement or fat-containing hemangiomas. The vertebral bone marrow signal is otherwise unremarkable. There are multilevel degenerative changes without significant spinal canal stenosis. The conus terminates at the L3-4 level, unchanged from prior study. Redemonstrated is clumping of the cauda equina nerve roots, which appear inseparable from the dorsal aspect of the thecal sac at the lower lumbar levels. Prone imaging demonstrates no significant translation of the spinal cord. There are postoperative changes of the paravertebral soft tissues.", "output": "1. Post-surgical findings related to prior lipomyelomeningocele repair and laminectomies with persistent low lying spinal cord and clumping of the cauda equina nerve roots, which appear inseparable from the dorsal aspect of the thecal sac at the lower lumbar spine, without significant anterior translation of the distal cord on prone imaging, suggestive of arachnoiditis with cord tethering.2. Multilevel degenerative changes of the lumbar spine without significant spinal canal stenosis.  "}
{"instruction": "Generate impression based on findings.", "input": "Recently diagnosed prostate cancer on active surveillanceEvaluate for dominant lesion for biopsy. Biopsy dated 1/21/2016 showed 3+3 vessel 1 mm 5% focus in the right apex. PELVIS:PROSTATE:Prostate Size: 3.3 x 4.9 x 4.3 cmPeripheral Zone: Mild hemorrhage in the left mid gland/apex. 3 mm rounded left mid gland T2 hypointense focus, low ADC signal suggested (see key image, suboptimally assessed secondary to very small size), indeterminate but small neoplastic focus not excluded. Wedge-shaped areas of T2 hypointensity seen medially bilaterally at mid gland and apex (posterior to urethra) nonspecific but favored to be scarring given configuration. Central Gland: BPH, probable BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: Subchondral degenerative femoral cyst formation. Small right fat-containing inguinal hernia.OTHER: No significant abnormality noted.", "output": "3 mm left mid gland T2 hypointense rounded focus, low ADC signal suggested, indeterminate but tiny neoplastic focus not excluded. Wedge-shaped areas of T2 hypointensity seen medially bilaterally at mid gland and apex (posterior to urethra) nonspecific but favored to be scarring given configuration. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female; 61 years old. Reason: Hx of IPMN on MRCP with recommended f/u q2 yrs. Evaluate for changes or progression History: H/O pancreatic IPMN ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter hepatic cysts. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Redemonstration of a round, well marginated, T2 hyperintense lesion in the pancreatic tail which communicates with the main pancreatic duct and measures 1.0 x 0.8 cm (series 3/15), previously measured 1.0 x 0.8 cm. No mural nodularity or significant enhancement. No main pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral renal cysts. Retroaortic left renal vein, normal anatomic variant.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Stable lower pulmonary nodule measuring approximately 11 mm, unchanged. Additional bilateral small pulmonary nodules in the partially visualized lung bases, similar prior exam.", "output": "1. Stable pancreatic tail branch type IPMN. No main pancreatic ductal dilatation.2. Bilateral pulmonary nodules, similar to the prior study."}
{"instruction": "Generate impression based on findings.", "input": "Fetal congenital cystic adenomatoid malformation. PELVIS:UTERUS, ADNEXA: Gravid uterus with one fetus in vertex position facing posteriorly. The placenta is along the posterior fundus and body of the endometrial canal. No evidence of placenta previa or accreta. The cervix appears closed. Normal volume amniotic fluid.The neural axis is unremarkable.The heart apex and stomach are left-sided. Note is made of several cyst like structures in the left lung base with the largest measuring 1.5 x 1.0 cm and 1.1 x 0.8 cm. No obvious communication between the cystic structures is demonstrable. The extent of the subtle signal abnormality associated with these larger cysts measures approximately 4.1 x 2.6 cm in the sagittal plane (series 1 301/15) and approximately 3.3 x 2.9 cm in the coronal plane (series 1 101/12). No findings to suggest an intralobular sequestration such as vascular supply from the systemic circulation. The diaphragm appears intact.Unremarkable kidneys bladder bowel liver gallbladder and spleen. 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": "Findings compatible with stated history of congenital pulmonary adenomatoid malformation with several macrocystic components visualized on MRI. The extent of the left lower lobe signal abnormality measures approximately 4.1 x 2.6 cm which includes the smaller cystic components. No specific findings to suggest a hybrid/combined-type CCAM and intralobar sequestration lesion.No additional fetal abnormality is identified."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female patient with intermittent left-sided perianal drainage with mucus and blood. Please evaluate for fistula or abscess. PELVIS:UTERUS, ADNEXA: The patient is status post hysterectomy and bilateral oophorectomy. There is a fluid collection adjacent to the vagina in the left hemipelvis that measures approximately 9.6 cm in craniocaudal dimension without peripheral enhancement.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are no fistulous tracts or fluid collections in the perianal region.OTHER: No significant abnormality noted.", "output": "1.No fistulous tracts or evidence of perianal abscess.2.Fluid collection in the left hemipelvis adjacent to the hysterectomy surgical bed most likely represents a lymphocele."}
{"instruction": "Generate impression based on findings.", "input": "Increased seizure frequency, catatonia, question of limbic encephalitis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The mesial temporal lobes are symmetric without evidence of signal abnormality. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral maxillary mucosal retention cysts. The orbits, skull, and scalp soft tissues are grossly unremarkable.", "output": "No stigmata of limbic encephalitis or evidence of potential seizure foci.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female with seizure, prior abnormal MRI and CT, evaluate for HIV encephalopathy, PML, or other. Several sequences are motion degraded. Given this caveat:Redemonstrated is bihemispheric T2 hyperintensity within the white matter and to a lesser extent basal ganglia and infratentorial structures. Globally, there has been overall reduction in the degree of T2 hyperintense abnormality, although this includes regions of improvement, regions of progression, and new signal foci in the other areas. For example the confluent nature of the centrum semiovale has significantly improved, and hyperintense abnormality within the basal ganglia remains significantly improved when compared to the older MRI of 10/11/2015. The previously noted more conspicuous rounded hypodense foci on the most recent CT correlates with a small focus of residual T2 hypointensity that has remained in a prior region of confluent abnormality. However, T2 hyperintensity has progressed within bilateral subinsular white matter. Additionally, T2 hyperintensity within the cerebellum is less conspicuous, however more confluent.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Scattered foci of mucosal thickening can be found throughout the paranasal sinuses without superimposed fluid levels. Mastoid air cells remain clear.", "output": "Redemonstrated is bihemispheric T2 hyperintensity within the white matter and to a lesser extent basal ganglia and infratentorial structures. Globally, there has been overall reduction in the degree of T2 hyperintense abnormality, although this includes regions of improvement, regions of progression, and new signal foci in the other areas. Given the asymmetry, PML is considered most likely. CMV infection can also present involving the white matter with asymmetry. Primary HIV encephalopathy most often represents in a symmetric faction and thus is considered less likely."}
{"instruction": "Generate impression based on findings.", "input": "Myelopathic symptoms. The spinal canal appears to be congenitally narrow throughout. There is superimposed multilevel degenerative spondylosis. At C3-4, there is a posterior disc-osteophyte complex and uncovertebral joint hypertrophy bilaterally, which results in considerable compression of the spinal cord and severe bilateral neural foraminal narrowing. There is perhaps a punctate focus of T2 hypertensity in the spinal cord at this level. At C4-5, there is a posterior disc-osteophyte complex and uncovertebral and facet joint hypertrophy bilaterally, which results in slight compression of the spinal cord and severe bilateral neural foraminal narrowing. At C5-6, there is a small posterior disc-osteophyte complex that nearly abuts the spinal cord. However, uncovertebral and facet joint hypertrophy bilaterally, results in severe bilateral neural foraminal narrowing at this level. At C6-7, there is a small posterior disc-osteophyte complex that nearly abuts the spinal cord. However, uncovertebral and facet joint hypertrophy bilaterally results in severe bilateral neural foraminal narrowing at this level. A C7-T1, there is uncovertebral and facet joint hypertrophy bilaterally that results in mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. At T1-T2, there is a posterior disc-osteophyte complex that results in severe right and mild left neural foraminal stenosis. At C2-3, there is no significant spinal canal or neural foraminal stenosis. There is irregularity of the superior and inferior endplates of C5 and C6. The other vertebral body heights are intact. Aside from degenerative signal alterations are multiple levels, the vertebral bone marrow appears unremarkable. The paravertebral soft tissues are unremarkable.", "output": "Multilevel degenerative spondylosis, with spinal cord compression at C3-4 and C4-5."}
{"instruction": "Generate impression based on findings.", "input": "Female, 57 years old, with painful mass on the right side of the thoracic spine at approximately the T4 level. Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are normal. No evidence of marrow replacement or marrow edema is detected. No pathologic marrow enhancement is seen.The visualized spinal cord is normal in both signal intensity and morphology. No intraspinal lesions are seen. No pathologic intracanalicular enhancement is detected.The intervertebral disks are within normal limits. No significant spinal canal or neuroforaminal stenosis is suspected.Please note that this examination is tailored for the assessment of the thoracic spine and immediate paraspinal tissues. The anterior and lateral chest wall regions, including the scapulae, are not included within the field of view.The right lobe of the thyroid is diffusely enlarged and somewhat heterogeneous as visualized partially on the T1-weighted images.", "output": "1. No spinal or immediate paraspinal abnormality is seen which would account for the patient's symptoms.2. Please note that the anterior and lateral chest wall regions including the scapulae are not included within the field of view of this examination. If these areas require imaging assessment, consultation with chest or musculoskeletal radiology is suggested for guidance as to the most appropriate examination.3. Incidental note is made of a large and heterogeneous right thyroid lobe. If this has not been previously assessed, a dedicated thyroid ultrasound should be performed. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: RLE calf pain > 1 yr, eval for gastroc tear vs myopathy The osseous alignment is within normal limits. There is no evidence of acute fracture. There is no abnormal bone marrow signal. The muscles appear within normal limits. The Achilles tendon appears intact.", "output": "Normal examination without evidence of myopathy or gastrocnemius tear."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with follicular lymphoma MRI brain:Again seen is a right transfrontal ventriculostomy/Ommaya catheter terminating in the right frontal horn laterally. There is a 15x24 mm focus of CSF intensity collection surrounding the catheter with extensive surrounding vasogenic edema, appearing similar in extent to recent CT study. This results in effacement of the adjacent cortical sulci and mild mass effect on the right frontal horn and mild midline shift to the left similar to prior study. The ventricular system caliber is not significantly changed from prior study, with transverse diameter of the left frontal horn of the lateral ventricle measuring 12 mm in caliber, unchanged, and the transverse diameter of the anterior third ventricle measuring approximately 10 mm, also unchanged. No evidence of infarct. No intracranial hemorrhage is identified. There is nonsuppression of CSF involving the bilateral frontoparietal sulci on the FLAIR sequence. No intracranial mass or mass effect. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.Left maxillary mucous retention cyst. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The images are degraded by motion artifact. No intraconal or extraconal space mass is identified. The globes and extraocular muscles are intact. Evidence of left lens replacement.Cervical spine:Marked suboptimal evaluation of the cervical spine due to motion artifact. Within these limitations there is no obvious mass effect or compression of the spinal cord. No cord signal abnormality. Minimal degenerative changes are seen without significant spinal canal stenosis.", "output": "1. Please note examination is limited due to absence of intravenous contrast and limited sequences obtained of the brain, orbits, and cervical spine. Patient could not tolerate further imaging and examination was terminated prematurely. 2. No obvious intracranial mass or diffusion abnormality to suggest lymphoma. There is nonsuppression of CSF on the FLAIR sequence involving the bilateral frontoparietal sulci which may be artifactual, but can be seen with leptomeningeal disease; postcontrast sequences would be helpful for differentiation. Again seen is 15x24 mm CSF collection surrounding the Ommaya catheter with extensive surrounding vasogenic edema and associated mass effect, similar to recent CT from 5/30/15. 3. No obvious orbital mass or cervical cord signal abnormality on the limited sequences."}
{"instruction": "Generate impression based on findings.", "input": "Patient is a 31-year-old female with BRCA mutation and a strong family history of breast cancer. No current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Multiple cysts are noted in the breasts. 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": "58-year-old male with history of metastatic rectal carcinoid on octreotide and status post Y90 embolization in 2011. Evaluate for disease. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent inguinal lymph nodes are noted.BOWEL, MESENTERY: No evidence of enhancing lesions within the rectum and visualized colon to suggest disease recurrence.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence of enhancing lesions within the rectum or the visualized colon to suggest disease recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up surveillance evaluation. History of pituitary adenoma status post resection x 2. Again seen are postoperative changes related to prior pituitary tumor resections. There is stable to minimal enlargement of the residual pituitary adenoma involving the right aspect of the sella, for example measuring up to 16 mm in the transverse dimension and 10 mm in the craniocaudal dimension, coronal T2 image 10, previously 15 x 9 mm re-measured similarly. AP dimension of approximately 12 mm is not significantly changed. Diminished central hypoenhancement involving the mass is again seen and likely reflective of prior treatment. The optic chiasm is tented downward with the infundibulum rightward deviated, as seen before and consistent with postoperative change. Thinning of the optic chiasm is again demonstrated. No mass effect on the optic chiasm is present. The mass abuts the right aspect of the cavernous sinus without clear evidence of invasion.Partially imaged brain demonstrates scattered foci of T2 hyperintensity involving the periventricular and subcortical white matter grossly similar to prior and compatible with small vessel ischemic changes. No evidence of intracranial mass effect, midline shift, or hydrocephalus.", "output": "Stable to minimal increase in size of the residual pituitary adenoma compared to 4/15/2015 involving the right aspect of the sella with measurements as above. No mass effect on the optic chiasm."}
{"instruction": "Generate impression based on findings.", "input": "Mid and low back pain now with saddle anesthesia. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are scattered focal fatty deposits in the vertebral bone marrow. There is also a subcentimeter area of high T2 signal in the T3 vertebral body. There are mild posterior disc-osteophyte complexes at C7-T1 and T8-9. In addition, there are minimal; disc bulges at L3-4 and L4-5 without significant neural foraminal stenosis. There is also a disc bulge at L5-S1 and facet hypertrophy with mild left and moderate right neural foraminal stenosis. However, there is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.", "output": "1. No evidence of spinal cord or cauda equina compression.2. A disc bulge at L5-S1 and facet hypertrophy is associated with mild left and moderate right neural foraminal stenosis.3. A subcentimeter area of high T2 signal in the T3 vertebral body is nonspecific, but may represent an atypical hemangioma, for example. Nevertheless, follow up via MRI with contrast may be useful."}
{"instruction": "Generate impression based on findings.", "input": "Female, 78 years old, status post right frontal craniotomy for tumor resection. Postoperative findings are seen consistent with right frontal craniotomy. Presumed packing material is evident within the frontal sinus and the underlying epidural space. A resection cavity is evident in the paramedian right frontal lobe containing a fluid-heme level. A majority of the previously demonstrated enhancing tumor has been resected. Residual enhancing tissue persists along the posterior cavity margin where it abuts the basal ganglia and ventricular margin.Restricted diffusion is seen surrounding the resection cavity including relatively thick diffusion restriction in the bilateral paramedian frontal lobes and wedgelike restriction in the right caudate head. T2 hyperintensity filling the right frontal lobe extending into the basal ganglia and insula appears similar to the preoperative study. The genu of the corpus callosum remains thickened with abnormal signal extending across midline to the left.Generalized mass effect is slightly improved though the right lateral ventricle remains effaced. Dilatation of the left lateral ventricle has slightly improved. The fourth ventricle is within normal limits. No new enhancing lesions are seen.", "output": "Postoperative findings are seen compatible with near complete resection of the enhancing component of a right frontal lobe tumor. A small amount of residual enhancing tumor is suspected along the posterior surgical cavity. Restricted diffusion surrounding the cavity and within the right caudate head is suspected to represent a combination of postoperative cytotoxic edema and ischemic injury. Vasogenic edema in the right frontal lobe is grossly unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Male 74 years old, evaluate left temporal lesion, episode of gait unsteadiness (resolved), small hyperdensity on CT Motion degrades sensitivity.There is redemonstration of a small left temporal lobe lesion with punctate central enhancement and mixed T2 signal measuring up to 7 mm (1701/156). The lesion demonstrates blooming on SWI with a complete peripheral T2 hypointense hemosiderin rim. No associated surrounding FLAIR hyperintensity or mass effect noted. An asymmetric branching area of susceptibility/enhancement posterior medially adjacent to the lesion is consistent with a developmental venous anomaly as seen on prior CTA dated 6/5/2016. Otherwise, the surrounding brain parenchyma demonstrates normal signal. Prominent curvilinear area of increased susceptibility (1001/91) along the left occipital sulci without an associated asymmetric vessel prominence on postcontrast images. There is no associated parenchymal abnormality. There are no other foci of abnormal susceptibility identified.Patchy areas of increased T2/FLAIR signal most prominent in the periventricular and subcortical areas suggestive of chronic white matter small vessel ischemic disease.There is no 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. Minimal fluid is present in the right mastoids. The orbits, skull, and scalp soft tissues are grossly unremarkable.", "output": "1. Left temporal lobe cavernous malformation with associated developmental venous anomaly, consistent with findings noted on CTA dated 6/5/2016. No other cavernous malformations identified.2. Curvilinear area of increased susceptibility in left occipital sulcus without correlating asymmetric vessel prominence on postcontrast images, although images are limited by patient motion. Findings may represent the remote possibility of small thrombosed vessel, or could in part be artifactual. No associated parenchymal abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Progression of multiple sclerosis symptoms. There is a punctate focus of nonspecific T2 hyperintensity in the right frontal lobe centrum semiovale. There is a small left frontal lobe white matter developmental anomaly. Otherwise, there is no abnormal intracranial enhancement. There is no evidence of intracranial mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst. There is a subcentimeter left adenoidal probable retention cyst as well.", "output": "Minimal nonspecific cerebral white matter T2 hyperintensity."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old with history of BRCA1 carrier. History of benign left breast MRI guided biopsy in September 2012. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: increasing weakness RLE History: increasing weakness RLE There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12 level.The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Incidental finding of the left renal cyst (about 20mm in diameter).Degenerative changes are specified by the intervertebral level as follows: T11-T12: There is broad based disc protrusion toward right side neural foramen which results moderate to severe neural foraminal stenosis.T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Mild disc desiccation. Diffuse bulging of disc with bilateral ligamentum flavum thickening causing minimal spinal canal stenosis. Broad-based disc bulging toward left side neural foramen causing minimal neural foraminal stenosis on the left side. L4-L5: Disc desiccation. Diffuse bulging of disc with bilateral ligamentum flavum thickening causing mild to moderate spinal stenosis. L5-S1: Disc desiccation. Diffuse bulging of disc causing minimal spinal canal stenosis.", "output": "1. Spinal cord signal intensity is normal.2. Degenerative changes of lumbar discs. In particular, there is a broad-based disc protrusion toward the right side neural foramen at the level of T11-12.3. Degenerative various degree spinal canal stenosis at the level of L34, L45 and L5S1."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with h/o glioblastoma presents with weakness. Evaluate for intracranial bleed. There is no evidence of intracranial hemorrhage, mass, or edema. Post-surgical changes of a right-sided craniotomy and right temporal resection with encephalomalacia are similar to prior. Extensive confluent hypoattenuation involving primarily the white matter of the right cerebral hemisphere is similar to prior. Based on recent MRI findings, this is compatible with post-radiation changes.Hypoattenuating lesions in the left thalamus is seen on prior MRI and is compatible with lacunar infarct. It demonstrates increased hypodensity, compatible with expected evolutional changes. 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 hemorrhage. Evolutionary change of lacunar infarct at left thalamus. Post-surgical and post-treatment changes similar to prior. "}
{"instruction": "Generate impression based on findings.", "input": "History of stroke now presenting with left-sided hyperreflexia. Motion artifact mildly degrades the postcontrast images.Brain:Scattered small foci of increased T2 signal in the periventricular and subcortical white matter compatible with chronic small vessel ischemic disease. No acute ischemia. No abnormal enhancement is identified postcontrast images.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:There is mild loss of vertebral body height involving multiple cervical vertebrae most notably at the C5 level where there is mild wedging deformity. Heterogeneous marrow signal is nonspecific and at least in part related to reactive endplate marrow changes. There is exaggeration of the cervical lordosis at C6-7 associated with minimal retrolisthesis of C6 on C7. There is loss of intervertebral disc signal throughout the visualized cervical spine compatible with desiccation. There is marked loss of intervertebral disc height from C4 to C6 and T2-T4. The visualized spinal cord is normal in signal and morphology throughout.Level by level findings are as follows:C2-C3: Mild disc osteophyte complex and hypertrophy of the ligamentum flavum. No significant spinal canal or neural foraminal narrowing.C3-C4: No disc bulge. Uncovertebral hypertrophy creates minimal right neural foraminal stenosis. No significant spinal canal or left neural foraminal stenosis.C4-C5: Small disc osteophyte complex. Minimal left neural foraminal narrowing. No significant spinal canal stenosis or right neuroforaminal narrowing.C5-C6: Small disc osteophyte complex and hypertrophy of the ligamentum flavum create minimal spinal canal stenosis. Moderate right and mild left neural foraminal stenosis.C6-C7: Moderate central disc osteophyte complex and prominent hypertrophy of the ligamentum flavum create a moderate spinal canal stenosis. Moderate to severe left neural foraminal stenosis. Mild right neural foraminal stenosis.C7-T1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.", "output": "1. Mild chronic small vessel ischemic changes in the brain.2. Multilevel spondylitic changes in the cervical spine which are most severe at C6-7 where there is moderate spinal canal stenosis and moderate to severe left neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "History of primary sclerosing cholangitis/IPMN. Evaluate for cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Unchanged irregular beaded appearance of the intra- and extra- hepatic bile ducts, with stricturing at the common hepatic duct, proximal right and left hepatic ducts and the proximal common bile duct. Mild biliary dilatation is unchanged. No suspicious hepatic lesion is identified. Stable punctate segment 7 hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: Stable punctate cystic lesions are better identified on prior MRI, probable sidebranch IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple 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": "Unchanged multifocal biliary strictures compatible with history of primary sclerosing cholangitis, with no suspicious hepatic lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Vision loss, evaluate left clinoid meningioma Again seen are postsurgical changes of left frontotemporal craniotomy for resection of previously seen extra-axial enhancing lesion in the left paraclinoid region. There is T2/FLAIR hyperintensity involving the left frontal lobe adjacent to the craniotomy which may represent retraction edema. There is also T2/FLAIR hyperintensity involving the posterior aspect of the left gyrus rectus and medial orbital gyrus compatible with edema in the surgical bed. No restricted diffusion to suggest infarct. There is linear enhancement at these sites. No discrete enhancing mass is evident to suggest residual tumor. Expected postsurgical changes include small amount of pneumocephalus and small extra-axial collection along the bilateral frontal and left anterior temporal convexity. Small intraventricular blood products in the right occipital horn also noted. Remainder of the brain demonstrates multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. No hydrocephalus. No evidence of mass effect, midline shift, or herniation. Major flow-voids are preserved. Evidence of bilateral intraocular lens replacement.", "output": "Expected postoperative changes related to meningioma resection without evidence of residual tumor. There is focal edema involving the posterior aspect of the left gyrus rectus and medial orbital gyrus in the surgical bed. Focal edema is also noted along the surface of the left frontal lobe beneath the craniotomy which may be related to retraction. No large hemorrhage or new mass effect is appreciated. Please note if there are new visual symptoms and evaluation of the optic nerves is desired, suggest dedicated MRI orbit study."}
{"instruction": "Generate impression based on findings.", "input": " MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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.MRA Brain: The intracranial internal carotid arteries demonstrate no signficant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRV head: The dural venous sinuses and deep venous structures demonstrate normal flow related signal. No evidence of venous sinus thrombosis is seen.", "output": "Unremarkable evaluation with no specific findings to account for the patient's symptoms.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Perirectal abscess ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left perirectal abscess measuring 2.6 x 2.5 cm. The abscess extends into the left ischiorectal fossae no fistula is to the skin intergluteal region. The size of the abscess in the is pararectal fossa is 4.5 x 2 cm. Inflammatory changes and possible fistulous tracts is also likely present on the right side. Further evaluation with pelvic MRI may be helpful for better depiction of the abscess and fistula tracts.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Left pararectal and ischiorectal abscess and fistula. Right perirectal inflammation. Further evaluation with a pelvic MR is recommended for better depiction of the fistula tracts."}
{"instruction": "Generate impression based on findings.", "input": "Adrenal mass seen on the prior CT. History of sweating, anxiety, hypertension. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal enlargement measuring 4.2 x 3.9 cm. This enlargement is predominantly cystic with internal fluid-fluid compatible with hemorrhage. The thin rim of adrenal tissue does not enhance suspiciously or have an associated soft tissue nodule/mass evident.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Punctate focus of diffusion restriction in the right psoas, partly imaged, likely represents a neurofibroma.OTHER: No significant abnormality noted otherwise.", "output": "Left adrenal hemorrhage, without adrenal mass identified. A follow-up MRI in 3-6 months is recommended to assess for an underlying mass as a potential etiology for hemorrhage. "}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female. Pain and weakness. Evaluate for rotator cuff tear. Images are somewhat degraded by motion artifact.ROTATOR CUFF: Slight increase in mild tendinosis of the infraspinatus and supraspinatus with a small subchondral cyst in the underlying humeral head. No discrete rotator cuff tear is evident. The supraspinatus, subscapularis, infraspinatus and teres minor muscles are intact.SUPRASPINATUS OUTLET: Trace fluid in the subacromial/subdeltoid bursa. Mild AC joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The glenoid labrum is grossly unremarkable within limitations of this non-arthrographic study.BICEPS TENDON: Postsurgical findings of biceps tenodesis with an orthopedic screw in the proximal humeral diaphysis. ADDITIONAL", "output": "Supraspinatus and infraspinatus mild tendinopathy without a discrete tear."}
{"instruction": "Generate impression based on findings.", "input": "Leg pain, spinal stenosis, multilevel disc disease. Compare with prior. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There appears to be some levoscoliosis at the lower lumbar level which can be better assessed with standing radiographs. No significant spondylolisthesis. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T12-L1: Mild disc bulge and loss of disc height similar to prior. No significant spinal canal or neural foraminal stenosis.L1-L2: Loss of disc height and minimal bulge similar to prior. There is also mild facet arthropathy. No significant spinal canal or neural foraminal stenosis.L2-L3: There is loss of disc height, ligamentum flavum thickening, and bilateral facet arthropathy. There is also prominence of the dorsal epidural fat. There is moderate to severe spinal canal stenosis at this level which is slightly worse than prior. There is effacement of the right lateral recesses, right worse in left. There is moderate right neural foraminal stenosis which is worse. There is no significant left neural foraminal stenosis.L3-L4: There is disc bulge, and bilateral facet arthropathy resulting in mild spinal canal stenosis at this level which is slightly worse. There is mild to moderate right and mild left neural foraminal stenosis similar to prior.L4-L5: There is progression of disc height loss at this level as well as left greater than right facet arthropathy and ligamentum flavum thickening which have progressed resulting in moderate central canal stenosis, particularly involving the left aspect of the thecal sac. There is also effacement of the left lateral recess which appears slightly worse. There is severe left and mild to moderate right neural foraminal stenosis stable to minimally progressed on the left since prior. There is evidence of prior right-sided laminotomy.L5-S1: Tiny central disc protrusion similar to prior. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.Bilateral renal cysts again seen.", "output": "Advanced degenerative changes in the lumbar spine with significant spinal canal stenosis at the L2-L3 and L4-L5 levels which has mildly worsened since 10/25/2011. There is also multilevel neural foraminal stenosis, worst at the right L2-L3 and left L4-L5 levels. Please see details above."}
{"instruction": "Generate impression based on findings.", "input": "Left hip pain Note that the patient terminated the exam prematurely and only coronal T1, coronal STIR, and axial T1 sequences were obtained.Within the limits of the exam, the marrow signal of the left hip is normal. The surrounding musculature of the left hip and pelvis is normal in caliber and signal.", "output": "Limited examination demonstrates no obvious marrow or soft tissue abnormality of the left hip."}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: eval GBM on Avastin+CCNU. History: GBM. Brain MRIThere again is the right frontal intra axial mass which shows mixed signal intensity on T2 and minimal peripheral enhancement. Previously the size of the lesion on T2 coronal scan was 18.6mm x 34mm and on axial scan it was 25.8mm x 33.4mm. Today, the corresponding scan showed increased in size since prior scan, the measured size were 25.5mm x 38.9mm on T2 coronal scan and 28.7mm x 31.7mm. The pattern of enhancement of the lesion appears to be slightly lessen especially on the lateral aspect of the mass, but overall it does not show significant interval change since prior scan.The extent of surrounding edema also does not show any significant interval change.No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are unremarkable. 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.MR perfusionThere is focal increased rCBV and rCBF on the anterior superior aspect of the intra axial mass indicating active tumor burden or increased angiogenectic activity. Corresponding brain MRI shows focal enhancement which again support the evidence of active tumor.", "output": "Interval increase size of the right frontal lesion with increased perfusion indicating interval progression of the tumor. There is no other lesion seen.No evidence of acute ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Neck pain, right arm tingles, has MS. There are few small T2 hyperintense lesions involving the cervical cord including the left lateral aspect of the cervicomedullary junction, right dorsolateral C2-C3 level, right dorsolateral C3-C4 level, as well as one at the left lateral C5-C6 level which is also associated with some volume loss. No large lesions are demonstrated. The above lesions are best seen on the axial T2* smFFE as well as proton density sequences. Vertebral body heights are normal. There is mild loss of cervical lordosis. Mild degenerative changes are seen including small central protrusion at the C3-C4 level and a small disc bulge at the C5-C6 level. There is no significant spinal canal stenosis at any level. The cervical neural foramina are also patent.", "output": "Multiple small lesions are suspected in the cervical cord as described above and compatible with demyelinating plaques. No lesions with enhancement."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Patient with memory loss, consent for history of strokes. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion-weighted images.There are several small foci of FLAIR and T2 hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres and minimally in the left basal ganglia as well as pons which considering patient's stated age of 83 likely representing chronic microvascular ischemic changes without evidence of hemorrhagic changes.The cerebral cortex as well as cortical sulci and ventricular systems remain within normal for stated age and with maintained midline.Signal void of major intracranial arterial branches are identified. The signal intensity of the intracranial venous sinuses are unremarkable.Unremarkable calvarium, orbits and mastoid air cells. Extensive left maxillary chronic sinus disease and unremarkable paranasal sinuses otherwise.", "output": "1.No acute intracranial process.2.Mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter and minimally of the left basal ganglia and pons.3.Unremarkable brain MRI otherwise for stated age.4.Left maxillary sinusitis and unremarkable other paranasal sinuses"}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for herniated disc or spinal stenosis. Signs and symptoms: Worsening sciatica. Nonenhanced lumbar MRI:Examination demonstrates moderate to advanced degenerative disc disease of the lumbar spine with resultant mild reversal of lumbar lordosis.The signal intensity of vertebral column demonstrate changes secondary to degenerative disease and unremarkable otherwise.The alignment of vertebral column remains anatomical.Limited view of the lower thoracic spine demonstrate moderate left neural foraminal compromise due to DJD at T11-T12 and no central spinal stenosis.T12-L1 is unremarkable.L1-L2 demonstrate moderate disc disease and loss of disc height, asymmetric (left greater than right) bulging disc with resultant subtle mass effect on the thecal sac is noted. No spinal stenosis or neural foraminal compromise.L2-L3 demonstrate advanced disc disease with significant loss of disc height, moderate bilateral ligamentum flavum and mild facet hypertrophic changes are present. Shallow broad-based bulging disc is also noted. There is resultant mild central spinal stenosis and moderate right neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, diffuse bulging disc more prominent on the right is noted. There is also moderate bilateral ligamentum flavum and mild bilateral facet hypertrophic changes present. Mild central spinal stenosis and significant right and moderate left neural foraminal compromise is noted.L4-L5 demonstrate advanced disc disease and loss of disc height, broad-based bulging disc more prominent on the left, moderate bilateral ligamentum flavum and moderate left facet and mild right facet hypertrophy changes are present. There is no convincing evidence of central spinal stenosis however significant left neural foraminal and left lateral recess compromise is noted.L5-S1 demonstrate mild disc disease and moderate bilateral ligamentum flavum and mild facet hypertrophic changes without central spinal stenosis. Mild bilateral neural foraminal compromise is however present.", "output": "1.Extensive degenerative changes of lumbar spine with a slightly alternative pattern of degree of degenerative changes likely secondary to mild scoliosis as detailed.2.There is mild central spinal stenosis at L2-L3 and L3-L4 levels as detailed.3.There are multilevel neural foraminal and lateral recess compromise (some significantly) as detailed per level above.4.Lower most visualized thoracic spine demonstrate asymmetric left-sided facet hypertrophic changes with resultant significant left neural foraminal compromise at T11-T12 level and no central spinal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: right shoulder pain History: right shoulder pain ROTATOR CUFF: There is a full-thickness near-complete/complete tear of the supraspinous tendon with retraction of fibers to the level of the glenohumeral joint. A few anterior fibers may extend to the greater tuberosity, but this is equivocal. There appears to be mild loss of supraspinatus muscle volume. There is also a complete tear of the infraspinatus tendon with similar retraction as well as moderate fatty atrophy of the infraspinatus muscle. There is moderate fatty atrophy of the teres minor muscle, although the tendon appears to extend to its insertion on the greater tuberosity. Mild thickening of the distal subscapularis tendon suggests tendinosis with a small linear undersurface tear of its superior fibers. The subscapularis muscle appears intact.SUPRASPINATUS OUTLET: Mild osteoarthritis of the acromioclavicular joint, with hypertrophy of the distal end of the clavicle. There is a small amount of fluid in the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding with slight posterior translation relative to the glenoid. There is subchondral cyst formation in the posterior aspect of the glenoid. Intermediate signal intensity and fluid undercuts the anterior labrum, suggesting a partial tear. There is attenuation of the posterior superior labrum, suggesting a tear. A small collection of fluid signal intensity along the posterior glenoid scapula neck may represent a paralabral cyst. There are a few ossicles within the superior aspect of the glenohumeral joint, suggestive of loose bodies, perhaps attached to the distal end of the torn rotator cuff.BICEPS TENDON: There is mild increased signal intensity within the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular groove.", "output": "Full-thickness retracted rotator cuff tear and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "65 year old with biopsy proven DCIS at two sites of lower outer quadrant in the right breast, presents for staging MRI. There is also a biopsy proven fibroadenoma in the right breat. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.RIGHT BREAST: There is a clip artifact at anterior 9:00 position at the site of recent fibroadenoma biopsy, and there are two clip artifacts at posterior 8:00 position, each from DCIS biopsy, in the right breast. Distance between these two clips at posterior 8:00 position is 15 mm.There is 15 mm slowly enhancing area around the clip artifact at anterior 9:00 position, at the site of proven fibroadenoma. This enhancement is likely post-biopsy changes.At the site of proven DCIS, there are only small post-biopsy seromas (less than 5 mm), without abnormal enhancement.A normal intramammary lymph node is present in the right lower outer quadrant.Elsewhere, there is no abnormal enhancing lesions.LEFT BREAST:No abnormal enhancement is seen in left breast. AXILLAE:No abnormal lymph nodes are identified in either axillary region.", "output": "Biopsy proven DCIS in the right breast at lower outer quadrant (2 sites). Only minimal post-biopsy changes are seen at the site of proven malignancy in the right breast. No MR evidence of malignancy in the left breast or either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with biopsy proven invasive ductal carcinoma at 2 sites in the left breast. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.LEFT BREAST: At the 2:00 position in the posterior left breast, there is an ovoid homogeneously enhancing mass with irregular margins, with artifact from the biopsy clip. This mass measures 18 x 16 x 17 mm (AP X ML X CC). While the lesion abuts the prepectoral fascia posteriorly, no definite enhancement is identified in the underlying pectoralis muscle.At the 3:00 position in the left breast, there is an irregular heterogeneously enhancing mass that measures 21 x 15 x 16 mm(AP X ML X CC), with biopsy clip artifact. This mass is located approximately 13 mm inferior to the mass at the 2:00 position described above.Just posterior to this mass at the 3:00 position there are 2 small enhancing satellite lesions, located medially and laterally. The largest of these satellite lesions located laterally measures 9 x 8 x 10 mm(AP X ML X CC); this lesion also abuts but does not appear to invade the underlying pectoralis muscle. Extensive non-mass enhancement is also noted surrounding the mass at the 3:00 position, extending anteriorly, laterally, and medially.Total extent of the 2 enhancing left breast masses, satellite lesions, and non-mass enhancement is 5.6 x 3.6 x 6.5 cm (AP X ML X CC).RIGHT BREAST: No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.", "output": "1.Two left breast masses, satellite lesions, and associated non-mass enhancement, compatible with the patient's known invasive ductal carcinoma with maximum extent of 5.6 x 3.6 x 6.5 cm. The masses/satellites abut but does not definitively invade the underlying left pectoralis muscle; see additional measurements above.2.No abnormality noted in the right breast or axillary regions. Due to some technical difficulties as patient returned on 4/13/16 for the breast MRI after a noninterpretable scan performed on 4/6/14, all images have been moved to accession # 16032912.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female. Status post Whipple 3/13/14 for IPMN, pancreatic divisum and chronic pancreatitis. Needs surveillance MRCP in March 2015. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic mass. No biliary ductal dilatation. Cholecystectomy clips. Fatty infiltration of the liver. Portal vein and hepatic veins are patent.SPLEEN: Subcentimeter T2 hyperintense focus in the spleen without appreciable enhancement, likely a cyst.PANCREAS: Post surgical findings of Whipple procedure. No evidence of local recurrence. Fatty atrophy of the pancreas, which has normal T1 signal intensity. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post-surgical changes in the midline abdomen.OTHER: No significant abnormality noted.", "output": "Post-surgical findings of Whipple procedure without evidence of recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Female, 45 years old, with bilateral upper extremity and lower extremity numbness. A mild reversal of the cervical lordosis is evident centered at C5-6. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. Mild edema is seen centered on the C5-6 endplates. Elsewhere, no pathologic marrow replacement or marrow edema is observed.The spinal cord is normal signal intensity and morphology throughout. No epidural abnormalities are suspected.Axial T2 images are degraded by motion artifact. Within this limitation, the following observations are made.C2-3: Left facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Mild posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild encroachment of the left neural foramen. C6-7: Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C7-T1: Left facet hypertrophy. Minimal posterior disc-osteophyte complex formation with a small left paracentral protrusion. No cord impingement or spinal canal stenosis is seen. No significant foraminal narrowing.", "output": "Relatively mild degenerative findings as above without significant spinal canal or foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with left hip pain There is a lobulated, septated mass of fluid signal intensity situated lateral to the supra-acetabular left ilium as well as within the gluteus minimus muscles, which measures approximately 6 x 4 cm in transverse dimensions and 5.5 cm in craniocaudad dimension. A tail of fluid also extends along the indirect tendon of the rectus femoris. Mild peripheral and septal enhancement of the fluid collection is noted. The cyst connects with a small acetabular cyst as well. This most likely represents a ganglion or para-labral cyst. Moderate osteoarthritis affects the left hip joint. Although the exam was not protocoled for evaluation of the labrum, irregularity of the anterosuperior labrum likely represents degenerative tearing. Trace fluid is present within the joint itself. Moderate osteoarthritis affects the right hip with a small amount of fluid within the joint. Degenerative arthritis affects the SI joints, particularly on the left. Moderate osteoarthritis also affects the pubic symphysis. There is mild edema within the rectus femoris muscles bilaterally, which is nonspecific and may represent bilateral strains. There is also a collection of fat posterior to the right rectus femoris which is incompletely visualized and may represent a lipoma. Mild edema adjacent to the greater trochanters bilaterally is not necessarily of any clinical significance.", "output": "1. Cystic collection adjacent to the left hip as described above, which may represent a para-labral cyst or ganglion and does not have the appearance of an abscess or neoplasm.2. Osteoarthritis and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Male 31 years old Reason: eval for colloid cyst resection History: eval for colloid cyst resection Motion artifact mildly degrades image quality and interpretation.Redemonstration of a right frontal ventriculostomy catheter with tip projecting midline in the anterior lateral ventricles. There is artifact from a prior left frontal surgical approach.There is persistent ventriculomegaly involving the lateral ventricles which is slightly decreased when compared to the preoperative MR, and there is slight interval decrease in periventricular T2 signal indicating a decrease in transependymal fluid shift. Foci of air within the anterior lateral ventricles seen on prior CT have decreased. Layering T2 hypointensity within the occipital horns has minimal susceptibility artifact compatible with postoperative blood products. Other scattered foci susceptibility are seen along the ventricular margins consistent with blood products.Redemonstration of a round mass in the third ventricle level of the foramen of Monro with low T1 and low T2 signal and only peripheral enhancement on the postcontrast images compatible with a colloid cyst. This measures 13 x 11 mm in the axial plane previously 17 x 16 mm on preoperative MRI.No pathologic extra-axial fluid collection.There is grossly stable cerebellar tonsils positioning, extending 5 mm below the level the foramen magnum, with associated pointing of the tonsils. Partially visualized syringohydromyelia in the cervical spinal cord at the level of C2 measures 9 x 8 mm in greatest axial dimensions and extends 2.5 cm in the craniocaudal dimension. There is crowding of structures at the level of the foramen magnum.The expected intracranial vascular flow voids are present.", "output": "1. Persistent residual colloid cyst at the foramen of Monro which measures 13 x 11 mm, decreased from the preoperative MR.2. Persistent dilatation of the lateral ventricles which is perhaps slightly decreased compared to the preoperative MR. The degree of transependymal CSF flow is also slightly decreased.3. Borderline cerebellar tonsillar ectopia with pointed configuration. Focal syringohydromyelia in the high cervical spinal cord is partially visualized. In retrospect this was present on the prior study but was largely obscured by motion artifact. Findings likely represent sequela of acquired Chiari I malformation. Additional spine imaging can be considered as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "12-year-old with history of Chiari malformation and syrinx. Interval follow-up exam. Cervical spine: Redemonstrated findings of a partially visualized Chiari 1 malformation with extension of the cerebellar tonsils 10 mm below the foramen magnum. There is crowding of the foramen magnum with partially diminished CSF spaces foramen magnum. CSF flow imaging shows diminished but present biphasic flow both anteriorly and posteriorly. Stable syringomyelia of the low cervical spine cord at the C6 and C7 levels which measures 16 mm in the craniocaudal dimension and 2 x 3 mm and axial dimension. There is also trace prominence of the central canal in the mid lower thoracic cord without frank syrinx formation, similar to prior. Redemonstration of decreased signal in the vertebral discs at C2-3 and C3-4 indicating desiccation which is associated with slight reversal of the cervical lordosis. Alignment is otherwise maintained. The vertebral body and intervertebral disc heights are preserved. Bone marrow signal is within normal limits. No significant spinal canal or neural foraminal stenosis.Thoracic spine:Alignment is within normal limits. The vertebral body and intervertebral disc heights are preserved. Bone marrow signal is within normal limits. No significant spinal canal or neural foraminal stenosis. Slight prominence of the central spinal canal as described above, otherwise the cord has normal signal and morphology.Lumbar spine:Alignment is within normal limits. The vertebral body and intervertebral disc heights are preserved. Bone marrow signal is within normal limits. No significant spinal canal or neural foraminal stenosis. The spinal cord has normal signal and morphology throughout. The conus medullaris terminates at the L1-2 level. The filum terminale is normal in appearance.", "output": "1. Stable findings of Chiari 1 malformation with the cerebellar tonsils extending 10 mm below the foramen magnum. There are diminished CSF spaces at the foramen magnum with preserved biphasic flow ventrally and dorsally. 2. Stable mild syringomyelia of the cervical spinal cord and trace prominence of the central canal in the thoracic cord.3. No findings to suggest tethered cord."}
{"instruction": "Generate impression based on findings.", "input": "48 year-old woman with history of low back pain. 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 normal in position and there is no cord signal abnormality.Mild multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Schmorl's nodes are noted in the inferior endplate of L2 and superior endplate of L3. No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is a mild disc bulge with minimal left neural foraminal stenosis. There is no spinal canal stenosis.L5-S1: There is a left paramedian disc protrusion causing significant stenosis of the left lateral recess. There is no significant spinal canal or neural foraminal stenosis. There is mild left L5/S1 facet joint arthropathy.The paraspinous soft tissues are within normal limits.", "output": "1.Disc protrusion at L5/S1 with effacement of the left lateral recess and possible impingement of the descending left S1 nerve root.2.Mild left L5/S1 facet joint arthropathy.3.Minimal left L4-L5 neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": " There is mild motion artifact limiting evaluation. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. Both vertebral arteries join to form the basilar artery. The anterior and posterior communicating arteries are present. There is no evidence of flow-limiting stenosis or aneurysm.Please note brain MRI was not obtained. There is soft tissue thickening along the inferior aspect of the left cavernous sinus and left anterior aspect of the petrous carotid canal which may correspond to reported history of schwannoma.", "output": "Mildly motion degraded MRA exam with no flow-limiting intracranial stenosis or aneurysm. Please note brain MRI sequences were not obtained as patient did not want to continue with the study.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, 56 years old, with medically intractable right temporal lobe epilepsy. Functional MRI requested for language lateralization. All language paradigms produced reliable language related cortical activation. Language is left dominant. Broca's area is identified as several foci of activation in the left inferior frontal lobe, primarily pars triangularis. Wernicke's area is identified as one or two foci of activation along the posterior aspect of the superior left temporal gyrus.", "output": "Successful functional MRI for language lateralization. Language is left dominant."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with liver lesions in the setting of NASH. Patient previously had FNH proven by biopsy, which has involuted. Other lesions are growing which was adenoma biopsy. She stopped all oral contraceptive pills. Please evaluate and characterize lesions, particularly the segment 4B lesion. Also prior history of osteosarcoma, AML, and diabetes. ABDOMEN:LIVER, BILIARY TRACT: Diffuse loss of signal intensity of the liver on out of phase imaging most suggestive of hepatic steatosis. Status post cholecystectomy.Multiple faintly T2 weighted hyperintense foci are again noted both lobes of the liver, and these lesions are stable to slightly decreased in size. Reference measurements listed below. Following contrast administration, these lesions demonstrate homogeneous enhancement on arterial phase and remain moderately hyperintense on portal venous and equilibrium phase imaging. The demonstration of avidly enhancing liver lesions against a background of hepatic steatosis may be seen in the setting of liver adenomas, particularly the inflammatory subtype. On the delayed/hepatobiliary phase, these lesions are centrally hypointense with a hyperintense peripheral rim (axial series 4 images 46, 76); FNH lesions typically demonstrate increased signal intensity in the hepatobiliary phase. The reference segment 4B lesion contains subtle focal increased T2 signal intensity, which could represent a central scar as in the case of FNH lesions.SPLEEN: No significant abnormality noted.PANCREAS: Stable small cystic lesion of the pancreatic head most compatible with a side branch IPMN (axial series 3 image 31 coronal series 6 image 26).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 8/29/2016 13:00:00)PERIPHERAL RIGHT HEPATIC LOBE LESION: 2.2 x 1.8 cm (Image 39, Series 10); 2.0 x 2.8 cm on prior (4/6/2016) (Image 35, Series 8).SEGMENT 4A LESION: 3.2 x 3.5 cm (Image 75, Series 10); 3.9 x 3.8 cm on prior (4/6/2016) (Image 68, Series 8).SEGMENT 2 LESION: 1.4 x 1.3 cm (Image 44, Series 10).", "output": "1. Bilobar enhancing lesions are stable to slightly decreased in size. Reference measurements listed above. Constellation of imaging characteristics are nonspecific and could represent atypical FNH lesions or atypical adenomas.2. Stable small cystic lesion of the pancreatic head most compatible with a side branch IPMN. "}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Hereditary hemorrhagic telangiectasia. Disorder of brain, unspecified. Other malformations of cerebral vesselsClinical question: 3T Scanner; please evaluate dural based lesion and likely AVM seen on May MRI/MRA for changes, growthSigns and Symptoms: Close surveillance of known lesions. HHT. MRI of the brainNo diffusion weighted abnormalities are appreciated.There is redemonstration of serpiginous flow voids extending in a linear fashion from the central sulcus just lateral to the hand motor area through along the perimedullary veins to the right lateral ventricle. There is associated enlargement of relevant cortical veins and subependymal veins.There is redemonstration of an extra-axial left parafalcine enhancing mass measuring 25x23 mm on coronal imaging and 28x25mm on axial imaging. There is associated susceptibility effect within the lesion. There is no evidence for signal change in the adjacent brain parenchyma. The adjacent superior sagittal sinus is narrowed and possibly occluded.No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left A1 segment is larger than the right A1 segment. The ACOMA is small. There is fetal origin of the left PCA with a large left p1 segment almost as large as the PCOMA. The right PCOMA is small.There is enlargement of the right posterior parietal artery, the right precentral artery and the central arteries associated with cortical and subependymal venous opacification.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.", "output": "1.Findings are compatible with a small AVM involving the right central sulcus with both superficial and deep venous drainage. The cortical venous drainage appears to drain anterior to the meningioma. The patient will need to be recalled to include the entire brain on the MRA at no expense to the patient.2.A left parafalcine meningioma is stable in size. It appears to narrow or obstruct the superior sagittal sinus. An MRV would help distinguish between narrowing and occlusion of the superior sagittal sinus if this is clinically relevant. 3.There is not evidence for cerebral edema."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other symptoms involving nervous and musculoskeletal systems(781.99)Dysphagia, unspecified(787.20)Clinical question: alteration in mental status, aphasia, concern for ICH vs massSigns and Symptoms: AMS Since the prior exam the patient has developed additional foci of diffusion restriction. Whereas previously they were more punctate and to a large degree involved watershed zones and cerebellum and patchy foci in the occipital lobes, there is now a larger area of diffusion restriction involving left middle and inferior frontal gyri and another new focus in the medial left occipital lobe involving calcarine cortex.Associated contrast enhancement with some of the infarction has evolved along some of the prior infarctions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Since the prior exam the patient has developed new foci of infarction involving the left frontal lobe and left occipital lobe as described above in addition to multiple foci of infarction as described above. Please note that some of the areas of infarction are associated with contrast enhancement which is likely related to subacute phase of infarction which is associated with breakdown of the blood brain barrier. This is supported by the evolution of contrast enhancement since the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Syncope. The left parieto-occipital region intraparenchymal hematoma from January 2016 has resolved, leaving encephalomalacia and hemosiderin staining at the site, and there is no evidence of acute infarction or mass. There is diffuse patchy cerebral and pontine white matter T2 hyperintensity and a punctate focus of encephalomalacia in the right thalamus. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere, which may represent a chronic lacunar infarct. There is a small developmental venous anomaly in the right cerebellar hemisphere. There is ex vacuo dilatation of the posterior left lateral ventricle superimposed upon mild diffuse cerebral volume loss. There is no midline shift or herniation. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.", "output": "1. Chronic right thalamus lacunar infarction and what likely represents chronic small vessel white matter ischemic disease, but no evidence of acute infarct. 2. The left parieto-occipital region intraparenchymal hematoma from January 2016 has resolved, leaving encephalomalacia and hemosiderin staining at the site."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with weakness and elevated CK to greater than 1000. ROTATOR CUFF: There is a near full thickness bursal surface tear of the supraspinatus tendon just proximal to its insertion on the greater tuberosity without significant retraction. Some of the articular surface fibers can be traced to their insertion on the greater tuberosity. The supraspinatus muscle appears intact. There is thickening and intermediate signal intensity within the infraspinatus consistent with mild tendinosis. The infraspinatus muscle and tendon appear intact. There is thickening and intermediate signal abnormality within the subscapularis indicating mild tendinosis. The subscapularis and teres minor muscle and tendons appear intactSUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of the glenoid labrum, the labrum appears intact. There is subchondral cyst formation within the humeral head.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL", "output": "1. Near full-thickness tear of the supraspinatus tendon as described above without significant retraction.2. No fatty atrophy or increased signal abnormality is identified within the imaged musculature of the right shoulder."}
{"instruction": "Generate impression based on findings.", "input": "Female 32 years old Reason: anterior vaginal wall cyst- rule out urethral diverticulum History: no symptoms- seen on exam PELVIS:UTERUS, ADNEXA: Note is made of a bicornuate bicollis uterus. There is a 3.1 x 1.6 cm T2 hyperintensity located in the anterior vaginal wall. The epicenter of the lesion is superior to the urethra and there is no definite connection to the bladder or urethra to suggest a diverticulum. The appearance is more suggestive of a Gartner duct cyst. Additional subcentimeter cysts identified within the lower cervix are also suggestive of nabothian cysts.Multiple ovarian follicles are noted. There are cystic lesions in the right adnexa, the largest measuring 3.9 x 2.4 cm, may represent a paraovarian cysts or peritoneal inclusion cysts. 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": "1.Cystic lesion in the superior vagina vault which is most consistent with a Gartner duct cyst.2. Paraovarian cyst versus peritoneal inclusion cyst formation in the right adnexal area."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female status post left THA. Evaluate for leg length discrepancy. Status post total left hip arthroplasty.Left leg:Acetabular roof to knee length: 45.0 cmKnee to talar dome length: 35.0 cmRight leg:Acetabular roof to knee length: 45.0 cmKnee to talar dome length: 35.0 cm", "output": "Leg length measurements as above."}
{"instruction": "Generate impression based on findings.", "input": "Back pain For the purposes of numbering, there are 5 nonrib-bearing lumbar vertebral bodies with mild sacralization involving the right aspect of the L5 vertebra. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5 and L5 on S1 with advanced facet arthropathy evident bilaterally at these levels. CT may be helpful to assess for pars defect. Bone marrow signal is benign including T1 hyperintense lesion involving the left posterior aspect of the T12 vertebral body compatible with a hemangioma. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: Minimal disc bulge and mild facet arthropathy. No significant spinal canal or neural foraminal stenosis. L4-L5: There is grade 1 anterolisthesis with disc uncovering, minimal bulge, and mild disc height loss. There is also advanced bilateral facet arthropathy. There is mild to moderate left neural foraminal narrowing. No significant spinal canal or right neural foraminal narrowing at this level. There is however mild spinal canal stenosis just inferior to the L4-L5 disc level involving the lateral aspects of the thecal sac.L5-S1: There is grade 1 anterolisthesis with disc uncovering, dorsal annular fissure, moderate disc height loss, and there is no significant spinal canal stenosis at any level. Advanced bilateral facet arthropathy. There is no significant central canal stenosis. There is partial effacement of the lateral recesses. There is mild to moderate right and no significant left neural foraminal narrowing. Paraspinous soft tissues are unremarkable. Small perineural cysts in the sacrum are incidentally noted.", "output": "Degenerative changes at the L4-L5 and L5-S1 levels including advanced bilateral facet arthropathy and grade 1 anterolisthesis at these levels. There is mild narrowing of the spinal canal just inferior to the L4-L5 disc level related to the facet arthropathy. There is also mild to moderate neural foraminal narrowing at the left L4-L5 and right L5-S1 levels. No higher grade spinal canal or neural foraminal stenosis is appreciated."}
{"instruction": "Generate impression based on findings.", "input": "28 year old male with history of Tetrology of Fallot s/p repair and PV replacement who presents for cardiac MRI to evaluate for right and left ventricular function and size Left VentricleThe left ventricle is upper limits of normal in size 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 193 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 106 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 80 g (normal range 164+/-36). There is global hypokinesis. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately increased in size with moderately reduced systolic function. The overall RV ejection fraction is 35%, the RV end diastolic volume index is 141 ml/m2 (normal range 82+/-16), the RVEDV is 260 ml (normal range 142+/-31), the RV end systolic volume index is 92 ml/m2 (normal range 31+/-9), and the RVESV is 168 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.The aortic valve is probably bicuspid in morphology; however, a good imaging plane was not able to be obtained when the patient was not having arrhythmia. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThere is a bioprosthetic pulmonic valve present. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a right sided aortic arch with mirror image brachiocephalic branching pattern. The aortic root is dilated in size.Sinus of Valsalva: 48 x 36 mm (5/1/2014: 47 x 35 mm)Sinotubular junction: 35 x 33 mm (5/1/2014: 36 x 33 mm)Ascending Aorta: 29 x 32 mm (5/1/2014: 30 x 29 mm)Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated in size. The LPA has a sharp angulated take off and is significantly narrowed at the ostium; however, there is no evidence of flow acceleration suggesting that the narrowing is not hemodynamically significant. Main pulmonary artery: 41 x 38 mm (5/1/2014: 39 x 38 mm)Right pulmonary artery: 24 x 23 mm (5/1/2014: 20 x 22 mm)Left pulmonary artery: smaller in caliber- 13 x 15 mm (5/1/2014: 16 x 15 mm)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. The left ventricle is upper limits of normal in size with mildly reduced systolic function [LVEF 45%]2. The right ventricle is moderately increased in size with moderately reduced systolic function [35%]3. Probably bicuspid aortic valve morphology3. Aortic root dilation with no evidence of aortic coarctation. No significant change from prior study.4. Pulmonary artery dilation with ostial left pulmonary artery stenosis.5. Bioprosthetic pulmonary valve present6. In comparison to the study performed 5/1/2014, there has been no significant change. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "History of Chiari decompression, new symptoms, difficulty swallowing and gait changes. Again seen are postsurgical changes of Chiari decompression with occipital craniectomy and cranioplasty. Posterior C1 arch resection is also again seen. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. There is good ventral and dorsal biphasic CSF flow at the foramen magnum. Again seen is prominence of the retrocerebellar CSF space. Multiple T2 hyperintense lesions are noted in the cervical cord, relatively largest at C2 and C7 levels, with smaller lesions including right C4-C5, left C6, and bilaterally at T1. These appear similar to 1/31/2013 without new lesions identified.Mild degenerative changes are seen as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal. Minimal left greater than right foraminal narrowing. C4-5: No significant compromise to the spinal canal. Mild left foraminal narrowing related to uncovertebral hypertrophy.C5-6: Prominent disc osteophyte complex and uncovertebral hypertrophy on the left which results in moderate left-sided neural foraminal stenosis. No significant compromise to the spinal canal or right neural foramina.C6-7: Small disc osteophyte complex, eccentric to the left with minimal left neural foraminal narrowing. No significant spinal canal or right foraminal narrowing..C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.", "output": "1. Postsurgical changes of Chiari decompression with preserved CSF flow ventrally and dorsally at the foramen magnum.2. Multifocal T2 hyperintense lesions throughout the cervical cord similar to prior from 1/31/2013, which are nonspecific, but most suggestive of chronic demyelinating disease. Other prior inflammatory processes may also be considered. No new lesions are demonstrated to suggest progression. MRI of the brain with contrast can be considered if there is possibility of active demounting disease in the brain.3. Degenerative changes in the cervical spine including left foraminal disc osteophyte complex at the C5-C6 level which results in moderate left-sided foraminal narrowing. No significant spinal canal stenosis at any level."}
{"instruction": "Generate impression based on findings.", "input": "Male, 22 years old, with urinary incontinence and back pain. Evaluate for cord compression. Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal intensity is within normal limits. The spinal cord demonstrates normal morphology and signal characteristics. No cord compression is seen. No epidural abnormalities are present. No significant disc bulge or disc herniation is seen. The spinal canal and neural foramina appear to be patent.", "output": "Unremarkable evaluation with no evidence of acute cord compression."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for patellar tendon rupture, other intra-articular knee pathology History: R knee injury, inability to extend, effusion. Due to the patient's body habitus, the high-definition knee coil could not be used. An alternative coil was used resulting in suboptimal image quality.MENISCI: No fluid-filled meniscal tears are evident.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is limited. There is moderate degeneration of the articular cartilage of the medial facet of the patella with near full-thickness to full-thickness fissuring. The remainder of the articular cartilage is unremarkable, given the aforementioned limitations.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is rupture of the patellar tendon at its attachment to the patella with a small portion of the tendon remaining attached to the patella, laterally. There is thickening and increased signal intensity of the tendon likely reflecting underlying moderate to severe tendinosis. The rupture results in a gap of just under 1 cm. There is also thickening and intermediate signal intensity within the distal quadriceps tendon suggesting tendinosis. There is also disruption of the lateral retinaculum with fluid from the joint insinuating between the torn retinacular fibers. The medial retinaculum also appears abnormally thickened with linear increased signal intensity traversing its anterior fibers suggesting a tear.ADDITIONAL", "output": "1. Limited study as described above.2. Patellar tendon rupture with additional tearing of the medial and lateral retinacula and tendinosis of the quadriceps and patellar tendons.3. Degeneration of the articular cartilage of the medial facet of the patella."}
{"instruction": "Generate impression based on findings.", "input": "weakness There are multiple restricted diffusion lesions on the right right superior and middle frontal gyri indicating acute or subacute ischemic infarctions. Gyriform susceptibility artifacts on GRE within the restricted diffusion area indicate hemorrhagic conversion and corresponding enhancement on post Gad images suggest subacute ischemic infarction related blood brain barrier disruption.High signal intensity lesion on the left precentral gyrus hand motor cortex on DWI is likely to be T2 shine through. The ventricles, sulci and cisterns are symmetric and unremarkable. 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": "Acute or subacute ischemic infarction on the right frontal lobe superior and middle frontal gyri with evidence of hemorrhagic transformation as described above."}
{"instruction": "Generate impression based on findings.", "input": "Left shoulder pain after fall ROTATOR CUFF: There is increased signal and thickening of the supraspinatus tendon reflecting moderate tendinosis. There is separation of the anterior fibers of the distal supraspinatus tendon at its insertion reflecting tear of the bursal surface fibers. The articular surface fibers may be intact. There is no evidence of retraction and the supraspinatus muscle is normal.There is mild tendinopathy of the distal infraspinatus tendon however there is no evidence of tear. The infraspinatus muscle is normal.The teres minor tendon and muscle are normal.There is mild insertional tendinosis of the subscapularis tendon without evidence of tear. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: There is severe acromioclavicular arthrosis. Fluid is noted within the subdeltoid bursa anterior to the region of the supraspinatus tear. The glenohumeral joint demonstrates mild osteoarthritic changes.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum appears normal for the patient's age. A small amount of joint fluid is present but there is no sizable effusion. Mild osteoarthritis affects the joint.BICEPS TENDON: There is mild tendinosis of the biceps tendon at the rotator interval without evidence of tear.", "output": "Rotator cuff tendinosis with focal tearing of the anterior insertional fibers of the supraspinatus tendon. There is no retraction or atrophy of the supraspinatus muscle. There is no evidence of additional rotator cuff tendon tear; additional findings of the shoulder are described above."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Weiner is a 46-year-old woman with a personal history of right breast IDC/DCIS status post lumpectomy in November 20, 2012. Patient received adjuvant radiation and chemotherapy. No current breast related complaints. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes are present within the right lower outer breast.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old male with a history of hnc and CRT, compare to previous measurements.Additional history from EMR: Adenoid cystic carcinoma of the right parotid gland (T4aN0), underwent right total parotidectomy and a right selective neck dissection with a rotational skin flap closure on 2/16/12. Redemonstrated are post-operative changes of a previous right parotidectomy without evidence of recurrence. A left parotid 7 x 6 mm T2 hyperintense nonenhancing cystic lesion is again seen which is nonspecific but remains unchanged in size. Chronic denervation changes are again seen in the left masticator space. There is stable nonspecific enhancement of the left petrous apex corresponding to the location of a previous dural based enhancing mass.The ventricles and sulci are prominent but stable, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are stable scattered nonspecific punctate foci of T2/FLAIR hyperintensity which could relate to mild chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is persistent fluid signal again seen within the right mastoid air cells.", "output": "1.Stable MRI of the brain without evidence of new intracranial metastatic disease.2.Stable postoperative changes in the right parotidectomy bed without recurrence 3.Unchanged appearance of the nonspecific subcentimeter cystic lesion in the left parotid gland centrally.4.Persistent nonspecific enhancement along the left petrous apex, adjacent to area of previous dural based mass may reflect post-treatment changes."}
{"instruction": "Generate impression based on findings.", "input": "87 year old man with elevated iron markers, referred for cardiac MRI to evaluate for cardiac iron overload. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 83 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 47 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. Based on T2 Star imaging, there is no evidence of myocardial iron overload (T2star 26 msec). There is borderline LVH with LV wall thickness of 10mm.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 127 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 79 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trace 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsT2star value in the liver is 11.4 msec. 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. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 69%.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%.3. There is no evidence of myocardial iron overload. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "99 years Female (DOB:2/17/1917)Reason: Stroke location History: R side weakness and aphasiaPROVIDER/ATTENDING NAME: DAVID G BEISER KOUROSH X REZANIA MRI of the brainFoci of diffusion restriction are present along the left insular cortex extending to the inferior aspect of the left precentral gyrus. Some punctate foci of diffusion restriction are present in the left centrum semiovale.. A 5 mm focus of diffusion restriction is present in the left temporal lobe.There are patchy foci of encephalomalacia present along the inferior aspects of the cerebellar hemispheres bilaterally.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some patchy lesions which are T2 and FLAIR hyperintense are present in the brainstem. Small T2 and FLAIR hyperintense foci are present in the basal ganglia.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain: Exam is degraded by patient motion artifact.Flow within the basilar artery and the distal left vertebral artery is not readily identified. The right vertebral artery and the left vertebral artery both appear relatively small. The posterior communicating arteries appear to supply the posterior cerebral arteries bilaterally.. There is opacification of the distal basilar artery including the superior cerebellar arteries.The left A1 segment is small. Findings suggest an azygos A2 segment. The left middle cerebral artery vasculature is not as readily visualized is the right middle cerebral artery vasculature. There appears to be divisional occlusion along the left middle cerebral artery territory most likely the inferior division. Is partly obscured by patient motion.", "output": "1.Occlusion of the proximal and mid portions of the basilar artery and possibly distal left vertebral artery. The distal basilar artery and the superior cerebellar arteries appear to be supplied from the anterior circulation through the circle of Willis. Please note that the MRA exam is somewhat degraded due to motion artifact. As a result details are less conspicuous. If clinically appropriate and further detail is necessary for clinical management a CT angiogram may be helpful to further evaluate this.2.Findings suggest left middle cerebral artery occlusion at the inferior division. Please note that the MRA exam is somewhat degraded due to motion artifact. As a result details are less conspicuous. If clinically appropriate and further detail is necessary for clinical management a CT angiogram may be helpful to further evaluate this.3.Findings are compatible with acute infarction involving left insular cortex and adjacent aspects of the left centrum semiovale and frontal lobe as well as a small lesion in the left temporal lobe. These are located in the left middle cerebral artery territory.4.Foci of encephalomalacia present along the inferior aspect of the cerebellar hemispheres which are most likely related to prior cerebrovascular event.5.Periventricular and subcortical white matter lesions of a mild degree as well as patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 6.The MRI of the brain exam is limited due to patient inability to cooperate. No susceptibility weighted imaging was performed. No T2 axial or imaging was performed. No axial T1 imaging was performed."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with cirrhosis, assess for portal vein thrombosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with nodular contour and fissural prominence. Small amount of perihepatic ascites. No significant change in eccentric filling defect in the main portal vein compatible with nonocclusive thrombus. Status post cholecystectomy.SPLEEN: Spleen is enlarged measuring 16 cm. Small perisplenic ascites.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Thickened left adrenal gland.KIDNEYS, URETERS: 2.6 cm simple cyst in the right inferior pole.RETROPERITONEUM, LYMPH NODES: Mildly prominent periportal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 1.3 cm cystic lesion in the right inferior breast.OTHER: No significant abnormality noted.", "output": "1.Nonocclusive thrombus in the main portal vein as described above is not significantly changed since the prior exam.2.Cirrhotic liver morphology is again noted without suspicious lesions."}
{"instruction": "Generate impression based on findings.", "input": "Pain in left knee. Is there a Baker's cyst or other pathology in the posterior knee? Also, what is the sclerotic focus mentioned in the April 22 knee radiograph? Exquisite tenderness and posterior knee with palpation. Evaluation the knee is limited on some sequences by motion artifactMENISCI: There is marked attenuation of the body and much of the posterior horn of the lateral meniscus, presumably reflecting extensive attritional tearing assuming there has not been a prior partial meniscectomy. The tearing also extends anteriorly to involve the inner fibers of the anterior horn of the lateral meniscus. There is also diffuse attenuation of the medial meniscus likely representing chronic attritional tearing in the absence of prior partial meniscectomy. Additionally, however, there is a complete longitudinal (vertical) tear of the posterior horn of the medial meniscus near the red-white junction.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee with much of the lateral tibiofemoral compartment devoid of articular cartilage, particularly posteriorly. Abnormal subchondral signal intensity in the lateral femoral condyle and tibial plateau is likely degenerative in etiology. There is also subjective thinning of the articular cartilage of the medial tibiofemoral compartment and moderate degeneration of the articular cartilage of the patellofemoral compartment with focal areas of full-thickness cartilage loss. There are tricompartmental osteophytes. There is an irregularly-marginated cortically-based focus of low signal intensity within the distal femoral metaphysis medially that corresponds to the sclerotic focus seen on recent radiographs. Small foci of high signal intensity are noted adjacent to this abnormality on the fluid sensitive sequences. I suspect that this represents the residua of an involuted benign fibroxanthoma (nonossifying fibroma).LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1.Severe osteoarthritis, particularly affecting the lateral tibiofemoral compartment.2.Attenuation of the menisci likely represents extensive chronic attritional tearing (assuming there has not been prior partial meniscectomy); there is also a complete longitudinal tear of the posterior horn of the medial meniscus.3.Although I see no Baker cyst, there is a joint effusion with a small amount of fluid extending posteriorly through a small rent in the posterior capsule.4.Predominantly low signal intensity focus within the distal femoral metadiaphysis corresponds to the sclerotic focus seen on radiographs. I suspect that it represents the residua of a involuted fibroxanthoma (nonossifying fibroma)."}
{"instruction": "Generate impression based on findings.", "input": " Redemonstrated are postoperative changes from L2 through L5 with complete or partial laminectomy present. Two previously demonstrated spinal cord stimulators entering at T12/L1 and L1/2 are not well demonstrated with MRI technique and may has been removed. Correlation with x-ray or CT could help better define.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: Bilateral facet hypertrophy without resulting stenosis, unchanged.L1/2: Mild disc bulge, ligamentum flavum thickening, and bilateral facet hypertrophy. There are no significant stenoses. These findings are unchanged.L2/3: Diffuse disc bulge, endplate spurring, facet hypertrophy, and presumed right incorporated posterior graft material. There is marked bilateral lateral recess and severe bilateral neural foraminal stenosis, unchanged.L3/4: Diffuse disc bulge, endplate spurring, facet hypertrophy, and presumed bilateral incorporated posterior graft material. There is mild central, marked bilateral lateral recess, and severe bilateral neural foraminal stenosis, unchanged.L4/5: Diffuse disc bulge, endplate spurring, facet hypertrophy, and presumed bilateral incorporated posterior graft material. There is severe central, marked bilateral lateral recess, and severe bilateral neural foraminal stenosis. Central and right foraminal stenosis have progressed. L5/S1:Asymmetric bulge to the right, endplate spurring, facet hypertrophy, and presumed bilateral incorporated posterior graft material. There is mild central, moderate right lateral recess, marked right lateral recess, mild left neural foraminal, and moderate to severe right neural foraminal stenosis, unchanged.SI Joints: Partial fusion with osteophytic bridging, unchanged.", "output": "1.L2/3: Marked bilateral lateral recess and severe bilateral neural foraminal stenosis, unchanged.2.L3/4: Mild central, marked bilateral lateral recess, and severe bilateral neural foraminal stenosis, unchanged.3.L4/5: Severe central, marked bilateral lateral recess, and severe bilateral neural foraminal stenosis. Central and right foraminal stenosis have progressed. 4.L5/S1:Mild central, moderate right lateral recess, marked right lateral recess, mild left neural foraminal, and moderate to severe right neural foraminal stenosis, unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Effusion and positive McMurray's. MENISCI: There is a complex tear with both radial and vertical components and fragmentation of the posterior horn of the medial meniscus. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is full thickness loss of articular cartilage of the weight-bearing portion of the medial femoral condyle in between the meniscal horns. There is also thinning of the articular cartilage of the weight-bearing portion of the medial tibial plateau along the medial aspect. The articular cartilage of the lateral compartment is intact. There is partial thickness heterogeneity of the lateral facet articular cartilage of the patella compatible with degeneration. The trochlear cartilage is intact. There is mild edema along the medial aspect of the medial tibial plateau.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: Increased T2 signal in the soft tissues anterior to the patellar tendon may reflect a prepatellar bursitis.ADDITIONAL", "output": "1. Complex tearing of the posterior horn of the medial meniscus.2. Chondromalacia as described above."}
{"instruction": "Generate impression based on findings.", "input": "Rule out spinal cord compression. History of subacute waxing and waning bilateral lower extremity weakness). There is mild superior endplate deformity at T12 vertebra with adjacent Schmorl's node, which is most likely related to mild chronic compression fracture. There is mild deformity also noted along the superior endplate of T4 vertebral body also likely related to mild chronic compression deformity. Remaining vertebral body and intervertebral disc heights are preserved. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.There are scattered degenerative changes throughout the spine including disc osteophyte complex at C5-C6 and C6-C7 with ligamentum flavum thickening. Small scattered disc bulges involving the lower thoracic spine is noted. The lumbar spinal canal appears developmentally narrowed. There is prominent epidural fat and disc bulges at L4-L5 and L5-S1 levels, with suspected mild to moderate spinal canal stenosis at these levels. There are focal scattered T1 hyperintense areas at multiple vertebral body levels which may represent focal fat or benign hemangiomas.", "output": "This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. Scattered degenerative changes throughout the cervical and thoracic spine but without high-grade spinal canal or neural foraminal narrowingDevelopmentally narrowed lower lumbar spinal canal with prominent epidural fat and disc bulge at L4-L5 and L5-S1, which results in mild to moderate narrowing of the spinal canal at these levels. Further evaluation with dedicated lumbar spine imaging can be obtained as clinically indicated.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female. Hepatic mass with chronic right upper quadrant pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Patient's known mass near the caudate lobe cannot be well seen on this single phase CT but remains grossly unchanged compared to previous MRI. No evidence of a complication related to this mass such as hemorrhage.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 7 x 4.3 cm cystic mass arising from the right ovary. Further evaluation with pelvic ultrasound is recommended.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "No significant change in the patient's known, most likely benign hepatic lesion. This lesion cannot be well seen or measured on this single phase CT.Right ovarian cystic lesion. Further evaluation with pelvic ultrasound is recommended to exclude a cystic ovarian neoplasm."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with liver lesions in the left lobe and caudate lobe. ABDOMEN:LIVER, BILIARY TRACT: The liver is mildly prominent in size, though of normal parenchymal appearance otherwise. There is no biliary ductal dilation. Two masses are seen in the liver. A caudate lobe mass measures 3.8 x 3.1 cm. A left hepatic lobe mass measures 2.9 x 1.8 cm. The masses are homogeneously isointense to the background liver on T2 sequences and hyperintense on T1 sequences, without signal dropout on out of phase images. The masses are gently lobulated. The masses demonstrate arterial enhancement on e-THRIVE sequences, with continued enhancement on delayed images. There is a question of a focal linear T2 hyperintensity in the caudate lobe mass, which demonstrates delayed enhancement suggestive of a scar.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abdominal fluid collections are noted.", "output": "Two enhancing masses seen in the liver, most likely representing focal nodular hyperplasia."}
{"instruction": "Generate impression based on findings.", "input": "Male 21 years old Reason: r/o meniscal or ligamentous tear History: pain MENISCI: There is perhaps mild fraying of the anterior edge of the posterior horn of the lateral meniscus. Otherwise no discrete meniscal tear is identified.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect in the lateral femoral condyle measuring approximately 5 mm in AP dimension, with underlying T2 hyperintense bone edema signal. There is thinning of the articular cartilage of the medial femoral condyle.LIGAMENTS: There is complete rupture of the anterior cruciate ligament. Diffuse yellow is intact. The MCL and LCL are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL", "output": "Complete rupture of the ACL and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with lower back pain and history of non-Hodgkin's lymphoma. Evaluate for metastatic involvement. Multiple areas of increased signal are present on STIR sequence. On the right, there is increased signal within the right acetabulum, right femoral head and neck junction, and greater trochanter with extension into the femoral diaphysis. On the left, there is increased signal within the acetabulum, intertrochanteric region, lesser trochanter, and greater trochanter with extension into the diaphysis.There is also extensive increased signal within the sacrum. The L3, L4, and L5 vertebral bodies are also involved.There is enhancement most prominent in the sacrum and lumbar vertebral bodiesCystic foci are present in the ovaries bilaterally.", "output": "Widespread metastatic disease in the lumbar spine, pelvis, and femurs as above."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Brain parenchymal injury/intraventricular hemorrhage. Signs and symptoms: Head trauma. Nonenhanced brain MRI:Diffusion weighted images demonstrate multiple varying size small foci of restricted diffusion involving the cortex and subcortical white matter of bilateral cerebral hemispheres.Regions of acute stroke demonstrate no evidence of hemorrhagic changes when compared with susceptibility MRI sequences. The largest finding in the right hemisphere is in the right posterior temporal cortex and measuring at approximately 6 x 12 mm in transaxial dimensions. The largest left hemispheric lesion is in the left frontal and partially involves the left insular cortex and measuring at approximately 8 x 9 mm in transaxial dimensions. These lesions are well identified as foci of T1 hyperintense and T2 hyperintense and without significant mass effect.Examination additionally demonstrate focus of acute hemorrhage hemorrhage/hematoma in the midline projecting in an AP semierect tibia at least partially within the corpus callosum and partially within the cisterna velum interpositum and with a small amount of hemorrhage in the right lateral ventricle as was noted on prior head CT.There is extra-axial subdural collection also in the right frontal and temporal convexity with subtle mass effect on the adjacent parenchyma and measuring maximum of 4 mm in thickness. Previously noted on head CT small right sided subdural hematoma along the right tentorial leaf is again noted and measures approximately 2 mm in maximum thickness.Unremarkable images through posterior fossa.Ventricular system remains within normal size and great maintained midline.The signal void of major intracranial arterial branches are identified.Images through the orbits are grossly unremarkable on this nondedicated study.There is extensive (R>L) opacification of mastoid air cells.Paranasal sinuses demonstrate mild sphenoid mucosal thickening.Nonenhanced brain MRA:Patent and unremarkable bilateral vertebral arteries, left PICA, dominant right Aica, basilar artery, superior cerebellar and posterior cerebral arteries and their branches.Patent and unremarkable right internal carotid artery, right anterior and middle cerebral arteries and their branches.Patent and unremarkable left internal carotid, left anterior and middle cerebral arteries.", "output": "1.Multiple scattered foci of restricted diffusion/acute stroke in bilateral cerebral hemispheres without evidence of hemorrhagic changes as detailed/measured above.2.Midline hemorrhage likely partially within the corpus callosum and partially within the cisternal development of positive as well as right lateral ventricle without significant change since prior head CT exam.3.Right frontal and temporal subdural measuring maximum of 4 mm in size is more conspicuous on this exam compared to prior CT.4.Subdural noted on prior head CT along the right tentorial is again identified and stable since prior exam with maximum of 2 mm in thickness.5.Opacification of bilateral mastoid air cells (R>L).6.Grossly unremarkable images through the orbits and paranasal sinuses.7.Unremarkable brain MRA."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female patient with history of recurrent inflammatory lesions of the brain. Reevaluate inflammatory lesions. There are stable postbiopsy findings in the left cerebellum with residual susceptibility artifact in the left cerebellar hemisphere. Additionally, there is residual mild high T2 signal in the left pons and pontomedullary junction region. There is an unchanged punctate focus of enhancement within the left pons with associated susceptibility artifact. Minimal periventricular T2 hyperintensity is unchanged and may represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or 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. There is fluid within the paranasal sinuses with air-fluid levels. The orbits, skull, and scalp soft tissues are grossly unremarkable.", "output": "1. Stable postbiopsy findings in the cerebellum without evidence of new inflammatory intracranial lesions.2. An unchanged punctate left pontine lesion may represent an underlying vascular malformation, such as a telangectasia, versus sequela of a treated inflammatory lesion.3. Air-fluid levels in the paranasal sinuses is suggestive of acute sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "74 year old woman with history of CAD s/p CABG in 2013, referred for further evaluation of inducible ischemia.MEDICATIONS: ASA, Lipitor, Coreg, Enalapril, Lasix, Nifedipine First Pass PerfusionDuring hyperemia, there were perfusion defects in the apical inferior, mid anterior and anterolateral and basal inferior walls.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. Mild left ventricular hypertrophy with a sigmoid septum. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 137 ml (normal range 109+/-23), the LV end systolic volume index is 24 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 39 g/m2, and the LV mass is 78 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Lipomatous hypertrophy of the interatrial septum. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern. Mild atherosclerosis noted in thoracic aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThyroid enlargement is noted. Sternal wires noted. 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. During hyperemia, there were perfusion defects in the apical inferior, mid anterior and anterolateral walls, and the basal inferior walls.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 64%). Mild left ventricular hypertrophy.4. Normal RV size and systolic function (RVEF 55%).5. Mild dilation of the main pulmonary artery.6. Moderate biatrial dilation with lipomatous hypertrophy of the interatrial septum. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female with a left groin mass. Please evaluate. A vitamin E marker overlies the medial aspect of the left anterior thigh which presumably represents the patient's palpable area of concern. There is a lobulated mass of predominantly fluid signal intensity along the anterior aspect of the thigh within the adductor brevis muscle of the adductor musculature, which measures approximately 3.9 x 4.0 x 5.6 cm (TR x AP X CC). There are associated septations which enhance on post contrast sequences. There is an inguinal lymph node along the anterolateral margin of the mass, measuring 6 mm in the short axis, which appears to retain its normal fatty hilum/morphology on coronal images. There are no inflammatory changes in the surrounding soft tissues to suggest an infectious etiology, although this cannot be completely excluded by this examination. No bone marrow signal abnormality is identified. The imaged musculature of the left hip and thigh are otherwise normal in appearance.", "output": "5.6 cm mass along the medial aspect of the left anterior thigh, with fluid signal intensity and enhancing septations suspicious for neoplasm, most consistent with an intramuscular myxoma. A soft tissue sarcoma is considered less likely, but cannot be completely excluded. "}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female with BRCA2 mutation. There is heterogeneous amount of fibroglandular tissue in both breasts, which appear symmetric. Moderate parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.", "output": "No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "NF type 2, deafness, vestibular schwannomas. There are postoperative findings related to bilateral retrosigmoid and right parietal craniotomy. Redemonstrated are numerous supratentorial and infratentorial extra-axial masses, including schwannomas and meningiomas, which are not significantly changed. In particular, the right vestibular schwannoma measures 3.7 x 2.3 x 2.2 cm, previously 3.7 x 2.2 x 2.2 cm and the left vestibular schwannoma measures 1.6 x 0.7 x 0.6 cm, previously also 1.6 x 0.7 x 0.6 cm. The brain parenchyma appears unchanged with mild areas of edema associated with some of the meningioma, particularly at the cerebral convexities. There is no evidence of acute cerebral infarction. The partially imaged intramedullary heterogeneously enhancing lesion within the upper cervical spinal cord appears grossly unchanged and is compatible with an ependymoma.", "output": "1. No significant interval change in the extensive intracranial stigmata of neurofibromatosis type 2, including bilateral vestibular schwannomas.2. Partially imaged ependymoma within the upper cervical spine."}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: lung adenocarcinoma staging History: SOB There are multiple susceptibility lesions involving bilateral frontal, parietal lobes and bilateral thalami. These lesions indicate possible abdomen lordosis or petechial small chronic hemorrhages or calcifications.No evidence of acute ischemic or acute hemorrhagic lesion.Patchy periventricular white matter FLAIR/T2 high signal intensity lesions are seen indicating non specific small vessel ischemic disease.There is no abnormal enhancement.The ventricles, sulci and cisterns are unremarkable. There is no mass, 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. Multifocal various sized susceptibility lesions indicating possible cerebral amyloidosis, petechial chronic hemorrhages or calcification.2. Non specific small vessel ischemic disease.3. No acute ischemic or hemorrhagic lesion. No abnormal enhancement."}
{"instruction": "Generate impression based on findings.", "input": "cT2N1 nasopharyngeal squamous cell carcinoma treated with TFHx and XRT. There are post-treatment findings in the nasopharyngeal. Thre is no residual measurable right nasopharynx mass. There is also no significant upper cervical lymphadenopathy. For example, a right level 2B lymph node measures 6 x 10 mm. The skull base is intact. The submandibular glands are relatively hyperenhancing, which may be attributable to treatment effects. The parotid glands are unremarkable. There are nonspecific scattered foci of T2 hyperintensity in the imaged cerebral white matter. There is mild scattered paranasal sinus mucosal thickening. There is a small amount of fluid within the right mastoid air cells.", "output": "No measurable residual treated right nasopharyngeal carcinoma and no significant upper cervical lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Chiari malformation, headaches. The cerebellar tonsils extend up to approximately 5 mm inferior to the foramen magnum and display rounded morphologies. In addition, there is intact biphasic flow across the foramen magnum, both anteriorly and posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The pituitary gland is unchanged, measuring up to 10 mm in height, which is within normal limits. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening.", "output": "The cerebellar tonsils extend up to approximately 5 mm inferior to the foramen magnum and display rounded morphologies. In addition, there is intact biphasic flow across the foramen magnum, both anteriorly and posteriorly."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out cord compression. Signs and symptoms: Leg weakness. Nonenhanced thoracic MRI:Examination demonstrates normal signal intensity and alignment of vertebral carotid.There is normal signal intensity and caliber of thoracic cord.There is no appreciable degenerative changes of the spine, spinal canal or neural foraminal compromise at any level.There is no detectable paraspinal soft tissue abnormalities.There is no interval change since prior cord compression MRI study from 6-25-15.Nonenhanced lumbar MRI:Examination demonstrates normal signal intensity and alignment of vertebral column. Minute degenerative disease at L5-S1 is noted. No detectable spinal canal or neural foraminal compromise/stenosis at any level.Normal signal intensity and morphology of the conus and cauda equina.No detectable. Spinal soft tissue abnormalities.", "output": "1.Unremarkable nonenhanced thoracic MRI.2.Unremarkable nonenhanced lumbar MRI."}
{"instruction": "Generate impression based on findings.", "input": "Female 49 years old Reason: knee pain, eval for meniscal or chondral injury History: as above. MENISCI: There is a small defect along the undersurface of the inner fibers of the posterior horn of the medial meniscus, indicating a small undersurface tear. Mild increased signal intensity within the posterior horn and body of medial meniscus indicates intrasubstance degeneration. The anterior horn appears normal. There is mild intrasubstance signal within the body of the lateral meniscus indicating degeneration, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is partial-thickness degeneration of the articular cartilage of the medial femoral condyle, above the posterior horn of the medial meniscus. There is also partial thickness degeneration of the articular cartilage of the medial femoral condyle above the anterior horn of the medial meniscus. There is minimal superficial fraying of the articular cartilage of the medial tibial plateau. Mild increased signal intensity of the articular cartilage of the lateral tibial plateau between the meniscal horns is suggestive of mild degeneration. The patellar cartilage appears normal for patient's age.LIGAMENTS: Mild edema type signal along the medial collateral ligament could represent a sprain in the correct clinical context, but the ligament itself appears normal. Lateral collateral ligament complex is intact. The cruciate ligaments are unremarkable. The femoral attachment of the medial patellofemoral ligament is indistinct, but the clinical significance of this is uncertain.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL", "output": "1.Small undersurface tear of the posterior horn of the medial meniscus.2.Foci of cartilage degeneration as described above.3.Joint effusion and Baker's cyst as described above."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with instability and pain ROTATOR CUFF: The muscles and tendons of the rotator cuff appear intact and normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is intact without evidence of tear or degeneration. The articular cartilage appears normal.BICEPS TENDON: Normally situated within the bicipital groove.ADDITIONAL", "output": "Normal shoulder arthrogram without findings to explain the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female with right ear pain, right neck pain, right shoulder pain, right suboccipital adenopathy, fever and chills. History of contrast allergy premedication (unreadable wording.) Enhanced CT of soft tissues of neck:Limited view of the intracranial content is essentially unremarkable for patient's stated age of 74.Images through the skull base, cavernous sinuses, paranasal sinuses and bilateral petrous bones are also normal.Very small soft tissue densities within the left external auditory canal is likely secondary to debris.The soft tissues of the suboccipital region demonstrate no evidence of lymphadenopathy as clinically indicated. No abnormality of occipital bone is detected either.Images through the neck demonstrate no evidence of a mass or pathologic adenopathy. The facia planes are well preserved. There is no evidence of any inflammatory changes of soft tissues of neck. There is no abnormal enhancement of soft tissues of neck. There is no evidence of any osseous or cartilaginous erosion. Limited images of mediastinum and upper lung fields are negative for masses or adenopathy.The aortic arch appears a slightly dilated and measures 43.5-mm in its widest visualized portion.Moderate degenerative disk disease at C5 -- C6 and C6 to C7 levels are noted. There is loss of disk height and subtle sclerotic changes of the adjacent endplates. There is a slight reversal of cervical lordosis which may be positional or secondary to degenerative spondylosis. There is partial visualization of the neural foramina in the cervical region. This demonstrate compromise the right neural foramina at C6 -- C7, C5 -- C6 bilaterally and C4 -- C5 on the right. Although this test is not appropriate for evaluation of central spinal stenosis there is no bony central canal stenosis. Considering a provided clinical date of an MRI of cervical spine might be helpful for further evaluation of patient's pain.", "output": "1.No evidence of mass or pathologic adenopathy in the neck.2.No evidence of any inflammatory/infectious process in the neck.3.No detectable suboccipital adenopathy as clinical data indicates.4.Well pneumatized paranasal sinuses, mastoid air cells and middle ear cavities.5.Degenerative disk disease throughout the cervical spine with multilevel neural foramina compromise as detailed above.6.Limited view of intracranial content is essentially unremarkable for patient's stated age."}
{"instruction": "Generate impression based on findings.", "input": " There is normal alignment of the cervical spine. The osseous marrow signal is benign. The cord signal is within normal limits. The visualized soft tissues are within normal limits. The visualized flow voids in the neck are patent.C2-3: Unremarkable.C3-4: Unremarkable.C4-5: Minimal left facet arthrosis with no disc herniation, spinal canal or neural foraminal stenosis.C5-6: Unremarkable.C6-7: Unremarkable.C7-T1: Unremarkable.", "output": "Unremarkable noncontrast cervical spine with no spinal canal or neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Male, 22 years old, with numbness, twitching limbs, speech difficulty, and headache. A 7 mm, relatively round T2 hyperintense lesion is evident within the left frontal white matter showing no evidence of associated mass effect, restricted diffusion or susceptibility artifact. A much smaller T2 hyperintense lesion is evident within the right periatrial white matterMild CSF prominence at the level of the right choroidal fissure is seen. Brain parenchymal morphology is otherwise within normal limits. No evidence of significant edema or mass effect is detected. No restricted diffusion is seen. No evidence of intracranial hemorrhage is detected. The ventricular system is within normal limits for size.", "output": "1.Two subcentimeter white matter lesions are identified, one within the left frontal lobe and one in the right periatrial region. Although these are not adequately specific to make a definitive diagnosis, the possibility of a demyelinating process should be considered. Imaging follow-up with contrast may be considered as clinically warranted.2.Mild CSF prominence at the level of the right choroidal fissure may represent an anatomic variation or a small choroidal fissure cyst, in any case likely an incidental finding."}
{"instruction": "Generate impression based on findings.", "input": "Point tenderness. There is no evidence of cervical spine bone marrow edema of gross ligamentous disruption. The vertebral body heights are preserved. There is multilevel degenerative spondylosis with associated spinal canal and neural foraminal narrowing, particularly at C4-5, C5-6, C6-7 and C7-T1. The spinal cord signal is preserved. There is lack of the usual cervical lordosis, but no spondylolisthesis. There is a left thyroid nodule.", "output": "1. No evidence of cervical spine bone marrow edema of gross ligamentous disruption.2. Multilevel degenerative spondylosis with associated spinal canal and neural foraminal narrowing, particularly at C4-5, C5-6, C6-7 and C7-T1. 3. Left thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Sensorineural hearing loss and headache. (Longstanding DM with retinal hemorrhages, now blind in the right eye and decreased visual acuity in the left eye, as well as sensorineural hearing loss of unclear etiology: possible vasculitis.) There is no evidence of significant steno-occlusive lesions in the cerebral arteries. There is also no evidence of cerebral aneurysms. There is a right scleral buckle and intraocular silicone oil.", "output": "No evidence of significant steno-occlusive lesions. However, MRA has limited sensitivity for small vessel vasculitis."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female s/p OLT now with altered mental status status There is patchy restricted diffusion in the pons with questionable mildly restricted diffusion involving the caudate nuclei and bilateral thalami. Corresponding T2 hyperintensity is seen involving the caudate and putamina bilaterally and possibly the medial temporal lobes and hypothalami. The ventricles are not frankly enlarged though they do appear to be 2 to 3 mm larger in caliber when compared to previous CT. There is a thin rim of ependymal T2 hyperintensity along the lateral ventricular margins.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified.", "output": "Restricted diffusion is evident in the pons, thalami and questionably the basal ganglia. Abnormal T2 signal intensity is seen in these areas, and also in the hypothalami and medial temporal lobes. Although the ventricles are not frankly dilated, they have increased in caliber by 2 to 3 mm and there is a thin rim of ependymal signal abnormality along the lateral ventricular margins. Some of the above findings could be accounted for by a metabolic derangement, perhaps osmotic demyelination related to osmotic stress, although other metabolic abnormalities are not excluded. On the basis of this examination, a nonspecific encephalitis (infectious, autoimmune or drug related) could also be considered. Findings are not typical for either an ischemic process or classic hepatic encephalopathy. Imaging follow-up with contrast enhanced MRI should be considered if symptoms fail to improve."}
{"instruction": "Generate impression based on findings.", "input": "52 year old female with history of hypertension, coronary artery disease s/p multiple PCI, dyslipidemia and sarcoidosis presenting for cardiac evaluation. MEDICATIONS: aspirin, amlodipine, clopidogrel, rosuvastatin, hydrochlorothiazide, isosorbide mononitrate, losartan and metoprolol First Pass PerfusionDuring hyperemia, the patient has a perfusion defect involving the basal inferior wall, the mid anteroseptal, anterior, anterolateral, inferior, and inferoseptal walls, and the entire LV apex. The perfusion defect is in the usual territory of the LAD and RCA.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 59 ml/m2 (normal range: 65+/-11), the LVEDV is 100 ml (normal range 109+/-23), the LV end systolic volume index is 59 ml/m2 (normal range 18+/-5), the LVESV is 35 ml (normal range 31+/-10), the LV mass index is 40 g/m2, and the LV mass is 69 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 108 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. There is communication between the left and right atria, likely consistent with patent foramen ovale. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The aortic valve is thickened and calcified with evidence of flow acceleration. Correlation with echo suggested to further quantify/ determine severity of aortic valve sclerosis/ stenosis.Mitral ValveThe mitral valve opens widely and there is at least mild, eccentric, mitral regurgitation. The anterior leaflet of the mitral valve was thickened and possibly calcified.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 FindingsThere is a large lymph node (22mm) in the left axilla. 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. Large perfusion defect/ \"ischemia\" noted in LAD and RCA territory.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 55%).5. Thickening/ calcification noted on aortic and mitral valves. 6. Small patent foramen ovale is note.7. Large left axillary lymph node noted.When compared to the prior study from 2/2009, there is no longer late gadolinium enhancement present.Findings conveyed to Dr. DeCara.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female, 63 years old, with temporal lobe epilepsy. Scattered foci of nonspecific periventricular T2 hyperintensity are seen. No evidence of edema or mass effect is detected. No pathologic intracranial enhancement is observed. The mesial temporal lobe structures are symmetric and free of pathologic signal abnormality. There are small hippocampal sulcus remnant cysts on the left. The ventricles, sulci and convexity subarachnoid spaces are prominent compatible with generalized parenchymal volume loss. No evidence of intracranial hemorrhage or any abnormal extra-axial collection is seen.", "output": "No findings are seen which would account for the patient's seizures."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal bloating after eating. History of dilated pancreatic duct on outside hospital CT. ABDOMEN:LIVER, BILIARY TRACT: Several liver cysts are noted. The liver is otherwise normal in morphology, size, signal intensity and enhancement without a focal suspicious lesion or intrahepatic biliary ductal dilatation with the common bile duct measuring up to 4 mm. The vessels are patent.Normally distended gallbladder.SPLEEN: The spleen is normal in size, morphology, signal intensity and enhancement without a focal lesion.PANCREAS: The main pancreatic duct is diffusely dilated up to 6 mm but tapers smoothly at the level of the ampulla without a discrete mass lesion or ampullary bulging. No significant pancreatic parenchymal atrophy. Normal post-contrast enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts. No suspicious lesion or hydroureteronephrosis.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": "Moderate diffuse dilatation of the main pancreatic duct to the level of the ampulla without a discrete mass lesion or pancreatic atrophy. No significant biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Assess right hip avascular necrosis There is serpentine signal abnormality within the epiphysis of the right femoral head indicating avascular necrosis involving the majority of the subchondral bone. The necrotic bone is of predominantly fat signal intensity on T1-weighted images. A thin curvilinear band of subchondral intermediate signal intensity likely represents a subchondral fracture, but I see no frank articular surface collapse. There is edema of the femoral head extending into the neck and intertrochanteric region. There is a small amount of fluid in the joint, but no large effusion.Similar although slightly less extensive avascular necrosis affects the left femoral epiphysis, with edema of the left femoral head extending into the left femoral neck. There is small amount of fluid in the joint, but no large effusion. The remainder of the bone marrow signal intensity is normal. The sacroiliac joints appear normal. The musculature appears normal. This study was not protocoled for detailed evaluation of the pelvic viscera, but I see no gross abnormalities. There are nodular subcutaneous lesions in the mons pubis which may represent cysts.", "output": "Avascular necrosis of the femoral heads and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Sensory level, gait instability. There is a slight disc protrusion at C4-5, which minimally effaces the anterior thecal sac cerebrospinal fluid. There is no significant neural foraminal stenosis or cord compression at any of the cervical spine levels. There is straightening of the vertebral column is the sagittal plane, but no spondylolisthesis. 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. There is an incompletely imaged pituitary lesion.", "output": "1. Slight disc protrusion at C4-5, but no significant neural foraminal stenosis or cord compression at any of the cervical spine levels.2. No evidence of demyelinating lesions in the imaged portions of the spinal cord. 2. Incompletely imaged pituitary lesion. Please refer to the recent pituitary MRI report for additional details. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 21 years old, currently 35 weeks GA, with suspected thymic mass on ultrasound. A solid, homogeneous, relatively T2 hypointense soft tissue structure is present in the anterior mediastinum where is drapes the great vessels and heart most compatible with thymus tissue. The margins of this tissue are well defined and gently curved as would be expected for thymus. The tissue is at most mildly prominent, with a transverse diameter of 38 to 40 mm. This is reasonably close to the reported normative mean of 36 mm for a GA of 35 weeks as assessed by ultrasound (Cho et al., Ultrasound Obstet Gynecol 2007; 29:634-638). No evidence of any invasive features or cystic spaces is seen. The adjacent tissues of the upper thorax are within normal limits. The airway is visualized and is unobstructed from the level of the pharynx to the carina. No other neck masses are seen. The fetal thyroid is identified as a distinct structure and is normal.", "output": "No evidence of any pathologic neck or mediastinal mass lesion is seen. The thymus is identified in its normal anterior mediastinal position. The internal consistency of the gland is unremarkable. Size of the gland is in the range of upper normal. No aggressive or concerning features are seen. These findings most likely represent a normal or at most mildly hyperplastic thymus.The adjacent mediastinal structures are unremarkable. In particular, the airway is patent from the pharynx to the carina."}
{"instruction": "Generate impression based on findings.", "input": " Cervical images are somewhat limited by patient motion. Within these limitations, post contrast images demonstrate numerous areas of abnormal enhancement, including a few foci within the right inferior cerebellum as seen on prior brain MRI. There is redemonstration of leptomeningeal enhancement along the left greater than right cerebellar sulci. In addition, there is patchy intramedullary cord enhancement most conspicuous along the right ventral C6 level, as well as areas of leptomeningeal enhancement scattered along the cord surface along its entire length. There is a small area of intrinsic T2 hyperintensity within the midline ventral cord at the mid T8 level with enhancement. There is also T2 abnormality along the left ventral aspect of the cord at the T9-T10 and mid T11 levels with enhancement. There is also similar abnormality along the left dorsal mid T12 level. Focal enhancing nodules also seen along some of the distal cauda equina nerve roots caudal to the L3-L4 level. There is focal 5 x 4 mm nodular enhancement in the right lateral thecal sac L1-L2 level presumably associated with a nerve root.The spine is in normal alignment. There is mild disk narrowing at L5-S1 with mild scattered lumbar disk desiccation. The vertebral body and disk heights are otherwise well-maintained. There is a mildly heterogeneous appearance of the marrow signal especially in the cervical and thoracic spine which is nonspecific. The spinal cord is of normal caliber. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level.Throughout the cervical spine, there are mild disk bulges with rightward predominance. There is minimal ligamentum flavum thickening at C5-C6 and C6-C7. There is mild central spinal canal stenosis at C5-C6. There is mild right foraminal narrowing at C3-C4 and C4-C5, as well as bilaterally at C5-C6.There is a trace disk bulge at L2-L3 with left paramedian annular fissure and shallow left foraminal disk protrusion. There is resultant mild/moderate left foraminal narrowing. Additional trace disk bulges noted at L4-L5 with small left distal foraminal/fat lateral annular fissures. Small central annular fissure is also present at L5-S1 with shallow right paracentral disk protrusion which abuts the descending right S1 nerve root.There is moderate fluid opacification of bilateral mastoid air cells.", "output": "1. Diffuse leptomeningeal disease within the spinal canal, with scattered early areas of intramedullary metastatic disease identified along cervical and lower thoracic spine which may in part relate to direct extension from areas of leptomeningeal tumor.2. Redemonstration of known leptomeningeal and parenchymal metastatic disease in the posterior fossa.3. Nonspecific heterogeneous appearance of the marrow signal.4. Mild scattered cervical and lumbar spondylotic changes as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral forearm pain and upper extremity numbness. There is right C4-5 uncovertebral hypertrophy with moderate neural foraminal stenosis. There is a small posterior disc-osteophyte complex at C6-7 and facet hypertrophy with perhaps mild right neural foraminal stenosis, but no significant spinal canal or left neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.", "output": "1. Right C4-5 uncovertebral hypertrophy with moderate neural foraminal stenosis. 2. Small posterior disc-osteophyte complex at C6-7 and facet hypertrophy with perhaps mild right neural foraminal stenosis, but no significant spinal canal or left neural foramen stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Male, 71 years old, with weakness. Possible TIA. MRI brain:No convincing restricted diffusion is seen. Numerous scattered periventricular and subcortical foci of T2 hyperintensity are evident within the cerebral hemispheres and brainstem. No evidence of significant edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.MRA brain:No high-grade intracranial stenosis or vascular occlusion is seen. There is mild irregularity of the cavernous ICAs. The ACOM artery is small and unremarkable. Prominent bilateral PCOM arteries are seen. No aneurysm or vascular malformation is suspected.MRA neck:Conventional aortic branching is seen. The origins of the great vessels are not well seen due to technical artifact. The carotid vessels of the neck are free of significant vascular stenosis by NASCET criteria. The origin of the right vertebral artery is not well seen. Otherwise, the vertebral arteries are free of significant vascular stenosis or occlusion.", "output": "1.No acute ischemia or other definite acute intracranial abnormality is seen. Findings compatible with chronic microvascular ischemic disease are evident.2.No significant vascular stenosis or occlusion is detected in the head or neck."}
{"instruction": "Generate impression based on findings.", "input": "Syncope and collapse: concern for seizures. There is no evidence of hippocampal sclerosis, heterotopia, intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, and cerebellum appear 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is an area with fat signal characteristics in the right clivus that measures up to 20 mm.", "output": "1. No evidence of potential seizure foci.2. An area with fat signal characteristics in the right clivus likely represents arrested pneumatization of the sphenoid, which is an anatomic variant. Further evaluation via dedicated skull base imaging may nevertheless be useful."}
{"instruction": "Generate impression based on findings.", "input": "Hodgkin's lymphoma with left buttock pain, post bone marrow biopsy in February. Now with numbness of left leg. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is some loss of normal lumbar lordosis. Alignment is otherwise within normal limits. The conus medullaris is normal in position. There are multiple small T1 hypointense, T2 hyperintense, and enhancing lesions throughout the lumbar spine and partially visualized lower thoracic spine.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: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is left paracentral disk protrusion with effacement of the left lateral recess which may be impinging on the traversing left L5 nerve root. No central spinal canal or neural foraminal stenosis. Mild facet hypertrophy.L5-S1: There is disk desiccation and small central disk protrusion. No significant spinal canal or neural foramina stenosis. Mild facet hypertrophy.Atrophic native kidneys and right renal transplant partially visualized. Paraspinous soft tissues are unremarkable.", "output": "1. Multiple small osseous lesions throughout the lumbar and visualized lower thoracic spine compatible with known lymphoma. No prior MRI lumbar spine is available for comparison. No pathologic fractures or evidence of epidural tumor. 2. Degenerative changes at the L4-L5 and L5-S1 levels as detailed above. There is left paracentral disk protrusion at L4-L5 which may be impinging on the traversing left L5 nerve root in the lateral recess."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Follow-up S1 lesion, status post SCT. Signs and symptoms: Left S1 radiculopathy. Pre and post enhanced lumbar MRI:Lower most visualized thoracic spine from T9 inferiorly demonstrate extensive postoperative changes including posterior bilateral transpedicular screw placement at T9, T10, T12 and L1 levels. Extensive artifacts from metallic hardware precludes precise assessment for pathology in this region. There is mild kyphotic deformity centered at L1 vertebrae which appears to be less than compressed. Mild central spinal stenosis at T10 and T11 level is suspected.T12-L1 demonstrate mild disc disease with loss of disc height, mild chronic compression deformity of the superior endplate and unremarkable exam otherwise.L1-L2 demonstrate mild disc disease and loss of disc height, mild chronic compression deformity of superior endplate and a Schmorl's node along the superior endplate. No spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy with resultant mild central spinal stenosis and no neural foraminal compromise.L3-L4 demonstrate mild disc degeneration and loss of disc height, moderate ligamentum flavum and mild bilateral facet hypertrophy. Mild central spinal stenosis without neural foraminal compromise is noted.L4-L5 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum and to a lesser degree facet hypertrophy changes are present. No spinal stenosis however moderate right neural foraminal compromise is identified.L5-S1 demonstrates advanced disc disease and loss of disc height, mild grade 1 retrolisthesis, mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis however moderate left and mild right neural foraminal compromise is present.There is a large metal demarcated focus of T1 hypointense and T2/T2 STIR hyperintense signal intensity in the left posterior body of S1 and left pedicle and sacral ala measuring at approximately 25 x 32 mm in transaxial dimensions. The findings demonstrate enhancement and highly suspected of a focus of multiple myeloma considering patient's history. The finding abuts the left S2 nerve root canal however without evidence of extension into the neural foraminal or mass effect on the nerve root. No fracture and no evidence of extraosseous soft tissue enhancement.", "output": "1.Well-demarcated focus of T1 hypointense, T2/T2 Stir hyperintense enhancing mass in the left posterior S1 vertebral body, pedicle and sacral ala suggestive of a metastatic multiple myeloma. No extraosseous spread of tumor.2.Mild central spinal stenosis secondary to degenerative disease at L2-L3 and L3-L4 levels.3.Neural foraminal compromise as detailed per level above.4.Extensive postoperative changes of posterior fusion extending from T9 through L1 with extensive metallic hardware artifact which precludes precise assessment. Within this limitation however mild central spinal stenosis at T10 and T11 is suspected."}
{"instruction": "Generate impression based on findings.", "input": "Female, 53 years old, with sharp shooting pains and paresthesias. Brain:At most, there may be trace nonspecific T2 hyperintense signal along the left frontal horn. No other focal signal abnormality is detected. No edema or mass effect is observed. Diffusion-weighted images are within normal limits. No findings are seen to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.C-spine:Alinement is anatomic. Vertebral body heights are preserved. No concerning areas of marrow replacement or marrow edema are seen.The visualized spinal cord shows normal signal characteristics throughout. No focal lesions are seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Moderate right and mild left foraminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Severe left and moderate right foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate right foraminal narrowing. C6-7: Loss of disc height with mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.", "output": "1.No specific findings are seen in the brain or cervical spine to account for the patient's symptoms.2.Relatively mild multilevel cervical spondylosis is evident but without high-grade spinal canal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Symptoms of vague numbness and burning pain involving the arms in recent months. The spinal cord displays normal signal and morphology. The tip of the conus medullaris is located at the L1 level and shifts appropriately between the prone and supine positions. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are no gross dysraphic defects. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. The cerebellar tonsils are mildly low-lying on the limited localizer images that include the cervical spine.", "output": "No evidence of syringohydromyelia in the imaged portions of the spinal cord. The conus medullaris is not low-lying and shifts appropriately between the prone and supine positions."}
{"instruction": "Generate impression based on findings.", "input": "Female, 77 years old, with lightheadedness multiple falls. Multiple scattered small foci of FLAIR hyperintensity are seen within the cerebral hemispheres. No restricted diffusion is seen.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. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.", "output": "1.Numerous scattered foci of FLAIR hyperintensity are seen which most likely represent chronic microvascular ischemia.2.No definite acute lesions are seen.3.No specific findings are detected to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Female, 58 years old, with GBM, IDH wild type. Findings related to multiple prior surgeries are again seen in the right temporal lobe. Again seen is a large rim-enhancing lesion occupying a majority of the anterior temporal lobe with extension into the insula and basal ganglia. On comparison with the immediate prior examination, the overall dimensions of this lesion have not significantly changed. The thickness of the enhancing rim has in some areas decreased which may reflect progressive necrosis.Generalized mass effect related to this lesion is unchanged. There is a stable midline shift to the left of approximately 6 mm. T2 hyperintensity spreading into the adjacent tissues reaching as high as the superior parietal lobule has improved in some areas. No new intracranial enhancing lesions are seen. Faint enhancement and diffusion restriction along the right atrial ependyma is probably unchanged. The size and shape of the ventricular system are unchanged. Periventricular T2 hyperintensity along the left lateral ventricle is unchanged and may be related to treatment.", "output": "The overall size of a large peripherally enhancing mass occupying the anterior right temporal lobe with extension into the insula and basal ganglia has not significantly changed from the immediate prior examination. The thickness of the enhancing rim has decreased which may indicate progressive necrosis. T2 hyperintensity surrounding this lesion has improved in some areas. No new intracranial lesions are appreciated."}
{"instruction": "Generate impression based on findings.", "input": " The ventricles and sulci are normal in size. 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": "No evidence of metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Subdural hemorrhageClinical question: Evaluate previously seen hemorrhageSigns and Symptoms: 2 yo M with subdural hemorrhage MRI of the brainThere is diffusion restriction present along the left cuneus.There is a left subdural collections present adjacent to the left frontal, parietal and temporal lobe which includes blood products and air with air fluid level present. It measures up to 15 mm in thickness.The patient is status post left sided craniotomy. There is a drainage catheter present at the medial most aspect of the collection which is better visualized on a recent CT of the head. The posterior aspect of the intracranial portion of the catheter (17mm) is in the subdural space and the majority of the anterior aspect (88mm) is subarachnoid. The catheter is best visualized on the coronal images.There is 3mm shift of the midline towards the right.There is a thin subdural hematoma present along the posterior aspect of the falx cerebri, tentorium and adjacent to the right occipital lobe.There is diffuse enhancement along the leptomeninges.There is subgaleal fluid present along the parietal bones bilaterally.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.", "output": "1.There is a left subdural hematoma present with mass effect and midline shift. 2.The drainage catheter at the left craniotomy site is mostly subarachnoid in location.3.There is diffusion restriction present along the left cuneus suggestive of an acute infarction.4.There is a thin subdural hematoma present along the posterior aspect of the falx, tentorium and adjacent ot the right occipital lobe.5.There is diffuse leptomeningeal enhancement present which is non-specific. This could be reactive to the above findings, though would not be possible to differentiate from leptomeningeal disease such as meningitis.6.Status post left sided craniotomy with associated postoperative changes.7.No evidence for compromise to the cervical spinal cord.8.MR venogram of the brain is within normal limits"}
{"instruction": "Generate impression based on findings.", "input": "Recent motor vehicle accident. Neck stiffness and decreased range of motion. Also, low back pain and stiffness with history of spondylolisthesis. The examination is mildly limited by patient's body habitus.CERVICAL SPINE:Included brain is notable for a partially empty sella which might be an incidental finding unless there are other manifestations of elevated intracranial pressure.Sagittal alignment is notable for straightening, which may reflect patient positioning. The vertebral bodies are preserved in height. Marrow signal is benign. There is disc desiccation at all levels. The spinal canal is preserved other than shallow ventral indentations by discs as described below. There is no epidural hematoma. The spinal cord shows normal shape and signal. STIR imaging shows no increased signal in the adjacent soft tissues.C2-C3: There is no spinal canal or neural foraminal stenosis.C3-C4: Shallow central ventral indentation of the thecal sac by small disc-osteophyte complex but no significant stenosis. There is mild right neural foraminal narrowing by uncovertebral arthropathy.C4-C5: There is shallow ventral indentation of the thecal sac by small disc-osteophyte complex but no significant stenosis. There is uncovertebral and facet arthropathy but no significant foraminal stenosis.C5-C6: Similarly, there is shallow ventral indentation of the thecal sac by disc-osteophyte complex but no significant spinal canal stenosis. There is mild right neural foraminal stenosis related to uncovertebral and facet arthropathy.C6-C7 and C7-T1: There is no significant spinal canal or neural foraminal stenoses.Included on sagittal imaging only are T1-T2, T2-T3 and T3-T4 levels, which show no significant spinal canal or foraminal stenoses.LUMBAR SPINE:There is transitional anatomy with 5 lumbar type vertebral bodies as well as a sixth lumbarized segment labeled S1 for the purposes of this study. Sagittal alignment is notable for an 8 mm/grade 2 anterolisthesis of L5 relative to S1 with bilateral L5 pars defects. There is increased fatty signal in the marrow along the endplates and along pars interarticularis defects. This is associated with severe disc height loss. The vertebral bodies are preserved in height. In addition to the severe fatty endplate reactive changes at L5-S1 levels, there is degenerative mild-to-moderate height loss at L1-L2 associated with type II/fatty degenerative marrow changes subjacent to the endplates anteriorly. The spinal canal is preserved at the other levels. The conus medullaris tip lies at L1-L2 level. The conus medullaris shows normal signal and shape.T11-T12 is included only on sagittal imaging without significant spinal canal or neural foraminal stenosis.T12-L1: There is no significant spinal canal or neural foraminal stenosis.L1-L2: Degenerative disc and osteophyte flattens the anterior aspect of the thecal sac but causes no significant spinal canal stenosis. Also there is mild facet arthropathy but no significant neural foraminal stenosis.L2-L3, L3-L4 and L4-L5 mild facet arthropathy but no significant spinal canal or neural foraminal stenosis.L5-S1: The spondylolytic anterolisthesis and associated advanced disc/endplates and facet degenerative changes result in effacement of the right lateral recess but no significant central spinal canal stenosis. There is also severe right and moderate left neural foramen stenoses.", "output": "1.There is no MR evidence of traumatic injury in the cervical spine.2.Cervical spine demonstrates minimal degenerative changes without significant spinal canal stenosis and only mild right foraminal stenoses as described above. 3.Lumbar spine: Please note variant anatomy with a lumbarized transitional segment labeled S1 for the purposes of this study. As numbered there is grade 2 spondylolytic anterolisthesis of L5 relative to the lumbarized S1 associated with severe right and moderate left neural foraminal stenoses. There is also effacement of the right lateral recess at this level without significant central canal stenosis. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Stroke. Signs and symptoms: Stroke. Nonenhanced CT of brain:The examination demonstrates fairly extensive supratentorial periventricular and subcortical low-attenuation with no associated mass effect. There is also suspected low-attenuation of corpus callosum. Although the above findings are nonspecific they could represent very advanced to small vessel disease of indeterminate age. Findings remain identical to prior study from 6 -- 2 -- 2010. Follow-up with an MRI examination is recommended to exclude other possibilities. Multiple prior studies and including patient MRI examination from 2009 demonstrated similar findings.An old right posterior temporal -- parietal cortical stroke is again identified and no change.Images through posterior fossa demonstrate suspected low-attenuation in the pons consistent with old lacunar strokes.There is no evidence of hemorrhage or acute cortical stroke. The ventricular system remains within normal range of size.", "output": "1.Stable exam since prior study.2.Extensive White matter findings likely secondary to advanced to small vessel disease of indeterminate age.3.Old right posterior parietal -- temporal cortical stroke. Local nor strokes of pons."}
{"instruction": "Generate impression based on findings.", "input": "Male; 68 years old. Reason: 67 yo male with hx of pancreas cyst; please do MRCP to evaluate for abnormalities History: pancreas cyst ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in inferior aspect of uncinate process abutting third portion of duodenum is not significantly changed, measuring 2.3 x 2 .2 cm, previously 2.5 x 2.5 cm (series 6, image 35). No enhancing or nodular component. No clear connection with the pancreatic duct is evident.The largest of these is located in uncinate process and measures 1.3 x 1 .1 cm, previously 1.1 x 1.1 cm (image 40; series 8). There is an additional fluid signal intensity lesion in the body of the pancreas, which measures 11 x 8 mm, which appears unchanged when compared to the most recent MRI examination dated 1/14/2014, however, when compared to a earlier MRI dated 7/30/2010, this appears slightly increased in size, previously measuring approximately 4 x 5 mm. Additional smaller cystic lesions are also not significantly changed. No pancreatic ductal dilation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Status post median sternotomy.", "output": "1. No significant interval change in size of the reference cystic lesions within the uncinate process abutting the duodenum, which may represent a side branch IPMNs.2. No significant interval change in size of the additional smaller cystic lesions throughout the pancreas, when compared to the most recent study dated 1/14/14. However, a cystic lesion in the body of the pancreas appears slightly increased in size when compared to a more remote study dated 7/30/2010, with measurements provided above.3. Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old male with colon cancer with metastases to the liver ABDOMEN:LIVER, BILIARY TRACT: There is a large hypoenhancing lesion in the left lobe of liver measuring 6.2 x 6.1 cm (series 11, image 170). Segment six lesion measuring 4.5 x 3.2 cm (series 11, image 117). Additional smaller lesions are also present in hepatic segment 7/8 and segment 6.Common bile duct is normal in caliber. Cholelithiasis.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: Mildly prominent gastrohepatic ligament lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Metastatic disease to the L4 vertebral bodyOTHER: No significant abnormality noted.", "output": "1.Masses in the liver compatible with metastatic disease.2.Osseous metastasis the L4 vertebral body.3.Cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "23 year old woman with shortness of breath when lying on right side and possible shunt noted on echo. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 81 ml/m2 (normal range: 65+/-11), the LVEDV is 140 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 65 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 76 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is an atypical pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls. The pattern spares the endocardium and is not consistent with prior myocardial infarction. It suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process, such as prior myocarditis. No ventricular septal defect is noted.Left AtriumThe left atrium is normal in size. No atrial septal defect are noted. The inter-atrial septum is deviated to the right, suggesting increased left atrial pressures. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 161 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 68 ml (normal range 35+/-13). There is extrinsic compression of the right ventricular outflow tract by the below described anteriorly-located esophagus. There is no obvious evidence of flow acceleration in the RVOT to suggest that the compression is hemodynamically significant; however, correlation with Doppler echo is suggested. 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. There is a modest amount of mitral valve billowing. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 mildly dilated (30 mm).Venous AnatomyThe right-SVC and IVC are normal in size and drain normally into the right atrium. A large hepatic vein travels anteriorly over the dome of the liver into the IVC , rather than through the hepatic hilum. There is a persistent left SVC which drains into the coronary sinus. ShuntNo atrial septal defect, ventricular septal defect, or anomalous pulmonary venous drainage is noted. There is a persistent left superior vena cava which drains into the coronary sinus, which is a normal variant. No large pulmonary AVMs are noted. The Qp/Qs is 1.05PericardiumThere is a small pericardial effusion.Extracardiac FindingsThe esophagus travels in between the heart and the sternum. It is significantly dilated and has an air-fluid level. Additionally, it appears to be extrinsically compressing on the right ventricular anterior free wall, this is related to patient's history of esophageal surgery. Trace bilateral pleural effusions are needed. 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. The left ventricle is normal in size with low normal systolic function (LVEF 54%). There is a non-myocardial infarction pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls. The pattern suggests an underlying fibrosis, inflammatory, or infiltrative process such as prior myocarditis. 2. The right ventricle is normal in size with normal systolic function (RVEF 58%). There is extrinsic compression of the right ventricular outflow tract by the anteriorly-located esophagus. There is no obvious evidence of flow acceleration in the RVOT to suggest that the compression is hemodynamically significant; however, correlation with Doppler echo is suggested. 3. There is a persistent left superior vena cava which drains into the coronary sinus (normal variant). A large hepatic vein travels anteriorly over the dome of the liver into the IVC , rather than through the hepatic hilum. 4. There is no significant shunt as suggested by Qp/Qs of 1.05. 5. Mildly dilated pulmonary artery. 6. Moderate tricuspid regurgitation. "}
{"instruction": "Generate impression based on findings.", "input": "59 year-old man with newly diagnosed heart failure, LVEF severely reduced on echocardiogram and normal coronaries is sent for MRI to evaluate for possible myocarditis. Left VentricleThe left ventricle is moderate-severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%, the LV end diastolic volume index is 132 ml/m2 (normal range: 74+/-15), the LVEDV is 323 ml (normal range 142+/-34), the LV end systolic volume index is 115 ml/m2 (normal range 25+/-9), the LVESV is 282 ml (normal range 47+/-19), the LV mass index is 100 g/m2 (normal range 85+/-15), and the LV mass is 246 g (normal range 164+/-36). There is global hypokinesis. Hyperenhancement noted on T2 stir imaging in the basal inferior, inferolateral and lateral walls suggestive of acute myocardial inflammation. This could be consistent with active myocarditis. There is no hyperenhancement noted in the septum in the region where an RV biopsy would be performed. There is also hyperenhancement of the pericardial space and possibly pericardium in this area. Loculated small collection of pericardial fluid noted also in the same area. There is patchy basal inferior, infero-lateral and mid-lateral late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is not consistent with myocardial infarction and could be consistent with myocarditis . Native myocardial T1 time 1090 msec.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 173 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 109 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.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 drain normally into the right atrium.PericardiumLoculated, basal pericardial effusion. Hyperenhancement on T2 stir of the basal pericardial sac suggestive of pericarditisExtracardiac FindingsInterstitial changes noted in the lungs. Minimal bilateral pleural effusions. 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. The left ventricle is moderate-severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%. There is global hypokinesis.2. Hyperenhancement noted on T2 stir imaging in the basal inferior, inferolateral and lateral walls suggestive of acute myocardial inflammation. This could be consistent with active myocarditis. There is patchy basal inferior, infero-lateral and mid-lateral late gadolinium enhancement suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is not consistent with myocardial infarction and could be consistent with myocarditis.3. No hyperenhancement noted in the septum in the region where an RV biopsy would be performed.4. The right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 37%5. Biatrial enlargement6. Loculated pericardial effusion noted at the base of the LV. Hyperenhancement on T2 stir imaged suggestive of pericarditis.7. See extra-cardiac findings. 8. The constellation of findings in this study are highly suggestive of myo-pericarditis. "}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male with right shoulder pain, evaluate for labral tear ROTATOR CUFF: There is thickening of the supraspinatus tendon with intermediate signal intensity compatible with tendinopathy. There is no evidence of tear and the supraspinatus muscle is intact. The infraspinatus, teres minor, subscapularis muscles and tendons are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is no evidence of labral tear. The glenohumeral joint is unremarkable.BICEPS TENDON: The biceps tendon appears normal throughout its course.ADDITIONAL", "output": "1. Findings compatible with tendinopathy of the supraspinatus tendon with no evidence of tear.2. No evidence of labral tear as clinically questioned. "}
{"instruction": "Generate impression based on findings.", "input": "28 year old with BRCA 1 mutation. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is a new non mass enhancement in the left breast at middle 10:00 position, measuring 15 x 10 x 11 mm (AP x LR x CC). In addition, a smaller non-mass enhancement is present at middle 12:00 position in the left breast, measuring 8 x 4 x 9 mm.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.", "output": "New suspicious non mass enhancement in the left breast. Diagnostic mammogram and ultrasound study is recommended. If no correlation is detected on mammogram or ultrasound, MR guided biopsy should be considered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "A 55 year old male with cardiac amyloid diagnosed by PYP scan which confirmed a wild type TTR amyloid. Echocardiography showed normal left ventricular ejection fraction with reduced strain, left ventricular hypertrophy. Referred to cardiac MR for further evaluation Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 193 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 83 ml (normal range 47+/-19), the LV mass index is 88 g/m2 (normal range 85+/-15), and the LV mass is 176 g (normal range 164+/-36). There is diffusely concentric hypertrophy up to 15mm. Based on myocardial tagging, there is mild hypokinesis at the base. There is a large amount of late gadolinium enhancement which is also worse at the base than the apex. It is present circumferentially along the endocardium throughout most of the heart and in some areas it is nearly transmural. The LV cavity and myocardium null at nearly the same time suggesting the presence of abnormal \"gadolinium kinetics\". The native myocardial T1 time is severely elevated in some regions (range 1075ms to 1265ms). These findings are diagnostic for cardiac amyloidosis. No evidence of iron overload. No intracavitary thrombus was noted.Left AtriumThe left atrium is severely dilated (166ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 180 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.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. The left ventricle is normal in size and systolic function, the LVEF is 57%. There is moderate concentric hypertrophy.2. There is extensive late gadolinium enhancement, abnormal gadolinium kinetics, and severely elevated native myocardial T1 relaxation times. All of these are strongly suggestive of the diagnosis of cardiac amyloidosis. 3. The right ventricle is normal in size and systolic function, the RVEF is 60%. 4. There is moderate 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": "Female 31 years old Reason: Characterization of retroperitoneal mass History: None associated ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Subcentimeter T2 hyperintense focus in the left lateral segment of the liver shows no central enhancement and may represent a small cyst.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology and signal. Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are normal in morphology. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: There is a T2 hyperintense retroperitoneal mass centered in the aortocaval region but primarily over the IVC. It measures 5.3 x 4.2 cm (image 47/series 5). There is brisk enhancement with areas of central necrosis.Along its anterior aspect it abuts the ileum and portion of transverse colon. Along its posterior aspect, it abuts the IVC and aorta. The right ureter passes along its right posterior lateral margin. Along its medial aspect it abuts the superior mesenteric vein.Along its lateral aspect it abuts the small bowel. There are small left para-aortic lymph nodes.Its superior margin terminates inferior to the uncinate process of the pancreas.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: Mild body wall anasarca.OTHER: Right adnexal cyst. Small cervical nabothian cysts.", "output": "1.Findings of the retroperitoneal mass anterior to the IVC. Differential considerations include extra adrenal pheochromocytoma, paraganglioma, spindle cell neoplasm and tumor of nerve cell origin. Dimensions of the mass and regional extension as detailed above.2.No definite evidence of metastatic disease in the upper abdomen."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Eval of OM of pelvis (ischial tuberosity) compared to CT. Establish baseline OM for comparison post abx History: Stage 3 decub ulcer with tracking to the bone. Pt is paraplegic and can't feel the area. There is a 2.2 x 4.6 cm peripherally enhancing fluid collection in the left ischioanal fossa/left posteromedial thigh with a sinus tract extending deep to the ischium, correlating with the abscess described on recent CT. There is extensive inflammation/edema of the adjacent soft tissues. There is a focal area of T1 hypointense, T2 hyperintense marrow signal that also demonstrates enhancement within the posterior aspect of the ischium. There is sclerosis of the left ischium representing chronic changes.An additional T2 hyperintense focus in the left inferior pubic ramus and is related to stress reaction rather than osteomyelitis. There are prominent inguinal lymph nodes bilaterally.", "output": "1. Small enhancing focus in the left ischium (adjacent to the tract ) is consistent with acute on chronic osteomyelitis.2. Stress reaction of the left inferior pubic ramus."}
{"instruction": "Generate impression based on findings.", "input": " MRI BRAIN:T2/flair signal abnormalities in the right posterior parietal and right cerebellar hemisphere. The cerebral and cerebellar hemispheres and the brain stem are normal morphologically. No restricted diffusion is seen to suggest acute infarction.Intracranial vascular flow voids are normal caliber.The ventricles are normal volume and the midline is maintained. No abnormal extra axial fluid collections, mass, acute infarction or intracranial hemorrhage.MRA Head and Neck : Right dominant vertebral artery, a normal variant. The vertebral, left and right carotid basilar, ACA, MCA, PCA, posterior and anterior communicating arteries demonstrate no evidence of stenosis, obstruction or dissection. Head CT: Encephalomalacia in the right posterior parietal and right cerebellar hemisphere likely corresponds to regions of prior stroke. The cerebral and cerebellar hemispheres and the brain stem are normal morphologically.The ventricles are normal volume.No abnormal extra axial fluid collections, mass, acute infarction or intracranial hemorrhage.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CTA: Right dominant vertebral artery, a normal variant. The vertebral, left and right carotid basilar, ACA, MCA, PCA, posterior and anterior communicating arteries demonstrate no evidence of stenosis, obstruction or dissection.", "output": "Old strokes in the right posterior parietal and right cerebellar hemisphere.No acute intracranial pathology.Unremarkable CTA and MRA of the head and neck. "}
{"instruction": "Generate impression based on findings.", "input": "Cuff tear Examination is limited by the patient's body habitus which limits usage of optimal coil. ROTATOR CUFF: There is suspected full-thickness tearing of the distal anterior fibers of the supraspinatus tendon however there is no significant retraction. There is also somewhat irregular appearance of the distal fibers of the subscapularis tendon which may reflect partial tearing. SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is no evidence of full-thickness detachment. Subchondral cystic changes are noted at the greater tuberosity.BICEPS TENDON: The intra-articular portion of the biceps is poorly seen which may be partially technical in nature or related to intrasubstance degeneration. ADDITIONAL", "output": "1. Limited examination secondary to the patient's body habitus.2. Suspected full-thickness tear of the distal anterior fibers of the supraspinatus tendon without significant retraction or muscle atrophy. Irregularity of the distal subscapularis tendon may could also reflect partial tearing.3. Poor visualization of the intra-articular long head of the biceps tendon which may be in part technical in nature or related to intrasubstance degeneration/partial tearing."}
{"instruction": "Generate impression based on findings.", "input": "Female, 10 years old. Previous cerebellar abnormality on imaging, compare with previous evaluate for change. Seizures, new onset HA There is no evidence of intracranial hemorrhage, mass, or acute infarct. Mild asymmetric prominence of the right cerebellopontine angle cistern of CSF signal intensity with mild flattening of the right cerebellum is not significantly changed from prior. There is no diffusion restriction. Otherwise, the ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift or herniation. There is no abnormal parenchymal or meningeal enhancement. The major cerebral flow voids are intact. There is enhancement and near complete opacification of the right sphenoid sinus and right ethmoid air cells, as well as moderate right maxillary sinus mucosal thickening. Adenoid hypertrophy is noted.", "output": "1.No evidence of intracranial hemorrhage, mass, or acute infarct.2.Unchanged mild asymmetric prominence of the right cerebellopontine angle cistern likely relates to a small arachnoid cyst.3.Prominent paranasal sinus thickening/opacification involving the right maxillary sinus, ethmoid air cells, and sphenoid sinus. Please correlate clinically."}
{"instruction": "Generate impression based on findings.", "input": "History of ataxia and vertigo, for the last 4 days. Assess for stroke. BRAIN MRI:There is no acute infarct. There is a tiny focus of susceptibility effect in the left frontal centrum semiovale which may represent hemosiderin staining or calcification. There is no associated edema or perceptible abnormality on the STIR sequences. There is no intracranial hemorrhage otherwise.Confluent periventricular and punctate deep and subcortical white-matter T2 FLAIR hyperintensities are present in both cerebral hemispheres. These are nonspecific but most likely reflect mild chronic microvascular ischemia. Focal CSF intensities in the left putamen and the medial aspect of the temporal lobes probably represent perivascular spaces and/or small cysts, which may be a normal variant. There is no space-occupying brain lesion. There is no midline shift or brain herniation. The ventricles and the other CSF-containing spaces are mildly expanded, reflecting mild global brain volume loss. The flow voids of the major intracranial vessels are preserved, reflecting gross patency.Minimal nonspecific opacification of the mastoid air cells. There is a small retention cyst in the right maxillary sinus. In addition, there is mild mucosal thickening in the right maxillary sinus and bilaterally in the frontal and the anterior ethmoid sinuses. These findings are also nonspecific. Orbits are notable for changes of previous bilateral cataract surgery. There is no destructive skull lesion.CRANIAL MRA:There is no flow-limiting stenosis of the major intracranial arteries. Minimal contour irregularity within the intracranial vasculature may represent mild atherosclerotic disease and/or related to technique. There is no definite aneurysm. NECK MRA:Aortic branching pattern is conventional. There is no significant stenosis of the common and cervical internal carotid arteries. There is mild irregularity of the vessel outline at the carotid bulbs, left more than right, which probably reflects atherosclerosis without significant stenosis. The vertebral arteries are also conventional in anatomy and preserved in caliber.", "output": "1.There is no acute infarct, intracranial mass, or mass effect. 2.Mild chronic small vessel ischemic changes in the brain. There is a tiny focus of susceptibility in the left frontal lobe compatible with a chronic microhemorrhage and nonspecific. 3.There is no significant stenosis in the intracranial circulation or the extracranial circulation in the neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Patient with hx of left lid ptosis, developed solitary fibrous tumor of the superior maxillary sinus with invasion into the orbit. S/p subtotal resection.Signs and Symptoms: left eye ptosis and and diplopia. MRI orbits:There is a mass which is centered along the inferior aspect of the left orbit which extends to involve the superior aspect of the maxillary sinus and inferior aspect of the left orbit. It previously measured 43 x 40 the millimeters coronal dimensions and now measures 35 x 32 mm coronal dimensions. It previously involved the majority of the left maxillary sinus. It is now smaller. The patient is status post left-sided paranasal sinus surgery. Some mucosal thickening is present in the left maxillary sinus. The mass is visually contiguous with the optic nerve sheath complex and abuts the left eye. There is anterior displacement of the left eye. The distance between the atraumatic line and the lens of the left eye is approximately 22 mm. The optic nerve is displaced superiorly; the inferior rectus muscle and inferior oblique muscle are displaced superiorly. The mass abuts the left medial rectus muscleA small left parotid well-circumscribed lesion measuring 5 mm in diameter is bright on T2-weighted imaging it is unchanged compared to the prior exam.There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .", "output": "1.There is a large mass centered along the floor of the left orbit which involves left maxillary sinus and of the left orbit with intraconal extension which is smaller in size on the current exam when compared to the previous exam. It displaces the left eye, left optic nerve and left inferior rectus and inferior oblique muscles.2.Findings raise the question of proptosis related to the patient's above described mass."}
{"instruction": "Generate impression based on findings.", "input": "Reason: AA. History: AA. There is redemonstration of postoperative changes of previous left frontal craniotomy for tumor resection, with slight increased posterior extent of T2/FLAIR hyperintensity along the posterior aspect of the left superior frontal gyrus abutting lateral margin of the anterior body the left lateral ventricle. There is progressive ex vacuo dilatation of the left lateral ventricle. Areas of extra-axial enhancement along the surgical bed again are unchanged. Previously seen nodular enhancement along the anterolateral aspect of the resection cavity has further decreased in prominence, essentially imperceptible on the current exam. However, there is an area of ill-defined subtle nodular enhancement which is again seen along the anterior aspect of the resection cavity on 1300/138. This is not significantly changed allowing for differences in technique.The ventricles and sulci are stable. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.", "output": "1. Interval further evolution of postoperative from previous left frontal lobe mass resection. No definite evidence of tumor recurrence or progression.2. Mild further interval increase in T2/FLAIR hyperintensity along the left superior frontal gyrus white matter extending to the left frontal horn may represent post-treatment changes given recent irradiation.3. Previously described nodular enhancement along the anterolateral aspect of the resection cavity is essentially resolved, with a small adjacent area of ill-defined nodular enhancement more anteriorly appearing similar to prior exams. Continued follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Past medical history significant for recurrent meningioma status post resection on 4/2/15, hypertension, fibroids, PUD, CAD, and obstructive lung disease who presents with recurrent falls. Left-sided weakness with right-sided visual field deficit. Brain: There are postoperative findings related to recent biparietal craniotomy with scattered pneumocephalus and dural thickening and enhancement. There are mild foci of susceptibility effect in the brain parenchyma surrounding the surgical cavity, which may represent blood products. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter of the bilateral posterior frontal, parietal and occipital lobes, which may represent vasogenic edema, as well as unchanged left parieto-occipital encephalomalacia. There is no convincing evidence of acute infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a partially empty sella. There is persistent right tympanomastoid fluid. MRV: There is lack of signal in the posterior superior sagittal sinus. The other dural venous sinuses are grossly intact.", "output": "1. Postoperative findings related to recent partial resection of the posterior falcine meningioma with persistent areas of enhancement diffuse along the surgical margins, which may be treatment-related, although residual tumor cannot be excluded.2. A portion of the posterior superior sagittal sinus has been resected and small amounts of residual tumor may infiltrate the margins of the dural sinus.3. Interval resolution of ischemic changes along the surgical margins without convincing evidence of acute infarction. 4. Persistent bilateral parieto-occipital lobe signal abnormality may represent edema.5. Persistent right tympanomastoid fluid may represent otomastoiditis."}
{"instruction": "Generate impression based on findings.", "input": "85 years Male (DOB:4/4/1931)Reason: r/o stroke History: right sided weaknessPROVIDER/ATTENDING NAME: DAVID G BEISER DAVID G BEISER MRI of the brainThere is diffusion restriction present along the left parietal lobe involving left postcentral gyrus and some the adjacent left superior parietal lobule extending down to the level of the insula and a small portion of the left temporal lobe.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.On susceptibility weighted imaging there are are several periventricular punctate foci of signal loss present which are nonspecific and in isolation of unknown clinical significance.. Additionally within the left sylvian fissure at the left M1 M2 junction there is a focus of blooming artifact. This corresponds to blood supply to the patient's area of diffusion restriction. Additionally there is intravascular signal hyperintensity on FLAIR imaging on a branch of the left middle cerebral artery.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left A1 segment is larger than the right A1 segment. In general the time of flight signal is diminished. There appear to be fewer vessels in the left sylvian fissure compared to the right sylvian fissure and the left M1 segment appears slightly smaller than the right M1 segment. The left angular artery is identified but is diminutive relative to the contralateral side. Additionally the left posterior parietal artery is not readily identified.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the right posterior cerebral artery. The right vertebral artery is larger than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is an 70% stenosis at the origin of the left vertebral artery. The left vertebral artery is smaller than the right vertebral artery.", "output": "1.Findings are compatible with acute ischemic cerebral infarction involving the left parietal lobe including the left postcentral gyrus, some of the adjacent left superior parietal lobule, some of the left posterior insular cortex and small portion of the left temporal lobe.2.Findings are suspicious for occlusion of at least one branch of the left middle cerebral artery most likely the M2 and M3 junction. If this is isolated to the left posterior parietal artery is suspected within the infarct would appear to be near-complete.3.70% stenosis at the origin of the left vertebral artery.4.Findings were discussed with the neurointensive care unit fellow at the time of the exam. Discussion also centered around intervention. It decided based on the fact of the patient's NIH stroke scale score improved from 19 to 11 and the fact that it appeared that the much of the left middle cerebral artery territory was patent that intervention was not warranted."}
{"instruction": "Generate impression based on findings.", "input": "Neck pain with paresthesia. There is a posterior disc-osteophyte complex that is eccentric to the right and mild disc space narrowing at C5-6 with associated moderate right neural foramen stenosis and minimal right spinal canal narrowing. Otherwise, there is no significant spinal canal or neural foramen stenosis at other levels of the cervical spine. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.", "output": "A posterior disc-osteophyte complex at C5-6 is associated with moderate right neural foramen stenosis and minimal right spinal canal narrowing. "}
{"instruction": "Generate impression based on findings.", "input": "Right lower extremity hyperreflexia and acute weakness. Evaluate for stenosis (cord or nerve impingement). Alignment of the cervical spine is anatomic. Bone marrow signal is benign with T1 hyperintense foci such as at the T2 vertebral body compatible with hemangioma or focal fat. No suspicious osseous lesions are seen.The spinal canal shows mild to moderate narrowing at the C3-C4 and C5-C6 levels as described below. Examination is motion degraded however no definite cord signal abnormality is appreciated.Multilevel degenerative changes, as described below:C2-C3: Small central/right paracentral disc-osteophyte complex indents the anterior aspect of the thecal sac and touches the spinal cord. The neural foramina are open.C3-C4: Left more than right facet and uncovertebral proliferative change results in mild bilateral foraminal narrowing. There is also ligamenta flava thickening contributing to mild to moderate spinal canal narrowing. Prominent left-sided facet arthropathy.C4-C5: Disc-osteophyte complex and uncovertebral hypertrophy causes mild canal narrowing and mild to moderate left foraminal stenosis. Left-sided facet arthropathy is evident.C5-C6: There is a disc extrusion that mild to moderately narrows the spinal canal. There is left more than right uncovertebral proliferative change which contribute to narrowing of the left neural foramen.C6-C7 and C7-T1: There is no significant spinal canal or foraminal narrowing.", "output": "Multilevel cervical spondylosis associated with mild to moderate spinal canal stenosis at C3-C4 and C5-C6. Examination is motion degraded however demonstrates no convincing cord signal abnormality. Foraminal narrowing is also suboptimally evaluated due to motion but is evident at multiple levels as detailed above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Recent laser ablation of the corpus callosum. There has been interval laser ablation of the corpus callosum via right transparietal and transfrontal approaches. There is expected peripheral restricted diffusion associated with the ablation zones, but no evidence of acute territorial infarction. There is no evidence of gross intracranial hemorrhage. There is no midline shift.", "output": "Expected findings related to interval laser ablation of the corpus callosum."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for spinal anomalies, Chiari, syrinx, tethered cord. Signs and symptoms: Scoliosis. Nonenhanced total spine MRI:Evaluation of the cervical spine demonstrate no evidence of Chiari malformation or cervical syrinx.There is normal anatomical development of vertebral column.There is a central broad-based bulging disk and C5 -- C6 which results in effacement of the ventral subarachnoid space, flattening deformity and posterior displacement of the cord and central spinal stenosis. CSF flow study at the level of foramen magnum demonstrate normal biphasic flow through the foramen magnum both anterior and posterior to the cord. Biphasic flow is also noted through the fourth ventricle and the aqueduct.Evaluation of thoracic spine demonstrate a metal demarcated centrally located fluid signal intensity extending from T11 inferiorly to T12 -- L1 disk level. It measures maximum of approximately 1.9 mm caliber. The finding could represent a prominent central canal or a tiny syrinx. The finding does not extend into the conus which terminates at the L1 -- L2 disk level.There is no convincing evidence of segmentation anomaly. No evidence of central spinal stenosis or any significant neural foraminal compromise. Mild asymmetric hypertrophy changes of posterior elements secondary to sclerosis is present.Evaluation of the lumbosacral spine demonstrate no evidence of segmentation anomaly.There is normal signal intensity of cauda equina and in particular no evidence of fatty filum detected.There is distinct anterior movement of the lower thoracic cord, conus and proximal cauda equina on prone sagittal T2-weighted images when compared with supine series.", "output": "1.Examination demonstrates no evidence of Chiari malformation or tethered cord as is questioned clinically.2.Tiny focus of T2 hyperintensity in the center of the cord extending from T11 to T12 -- L1 level without extension to the conus. Finding could represent a prominent central canal or a tiny syrinx. There is normal termination of the cord and L1 -- L2 disk level.3.There is anterior movement of the lower cord, conus and proximal cauda equina on sagittal prone series compared to supine.4.There is normal signal intensity of cauda equina.5.There is no detectable segmentation anomaly of the vertebral column, no spinal stenosis or neural foraminal compromise"}
{"instruction": "Generate impression based on findings.", "input": "Reason: Please evaluate for temporal or mesial temporal seizure focus in patient with complex partial epilepsy and bilateral temporal discharges History: Complex partial seizures with head turn to right, stiffening, secondary generalization; language and social delays; active L>R temporal/occipital discharges Brain parenchyma appears within normal limits. No evidence of intracranial mass or mass effect. No findings to suggest cortical dysplasia, gray matter heterotopia, or other findings to suggest seizure focus. No diffusion abnormality or evidence of hemorrhage. Ventricles are normal in size. The hippocampi are symmetric bilaterally without atrophy, signal abnormality, or loss of internal architecture. The midline structures and posterior fossa structures appear within normal limits. The major cerebral flow voids are intact. Moderate mucosal thickening of the sphenoid and left maxillary sinus. Mild mucosal thickening of the left frontal, ethmoid and right maxillary sinus. Bone marrow signal and extracranial soft tissue structures are otherwise unremarkable.", "output": "No structural abnormalities to suggest possible seizure focus are appreciated. No findings to suggest mesial temporal sclerosis. "}
{"instruction": "Generate impression based on findings.", "input": "Acute disseminated encephalitis and encephalomyelitis, with worsening headache. There are postsurgical findings related to right frontal approach stereotactic biopsy of the pontine enhancing lesions. There is significant interval improvement in the foci of enhancement within the pons. There are no new enhancing foci are significant abnormality. There are unchanged mild scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. 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 are grossly unremarkable.", "output": "Interval improvement of the pontine lesions, status post biopsy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Decreased range of motion, check for cuff injury Mild osteoarthritic changes, largely involving the glenohumeral articulation. Mild sclerosis and small osteophytes. The overall shape of the humeral head appears grossly intact, however mild rotation of the shoulder on the AP projection creates a mild distortion. Specifically no superimposed acute abnormality observed. Acromiohumeral distance is within normal range, allowing moderate sensitivity for chronic rotator cuff injury, however in less acute or subacute injury. MRI can be considered if suspicion remains high and further characterization is needed.Incomplete visualization of marked scoliosis and distortion of the upper thoracic spine, consider dedicated imaging, yet grossly unchanged from 2014 imaging.", "output": "Mild shoulder osteoarthritis with more pronounced degenerative and alignment changes involving the lower cervical and upper thoracic spine, incompletely visualized."}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of unspecified kidney, except renal pelvis [C64.9], Reason for Study: ^Reason: Metastatic renal cancer, increasing dizziness, r/o brain mets History: dizziness There is replacement of fatty marrow of clivus with T1 low signal intensity lesion which shows mild enhancement on Gad. Similar lesions are seen on calvarium especially frontal bone. Considering multiple vertebral metastasis, these lesions could represent metastatic lesions. Thus, additional imaging study such as bone scan can be considered for further imaging evaluation.There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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 mastoid air cells are clear. Bilateral maxillary sinus retention cysts.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement indicating brain parenchymal metastasis.3. Heterogenous bone marrow signal intensity involving clivus and skull as described above indicating possible metastatic lesions. Further imaging evaluation such as bone scan can be considered. "}
{"instruction": "Generate impression based on findings.", "input": "Female 44 years old Reason: MNG, right lobe nodule biopsied and showed PTC. Please ultrasound lateral neck for lymph nodes. History: MNG, right lobe nodule biopsied and showed PTC. Please ultrasound lateral neck for lymph nodes. RIGHT LOBE MEASUREMENTS: 1.3 x 2.5 x 5 cmLEFT LOBE MEASUREMENTS: 6 x 3.4 x 6.4 cmISTHMUS MEASUREMENTS: 9 mmRIGHT LOBE: There are multiple solid nodules in the right thyroid lobe largest measuring 1.6 x 1.9 x 2.3 cm near the isthmus. There is a 1.2 by 1.7 centimeter, round, homogeneous hypoechoic lesion posterior to the inferior right thyroid lobe which may represent an exophytic nodule versus a parathyroid adenoma.LEFT LOBE: A large solid nodule measuring 5.7 x 6.2 cm replaces the left lobe of the thyroid.ISTHMUS: Bilateral nodules in both isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral solid thyroid nodules. There is an exophytic nodule posterior inferior to the right lobe of the liver which may represent a thyroid nodule versus a parathyroid mass."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with left breast cancer status post lumpectomy, chemotherapy, decreased ejection fraction, chest pain and fatigue.MEDICATIONS: anastrozole, cranberry extract, docusate, omeprazole. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LVEDV is 124 ml (normal range 142+/-34), the LV end diastolic volume index is 78 ml/m2 (normal range: 74+/-15), the LVESV is 62 ml (normal range 47+/-19), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LV mass is 56 g, the LV mass index is 35 g/m2. There are no regional wall motion abnormalities present. The native myocardial T1 relaxation time is within normal limits (1025ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RVEDV is 124 ml (normal range 142+/-31), the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVESV is 57 ml (normal range 54+/-17), and the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9).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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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.No perfusion defects/ \"ischemia\" present during hyperemia.2.No prior myocardial infarction. The entire myocardium is viable.3.Normal LV size with mildly reduced systolic function (LVEF 50%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4.Normal RV size with normal systolic function (RVEF 50%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": " Brain MRI:The lateral ventricles are prominent with irregular borders associated with white matter volume loss and a very thin corpus callosum.Assuming a 4 month old gestational age brain (correcting for 28 weeks prematurity in this 7-year-old male), there is diffuse hypomyelination.There is a punctate focus of susceptibility hypointensity at the expected location of the right terminal matrix, and questionably in the similar location on the left. Additionally, there is evidence for old hemorrhagic products layering within bilateral occipital horns.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 acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. Complete spine MRI:Bibasilar atelectasis is presumed secondary to the patient's sedated status.There are no fractures or subluxations. The marrow signal is benign. The cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in appropriate position. The conus is normal in signal and morphology and terminates at L2. The visualized paraspinal contents are unremarkable. There are no segmentation anomalies or stenoses.", "output": "1.The lateral ventricles are prominent with irregular borders associated with white matter volume loss and a very thin corpus callosum consistent with periventricular leukomalacia.2.Diffuse hypomyelination for age.3.There is a punctate focus of old hemorrhage at the expected location of the right terminal matrix, and questionably in the similar location on the left. Additionally, there is evidence for old hemorrhagic products layering within bilateral occipital horns.4.Negative complete spine MRI."}
{"instruction": "Generate impression based on findings.", "input": "86 year old man with LV dysfunction referred to assess for viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 18%, the LV end diastolic volume index is 141 ml/m2 (normal range: 74+/-15), the LVEDV is 265 ml (normal range 142+/-34), the LV end systolic volume index is 116 ml/m2 (normal range 25+/-9), the LVESV is 217 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 118 g (normal range 164+/-36). There left ventricular systolic dysfunction is global with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No left ventricular thrombus is seen. No evidence of myocardial iron overload.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 29%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 211 ml (normal range 142+/-31), the RV end systolic volume index is 80 ml/m2 (normal range 31+/-9), and the RVESV is 149 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild to moderate atherosclerosis of the aortic arch.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 a small pericardial effusion.Extracardiac FindingsThere are bilateral pleural effusions, left greater than right. 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. Severe LV dilation with severely reduced systolic function (LVEF18%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. No evidence of prior myocardial infarction. Most of the LV is likely to be viable.2. Normal RV size with severely reduced systolic function (RVEF 29%).3. Severe left atrial dilation.4. Moderate right atrial dilation.5. Mild to moderate atherosclerosis of the aortic arch.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for soft tissue infection. Check deep spaces given contusion of left thigh, subsequent encounter Overall the heterogeneous and ill-defined soft tissue mass in the areas previously described by both CT and MR appears similar to mildly enlarged, specifically the morning or chronic components have minimally increased since 9/25/2015 and mild areas of involvement since the prior MR only evaluating the lower pelvis and upper most thigh. The mass margins remain poorly defined and difficult to measure axially consistently, yet when compared to the prior CT at the level of the upper thigh and area of scattered calcifications, again the mass roughly measures 10 x 9 cm with increased extension and involvement into the left subcutaneous tissues and fat underlying the midline crease (image 21 series 19). Interval increased necrotic and cystic components are again observed inferior to the ischial tuberosity and for reference the 9 x 3 cm collection currently measures 13 x 4 cm (image 19 series 20).Similar mild enlargement of the lobulated cystic and necrotic component centered in the abductor magnus musculature, remains mildly more discrete in margin and currently measures 5.3 x 4.7 cm (image 6 series 40) with mild peripheral enhancement, previously 4.5 x 3.4 cm. The overall pattern of enhancement and signal abnormality begins supports tumor invasion as apposed to specific signs of infection such as gas. Again diffuse subcutaneous reticulation and skin thickening is observed throughout the left thigh, of uncertain significance and although tumor invasion cannot entirely be excluded, this may be possibly related to radiation therapy; please correlate. This larger fluid collection in the abductor magnus however would be readily accessible if sampling was needed clinically.", "output": "Persistent redemonstration of heterogeneous ill-defined soft tissue mass throughout the left groin demonstrating mild interval minimal enlargement but largely enlarging central to chronic cystic components. See measurements provided. Overall appearance again remains compatible with known sarcoma and possible interval posttreatment changes. Specifically no discrete new findings to support concern for focal infection, however given tumor characteristics and appearance, specificity and exclusion is difficult to confirm."}
{"instruction": "Generate impression based on findings.", "input": "16-year-old male. Elbow pain medially for a year. Evaluate for UCL tear. LIGAMENTS: We see no full-thickness rupture of the UCL; however, there is thin linear intermediate signal intensity between the distal fibers of the anterior bundle of the UCL and the underlying sublime tubercle of the coronoid process of the ulna, suggestive of mild partial thickness undersurface stripping of the ligament. The lateral collateral ligament appears intact.TENDONS: The common flexor and extensor tendons are intact. The biceps and brachialis tendons are intact. The triceps tendon is intact.ARTICULAR SURFACES AND BONE: We see no osteochondral defects and the bone marrow signal intensity is within normal limits.SURROUNDING STRUCTURES: Contrast extends down the lateral musculature of the forearm related to the arthrogram injection.ADDITIONAL", "output": "Mild stripping of the undersurface fibers of the anterior bundle of the UCL from the coronoid process that suggests a partial-thickness undersurface tear."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Malignant neoplasm of unspecified site of right female breast Malignant neoplasm of unspecified site of right female breastClinical question: history of breast cancer with new right arm pain and neuropathySigns and Symptoms: right arm pain and numbness and tingling The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.There is a T1 hyperintense focus present within the 12 vertebral body. A similar lesion is present at L1 but a bit smaller. It suppresses on the inversion recovery images. Most likely these represent vertebral body hemangiomasThere is a right paramedian disc extrusion present at C6-7 which is not entirely included on this exam. There is a partially visualized left-sided pleural effusion present.", "output": "1.There is no evidence for spinal metastases to the thoracic spine.2.Findings suggest a right C6-7 disc extrusion which is not entirely included on this exam and likely encroaches the right-sided exiting nerve roots at this level. Please refer to MRI of the cervical spine for further comments.3.There is a left-sided pleural effusion present which is not entirely imaged on this exam."}
{"instruction": "Generate impression based on findings.", "input": "Compression of brain. Cord edema. MRI thoracic spine:There is accumulation of a collection behind and around the cord which is high signal on T1 and T2 STIR throughout the thoracic spine but predominantly along the upper thoracic spine. This is associated with the diffuse enhancement. There is effacement of spinal fluid ventral and posterior to the spinal cord especially at the T3 vertebral body level. There is abnormal signal within the spinal cord centrally from the cervical cord down to T8 level.The thoracic vertebral bodies are appropriate in the overall alignment and height. There are bilateral pulmonary opacities with pleural effusions. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The ureters and renal pelves are dilated.", "output": "1.Suspect combination of epidural lipomatosis, epidural venous engorgement and possibly epidural fluid in the thoracic spine (predominantly upper thoracic) associated with compression of the thecal sac.2.Extensive central cord signal abnormality (C3-T8). Differential considerations include pre-syrinx and venous congestion. The distribution of the cord signal abnormality does not match the vascular distribution of a specific spinal artery. Thus cord infarct is less likely here.3.Bilateral pulmonary opacities with pleural effusions. Please correlate with chest x-ray findings.4.The ureters and renal pelves are dilated. Please correlate with renal findings for possible hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Multiple myeloma, right lower extremity and back pain There are multiple foci of abnormal marrow signal scattered throughout the pelvis and proximal femora consistent with history of multiple myeloma. When compared to a prior MRI of 5/24/2016, these lesions have progressed in size and number. There is now a confluent lesion involving the majority of the right sacrum measuring at least 6.2 x 4.6 x 8.1 cm in the greatest transaxial and craniocaudal dimensions. This particular lesion obliterates a portion of the S1 nerve root as well as the majority of S2.The visualized soft tissues are normal in signal intensity.", "output": "Diffuse myelomatous involvement of the pelvis which is progressed from the prior exam. There is a confluent expansile lesion involving the right sacrum which obliterates portions of the S1 and S2 nerve roots."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for etiology of breakthrough seizures, history of temporal lobe epilepsy. Signs and symptoms: Breakthrough seizures. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.On coronal flair/T2 series examination demonstrate increased signal intensity on the left hippocampus with suggestion of subtle underlying parenchymal volume loss and resultant enlargement of adjacent sulci and the tip of left temporal horn consistent with mesial temporal sclerosis. There are no prior MRI exams for comparison.Examination also demonstrates subtle uniform prominence of cerebral cortical sulci for patient's stated age of 30. The ventricular system are also mildly prominent in particular on the left side for stated age. Extensive signal abnormality in bilateral frontal horns (left greater than right) is consistent with ulceration artifact and not a true pathology.Myelination of the brain remains within normal.Images through posterior fossa are unremarkable.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal and mid normal pattern of enhancement. Unremarkable images through the orbits and including axial fat sat post enhanced series.", "output": "1.No acute intracranial process.2.Findings of mesial temporal sclerosis on the left as detailed.3.Mild uniform prominence of cerebral cortical sulci for patient's stated is noted. 4.Unremarkable pre-and post enhanced brain MRI otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status [780.97], Reason for Study: ^Reason: concern for SC abscess History: concern for SC abscess Brain MRI:Multifocal restricted diffusion lesions on bilateral frontal lobes, left frontal, parietal and temporal lobes. In addition, there are restricted diffusion lesions on bilateral mesial thalami, left basal ganglia, bilateral mesial hippocampi, bilateral midbrain, posterior aspect of pons and medulla, cerebellar vermis and bilateral mid-cerebellar peduncle. The right hemispheric subacute to early chronic ischemic infarction lesions show usual evolution including encephalomalacia with minimal mass effects toward right lateral ventricle. There are multifocal petechial signal voids within the right MCA ischemic lesion indicating hemorrhagic conversion.Mucosal thickenings on bilateral maxillary sinuses.Partial opacifications on bilateral mastoid air cells.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.C-Spine MRIThere are T2 and STIR high signal intensity spinal cord gray matter from skull base to the level of upper thoracic spinal cord. Diagnostic possibilities include acute anterior spinal artery occlusion related spinal cord infarction, extension of brain edema, or less likely demyelinating disease. Spinal cord diffusion weighted image can be attempted to clarify the possibility of spinal cord infarction.Cervical vertebral column shows kyphotic angulation at C56 with focal central protrusion of disc at the level of C45 and broad based disc bulging at the level of C56 abut thecal sac. However, there is no evidence of spinal canal stenosis or neuroforaminal stenosis.Diffuse enhancement of nasopharynx and oropharynx on Gad injection is likely related to endotracheal intubation and nasogastric tube insertion.", "output": "1. Multifocal supra and infra tentorial, hemispheric and brain stem acute ischemic infarctions as described above. 2. Cervical spinal cord gray matter lesions, differential diagnosis include acute spinal cord ischemia or extension of brain stem ischemia related edema. Cervical spinal diffusion weighted imaging can be considered for further evaluation.3. Right MCA territorial subacute or early chronic ischemic infarction with petechial hemorrhages.4. No evidence of intracranial arterial stenosis or intracranial arterial aneurysm. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Patient with altered mental status, confusion, UE weakness, please evaluate for stroke/ ischemic changes The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Images are mildly degraded by patient motion which may obscure more subtle abnormalities.", "output": "1.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction identified.3.Images are mildly degraded by patient motion which may obscure more subtle abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Patient has memory impairment, evaluate for brain atrophy. Signs and symptoms: Memory impairment. Nonenhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates a few punctate nonspecific subcortical and periventricular low-attenuation white matter which are nonspecific. Considering patient's stated age possibility of minute chronic nonhemorrhagic small vessel ischemic strokes considered.There is mild prominence of parietal cortical sulci and unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise for patient's stated age of 77.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.", "output": "1.No acute intracranial process.2.Findings suggestive of very minimal chronic nonhemorrhagic small vessel ischemic strokes.3.Mild prominence of parietal cortical sulci which may be at the upper limits of normal and unremarkable brain MRI otherwise for patient's stated age"}
{"instruction": "Generate impression based on findings.", "input": "Left knee pain The knee appears normal without specific findings to account for the patient's pain.", "output": "Normal-appearing knee without findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Pt is a 66 y/o female with h/o high risk RCC, s/p nephrectomy, evaluate for progression/recurrence History: RCC ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter liver cysts are unchanged. Previously described liver dome lesion is no longer visualized.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrent or residual disease in the nephrectomy bed. Multiple subcentimeter renal cysts are again seen in the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "No evidence of recurrent or residual disease. No measurable metastatic disease, no significant interval change. Please refer to concomitant CT chest exam from same day for additional findings."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old male with pain. History of previous ACL reconstruction. Evaluate for chondral injury. MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the medial tibiofemoral compartment appears intact. There is a focal partial thickness articular cartilage cleft/fissure within the posterior aspect of the lateral tibial plateau, beneath the posterior horn of the meniscus. The articular cartilage of the lateral tibiofemoral compartment otherwise appears intact. No full-thickness or near full-thickness articular cartilage defects are identified. There is increased bone marrow signal abnormality within the patella which may reflect postsurgical change. There is increased signal abnormality within the posterior aspect of the lateral tibial plateau which may reflect bone contusion from prior injury.LIGAMENTS: The cruciate and collateral ligaments appear intact. Note is made of postsurgical changes of prior ACL graft reconstruction. The graft appears intact. There is decreased signal abnormality along the anterior aspect of the ACL graft which appears most consistent with anterior arthrofibrosis versus synovitis.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Findings consistent with prior ACL graft reconstruction. The graft appears intact. Signal abnormality along the anterior aspect of the ACL graft likely represents anterior arthrofibrosis versus a synovitis.2. Focal partial thickness articular cartilage cleft/fissure along the lateral tibiofemoral compartment as described above.3. Small joint effusion."}
{"instruction": "Generate impression based on findings.", "input": "68 year old male with history of IPF and known coronary disease (CTO RCA, intermediate LAD disease), hypertension, AAA s/p repair and dyslipidemia presenting for evaluation of coronary disease prior to PCIMEDICATIONS: atorvastatin, amlodipine, warfarin. First Pass PerfusionDuring hyperemia, there is a perfusion defect involving the (1) basal anteroseptum, inferoseptum, inferior, and inferolateral wall and the (2) mid inferior wall. Viability/ Myocardial ScarThere is a large myocardial infarction in the RCA territory. It is nontransmural at the basal inferoseptum, inferior, and inferolateral walls. These segments have an intermediate probability of viability. The infarction is transmural in the mid inferior wall. This segment is not viable. The remainder of the myocardium is free of myocardial infarction and is viable. Left VentricleThe left ventricle is normal in size with normal ventricular function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 87 ml/m2 (normal range 25+/-9), the LVESV is 41 ml (normal range 47+/-19), the LV mass index is 38 g/m2, and the LV mass is 81 g. The mid to basal inferior wall is hypokinetic. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 25%, the RV end diastolic volume index is 143 ml/m2 (normal range 82+/-16), the RVEDV is 304 ml (normal range 142+/-31), the RV end systolic volume index is 107 ml/m2 (normal range 31+/-9), and the RVESV is 227 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (34 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is bilateral lung markings consistent with chronic lung disease (refer to dedicated lung imaging). Mediastinal lymph nodes are noted. 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. There is a large myocardial infarction in the territory of the right coronary artery associated with mild, peri-infarct ischemia. 2. Most of the segments affected by the infarction have an intermediate probability of viability.3. Normal LV size and systolic function (LVEF 57%) with hypokinesis of the basal to mid inferior wall.4. Moderately dilated right ventricle with severely reduced systolic function (RVEF 25%).5. Moderately dilated pulmonary artery. 6. Severe right atrial dilation. "}
{"instruction": "Generate impression based on findings.", "input": "Medically refractory epilepsy treated with cortical resective surgery 2008 and status post vagal nerve stimulator surgery 2010. There are postoperative findings related to left temporal topectomy. There is confluent T2 hyperintensity along the surgical margins. There is mild compensatory midline shift to the left and mild ex vacuo dilatation of the left temporal horn. The hippocampi appear to be intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.", "output": "Postoperative findings related to left temporal topectomy with confluent T2 hyperintensity along the surgical margins, which may represent gliosis and/or encephalomalacia. "}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of spinal cord [192.2], Reason for Study: ^Reason: hx cervical fibrous tumor w/ Atypical features. F/u 6 months for growth History: surveillance imaging for growth Plaque like enhancing mass on the posterior aspect of the T1 vertebral body is now measured about 29mm x 11.7mm x 9.4mm which was about 22.4mm x 9.7mm x 6.9mm showing interval increase in size.Accordingly external compression toward left side of spinal cord and thecal sac has been aggravated since prior scan.At the level of T1-T2 left side neural foramen, there is low signal intensity lesion on the left ventral aspect of the spinal cord extending toward the left side neural foramen. This lesion does not show any evidence of enhancement (series 1201, image 8/48) and shows low signal intensity on both T1 and T2 weighted images indicating fibrous tissue or non enhancing portion of the tumor mass. Comparing to prior scan, this lesion does not show any significant interval change.Prior laminectomy at the level of cervicothoracic junction, vertebral body signal changes due to prior radiation and various degreed enhancement of vertebral bodies and posterior compartments on C3 and skull base show no significant interval change. Spinal cord signal intensity appears to be normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. Intervertebral discs show dessication of discs at the level of C34, C45 and C56 without showing evidence of disc herniation.", "output": "1. Interval increase in size of T1 level extradural enhancing mass with increased mass effect toward spinal cord as described above.2. No abnormal spinal cord signal intensity."}
{"instruction": "Generate impression based on findings.", "input": "MRI CARD WWO CNTRST, VIABLTY/SCAR IMAG.MORPH/FUNCT, 10/27/2016 2:48 PM Left VentricleThe left ventricle is normal in size with normal systolic function. There is no hypertrophy (lateral wall and septum 7-9mm in thickness). There is abnormal septal motion consistent with a bundle branch block. The overall LV ejection fraction is 57%. The LVEDV is 195 ml (normal range 142+/-34), the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVESV is 85 ml (normal range 47+/-19) and the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time in the lateral wall is 1124 ms and in the IV septum it is 1114 ms. These values are mildly elevated and are suggestive of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%. The RVEDV is 212 ml (normal range 142+/-31), RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVESV is 107 ml (normal range 54+/-17), and the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, 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.The native T1 myocardial relaxation time in the lateral wall is 1124 ms and in the IV septum it is 1114 ms. These values are mildly elevated and are suggestive of underlying diffuse fibrosis or infiltration. However in the absence of delayed enhancement, this is a non-specific finding.2.The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%.3.The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old female with left upper quadrant and left lower quadrant pain ABDOMEN:LUNG BASES: Mild bronchiectasis and nonspecific, careful increased densities at the lung bases, not significantly changed from previous study.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Interval increase in the size of the previously described hypodense lesion in the neck of the pancreas. This lesion now measures 2.5 x 1.7 cm on image number 38, series number 3. Left of IV contrast limits optimal evaluation of this lesion. MRI is recommended for further evaluation.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lower pole punctate nonobstructing stone.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Right adnexal cystic lesion is unchanged measuring 4.2 x 4.2 cm on image number 112, series number 3. Left adnexal solid-appearing lesion measures 6.4 by 5 cm on image number 109, series number 3, slightly increased in size compared to previous CT.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Limited study lack of IV contrast. Right renal nonobstructing stone.Slight interval increase in the size of the cystic lesion in the head of the pancreas. MRI of the pancreas is recommended for further evaluation.Interval minimal increase in the size of the left adnexal solid lesion. Ultrasound may be helpful for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old female with left knee pain Evaluation of the proximal tibia is limited by metallic susceptibility artifact resulting from an intramedullary rod.MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Mild increased signal intensity of the articular cartilage of the lateral facet of the patella inferiorly is suspected to be of no clinical significance although could conceivably represent mild intrasubstance degeneration. No fluid-filled cartilage defects. No bone marrow lesions.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: Diffuse thickening of the patellar tendon compatible with tendinosis with mild signal intensity within the proximal fibers at the patellar attachment. No fluid signal intensity to indicate a tear is seen. Quadriceps tendon appears intact.ADDITIONAL", "output": "Postoperative changes and thickening of the patellar tendon compatible with tendinosis. Otherwise, no findings to account for the patient's knee pain."}
{"instruction": "Generate impression based on findings.", "input": " There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Left facet hypertrophy causes minimal left neural foraminal stenosis.C3/4: Mild posterior osteophyte disc complex and left uncinate hypertrophy causing minimal left neural foraminal stenosis.C4/5: Posterior osteophyte disc complex causes slight anterior and anterior cord without intrinsic cord signal abnormality. There is also ligamentum flavum thickening and bilateral uncinate hypertrophy. There is mild central, moderate to severe left neural foraminal, and moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and left uncinate hypertrophy. There is mild to moderate left neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis.C7/T1: Trace anterolisthesis C7 on T1, minimal disc bulge, and bilateral facet hypertrophy. There is mild to moderate bilateral neural foraminal stenosis.Facet hypertrophy is noted of the visualized upper thoracic spine which encroach the leftward neural foramina at T1/2 and T2/3.", "output": "1.C2/3: Minimal left neural foraminal stenosis.2.C3/4: Minimal left neural foraminal stenosis.3.C4/5: Mild central, moderate to severe left neural foraminal, and moderate right neural foraminal stenosis.4.C5/6: Mild to moderate left neural foraminal stenosis.5.C6/7: Mild bilateral neural foraminal stenosis.6.C7/T1: Mild to moderate bilateral neural foraminal stenosis.7.Facet hypertrophy is noted of the visualized upper thoracic spine which encroach the leftward neural foramina at T1/2 and T2/3. If the patient has symptoms referable to the thoracic spine, dedicated thoracic MRI would be recommended if deemed clinically beneficial."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question to be answered: Evaluate interval change. Signs and symptoms: Worsening mental status. In comparison with the prior examination extensive post operative changes remain stable. Extensive CSF collection under the scalp is redemonstrated. Intracranially no evidence of any new area of hemorrhage. There is however a significant thickening and minimally high density of the cortex of the left hemisphere possibility of petechial hemorrhage within this thickened cortex is suspected. This can be further evaluated by an MRI. Multiple areas of low attenuation (likely edema) within the cortex of the left hemisphere are consistent with areas of cortical stroke. Images at the level of the sylvian fissure on the left demonstrate thrombosed branches of left MCA. This is believed to be secondary to clipping of the feeding pedicles to the AVM.Overall degree of mass effect remains a stable and minimal midline shift demonstrates no interval change. Minimal blood within the dependent portion of the left lateral ventricle is redemonstrated. Minimal blood within the subarachnoid space on the right may be secondary to placement of pressure monitor.", "output": "Overall stable CT examination of brain. Please see above comments."}
{"instruction": "Generate impression based on findings.", "input": " There are postoperative findings related to right retrosigmoid craniotomy for resection of an internal auditory canal and cerebellopontine angle mass. There is subjacent unchanged CSF signal intensity extra-axial fluid collection resulting in mild mass effect on the right cerebellar hemisphere as well as the right CN V and VII and VIII. There is a rounded focus of enhancing tissue within the right internal auditory canal that measures approximately 6 x 5 mm, previously 7 x 6 mm. There is also a rind of enhancing tissue along the resection margins in the right cerebellopontine angle that appears slightly thicker anteriorly (3 mm vs. 2 mm on the prior exam) although resolved medially and posteriorly.There is persistent ventriculomegaly that is improved from the prior exam. There is no evidence of acute infarct. There are a few unchanged scattered patchy foci of T2 intensity within the supratentorial white matter are most compatible with mild chronic small vessel ischemic disease. There are no areas of abnormal parenchymal signal. There is no midline shift or herniation. The major cerebral flow voids are intact, although, there are unchanged findings of a right middle cerebral artery bifurcation aneurysm and a left M1 segment aneurysm that are not well assessed on this exam.", "output": "1.Postoperative findings related to partial resection of a right vestibular schwannoma with residual intracanalicular and cisternal enhancing presumed tumor that is not significantly changed. 2.Persistent but improved ventriculomegaly.3.Bilateral middle cerebral artery aneurysms that are not well assessed on this exam."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic squamous cell carcinoma of the lung: AMS. There is interval increase in size a right precentral gyrus lesion now measures up to 7 mm, previously 4 mm. In addition, there are several newly apparent bilateral brain metastases. There is also interval increase in size of the left frontal bone metastasis with epidural extension. There is an unchanged background of mild cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemia and a chronic left caudate lacunar infarct. There is no evidence of intracranial hemorrhage or 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. There is a chronic right lamina papyracea fracture. There is fluid in the right mastoid air cells.", "output": "1. Interval progression of the brain metastases.2. Increase in size of the left frontal bone metastasis with epidural extension."}
{"instruction": "Generate impression based on findings.", "input": "Right lower occipital weakness. Progressive back pain L3 fracture, stable L1 fracture, severe L3-L4 stenosis. Five lumbar type vertebral bodies are presumed to be present. There is a transitional anatomy at the L5 level with pseudoarticulation involving the left L5 transverse process with the sacrum with superimposed degenerative changes. Again seen is compression fracture involving the L1 vertebral body with approximately 50% loss of height. There is a severe compression fracture involving the L3 vertebral body with particular height loss in its mid aspect as seen on recent CT from 11/1/2016 and progressed since prior MRI from 6/5/2016. There is mild osseous retropulsion at both of these levels. Edema involving the L3 vertebral body is decreased compared to prior. There is a mild compression fracture involving the superior endplate of the L4 vertebral body with 20% loss of height which is new since prior from 6/5/2016 and grossly similar from recent CT. There is mild edema involving the superior L4 endplate. There is T1 shortening involving the L1 vertebral body as well as the pelvis which may be related to prior radiation.There is moderate to severe spinal canal stenosis at the L3-L4 level which is progressed since prior. There is fairly mild spinal canal narrowing at the L2-L3 and L4-L5 levels.Additional details as described below:L1-L2: No spinal canal stenosis. There is mild bilateral neural foraminal narrowing related to minimal disc bulge and bilateral facet arthropathy.L2-L3: There is mild spinal canal narrowing. There is mild right neural foraminal stenosis related to prominent right-sided facet arthropathy. Left neural foramen is patent.L3-L4: There is moderate to severe spinal canal stenosis related to combination of osseous retropulsion, disc bulge, ligamentum flavum thickening, and facet arthropathy. There is also severe right and moderate left neural foraminal stenosis, which have also progressed. L4-L5: Mild disc bulge and advanced facet arthropathy. There is mild narrowing of the spinal canal. There is moderate left and mild right neural foraminal stenosis similar to prior.L5-S1: There is a disc bulge and bilateral facet arthropathy, worse on the left. There is no spinal canal stenosis. There is mild to moderate, left relatively greater than right, neural foraminal stenosis which is similar to prior.No definite evidence of metastatic disease is evident within the limits of noncontrast study.", "output": "1. Compared to prior MRI from 6/5/2016, there is progression of a severe compression fracture of L3, new mild compression fracture of the L4 vertebral body, and unchanged moderate L1 compression fracture. These findings are similar to recent CT from 11/1/2016.2. At L3-L4, there is moderate to severe spinal canal stenosis, severe right neural foraminal stenosis, and moderate left neural foraminal stenosis. These findings have all significantly progressed since prior MRI from 6/5/2016.3. No definite evidence of metastatic disease is evident within the limits of noncontrast study. Additional levels as above."}
{"instruction": "Generate impression based on findings.", "input": "Re evaluate lesion in right middle temporal gyrus. There is an unchanged area of subcortical radial linear high T2 signal in the right middle temporal gyrus with perhaps slight overlying cortical thickening, but no associated enhancement. 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 skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening and suggestion of a small air-fluid level in the right maxillary sinus. The orbits are unchanged.", "output": "An unchanged area of signal abnormality in the right middle temporal gyrus may represent focal cortical dysplasia or perhaps a low-grade neoplasm, for example. "}
{"instruction": "Generate impression based on findings.", "input": "32 years Female (DOB:11/16/1983)Reason: 3T scanner, please evaluate for aneurysms (family hx of aneurysms) History: Fam history of aneurysms (sister had ruptured aneurysm in 20s)PROVIDER/ATTENDING NAME: ISSAM A AWAD ISSAM A AWAD Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The cerebellar tonsils extend approximately 5 mm below the level of the foramen magnum. The cerebellar tonsils are rounded there is straightening of the normal cervical curvature.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. There is mild disc desiccation present at this level. At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild disc desiccation and a minor disc bulge at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is mild disc desiccation and a minor disc bulge at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The posterior communicating arteries are small to medium-sized. The anterior communicating artery is small.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. The left vertebral artery is larger than the right vertebral artery. There is extracranial origin of the right posterior inferior cerebellar artery.CSF flow study:CSF flow study demonstrates normal biphasic flow. The cerebellar tonsils extend approximately 5 mm below the level of the foramen magnum.", "output": "1.There are mild degenerative changes present in the cervical spine without significant compromise to the spinal canal or exiting nerve roots. Please note that straightening of the normal cervical curvature on MRI is nonspecific finding which could relate to muscle spasm or patient positioning.2.There is no compromise to the thoracic spinal cord or cervical spinal cord. No lesions are identified in the spinal cord.3.There is no evidence for intracranial aneurysm or intracranial stenosis.4.The cerebellar tonsils are low lying. CSF flow study at the level of foramen magnum is within normal limits."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old man with history of HCV and liver lesion on CT. ABDOMEN:LIVER, BILIARY TRACT: Liver is cirrhotic in morphology. In segment 6 of the liver (3/21) there is a 17 mm T1 hypointense, T2 hyperintense lesion without signal loss on opposed phase imaging. Otherwise, no focal hepatic lesion is identified.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys with innumerable bilateral cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enteric duplication cyst is noted arising from the jejunum in the mid abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Segment 6 liver lesion which remains indeterminate on this nonenhanced study but could be benign or malignant in etiology (including a focal nodular hyperplasia, sclerosed hemangioma, or hepatocellular carcinoma). Further evaluation with an enhanced MR or direct tissue sampling can be considered, recommendations forwarded to ordering provider (Melanie Samardzija) through the EMR at time of dictation."}
{"instruction": "Generate impression based on findings.", "input": " Following a discussion of the procedure with the patient, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Localizing CT examination demonstrated a oval soft tissue mass along the anterior aspect of the subscapularis muscle corresponding to the findings on recent PET/CT and MRI examinations. Using CT guidance, a 16-gauge Achieve core biopsy needle was advanced into the lesion. Four 16-gauge core needle biopsy specimens were obtained and placed in formalin. Touch preparations were performed and handed to cytopathology to evaluate for specimen adequacy.The core biopsy specimens were hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient\u2019s skin.", "output": "CT guided biopsy of left shoulder soft tissue mass."}
{"instruction": "Generate impression based on findings.", "input": "Left hemiparesis.. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are few punctate T2/FLAIR-hyperintense foci in the frontal white-matter without associated diffusion restriction or susceptibility effect. The brain parenchyma and pituitary gland appear unremarkable, otherwise. 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. There is very minimal mucosal thickening in the maxillary and ethmoid sinuses without fluid. The other paranasal sinuses are clear. The orbits, skull and scalp soft tissues are grossly unremarkable.", "output": "No evidence of acute intracranial hemorrhage, mass, or acute infarct. Few punctate frontal white-matter lesions are very nonspecific but may reflect minimal microvascular ischemia."}
{"instruction": "Generate impression based on findings.", "input": "Right upper extremity pain and weakness. The bones and soft tissues of the forearm appear normal without findings to account for the patient's pain or weakness.", "output": "Normal-appearing forearm without findings to account for the patient's pain and weakness."}
{"instruction": "Generate impression based on findings.", "input": " There are several scattered foci of restricted diffusion in the bilateral cerebral hemispheres. These include the right superior frontal gyrus, bilateral corona radiata and centrum semiovale, right thalamus, left temporal lobe, as well as a splenule of the corpus callosum on the right. There is a background of patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter consistent with chronic small vessel ischemic disease. Multiple chronic lacunar infarcts including the bilateral centrum semiovale as well as the pons are evident. There are numerous foci of susceptibility compatible with chronic microhemorrhages throughout the brain. Relatively larger areas of chronic hemorrhage including the right cerebellar hemisphere as well as the left greater than right basal ganglia which may be be related to chronic hypertension. More peripheral foci of chronic hemorrhage may be related to amyloid angiopathy but are nonspecific. There is no intracranial mass or mass effect, midline shift, or herniation. No hydrocephalus. There is mild degree of global parenchymal volume loss which is advanced for age. MRA HEAD", "output": "1. Multiple scattered acute infarcts in the bilateral cerebral hemispheres superimposed on a background of moderate chronic small vessel ischemic disease with multiple chronic lacunar infarcts.2. Numerous foci of chronic microhemorrhage as well as relatively larger areas of chronic hemorrhage involving the right cerebellar hemisphere and left basal ganglia. Distribution is nonspecific but suggests chronic hypertension and possibly also amyloid angiopathy.3. Major intracranial arteries are patent.4. No high-grade stenosis or occlusion involving the bilateral common carotid, internal carotid, or left vertebral arteries. Right vertebral artery is diminutive which may be related to hypoplasia and/or stenosis. Motion degradation and lack of contrast limits evaluation. If further evaluation is warranted, suggest postcontrast MRA or CTA.5. Mild multilevel degenerative changes in the cervical spine without high-grade spinal canal stenosis or cord signal abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Dysphagia after deep brain stimulator electrode placement for Parkinson's disease. There are bilateral deep brain stimulators in position for Parkinson disease, without evidence of acute infarction or hemorrhage. There is blurring of the bilateral substantia nigrosomes. There is mild nonspecific periventricular white matter T2 hyperintensity. 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. There is fluid within the bilateral mastoid air cells and scattered mild paranasal sinus mucosal thickening.", "output": "Unremarkable bilateral deep brain stimulators for Parkinson disease, without evidence of acute infarction or intracranial hemorrhage."}
{"instruction": "Generate impression based on findings.", "input": "Male, 52 years old, with history of left T2 N2 nasopharyngeal carcinoma status post treatment, follow-up examination. Slight distortion of the mucosal contour of the nasopharynx is unchanged. No masslike lesions are identified. There may be mild edema of the supraglottic larynx which is unchanged, but the remainder of the aerodigestive mucosa is unremarkable.No pathologic adenopathy is detected by size criteria. The salivary glands and the thyroid are unremarkable. The marrow space of the cervical spine shows evidence of prior radiation treatment. Otherwise, the osseous structures are unremarkable.The globes are round and symmetric. The extraocular muscles and optic nerves demonstrate normal morphology and signal characteristics. No intraorbital masses are seen.", "output": "No evidence of recurrent nasopharyngeal tumor or pathologic adenopathy is seen."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent vulvar cancer with probable spread to rectum. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent right external iliac lymph node, not pathologically enlarged by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 3.9 x 1.8 cm soft tissue mass in the perineal region at the vaginal introitus (axial series 1201, image 88) (sagittal series 601, image 25). This mass abuts the anterior wall of the anus with questionable extension along the left lateral wall. There is obliteration of the fat planes between the vagina and anus suspicious for bowel wall invasion. There is no bowel obstruction.", "output": "Perineal soft tissue mass at the vaginal introitus with findings suspicious for bowel wall invasion of the anus"}
{"instruction": "Generate impression based on findings.", "input": "Left shoulder pain ROTATOR CUFF: There is partial articular tearing of the supraspinatus tendon at its insertion upon the greater tuberosity which measures approximately 8 mm in the AP dimension. This is superimposed upon mild tendinosis of the supraspinatus tendon. Additionally, there is mild insertional tearing and tendinosis of the subscapularis. The teres minor and infraspinatus tendons are intact. The rotator cuff musculature is relatively preserved in caliber although there is perhaps minimal fatty atrophy along the myotendinous junction of the supraspinatus, infraspinatus, and teres minor tendons.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. An os acromiale is noted with degenerative changes and mild edema across the articulation. There is no significant subacromial subdeltoid fluid.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate osteoarthritis affects the glenohumeral joint and there is diffuse degeneration and tearing of the labrum is likely age-related.BICEPS TENDON: There is split tearing of the intra-articular portion of the long head of the biceps tendon. Its proximal portion is partially perched on the greater tubercle possibly reflecting a split tear of the distal subscapularis tendon.ADDITIONAL", "output": "1. Partial articular surface tearing of the supraspinatus tendon at its insertion which appears slightly progressed from an exam dated 3/17/2011. There is additional insertional tearing/tendinosis of subscapularis tendon but there is no evidence of a full-thickness rotator cuff tear.2. Osteoarthritis of the glenohumeral and acromioclavicular joints with mild degenerative change across an os acromiale.3. Split tearing of the intra-articular portion of the long head of the biceps tendon.4. Diffuse degeneration and tearing anterior labrum which is likely age-related."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with cerebral cavernous malformation, annual surveillance. Please note the patient declined the research scan portions of the study. Artifact from a right frontal approach ventriculostomy catheter somewhat obscures adjacent structures.There is redemonstration of a cerebral cavernous malformation in the right paramedian quadrigeminal plate, again measuring approximately 9 x 9 x 9 mm, without significant appreciable change. Surrounding hemosiderin laden parenchyma is stable, and there is no perilesional edema. As before, there is very subtle mass effect on the aqueduct without change. There is revisualization of a previously seen associated developmental venous anomaly with recruitment of the left perimesencephalic and basal vein of Rosenthal which is stable in appearance. There are no MR findings of other similar appearing foci.There is no restricted diffusion to suggest acute ischemia. A right frontal approach ventriculostomy catheter is present with the tip projecting into the basilar cistern, unchanged. The ventricles are stable in size and configuration. There is revisualization of a stable small right frontal developmental venous anomaly. There are a few punctate nonspecific foci of increased T2 hyperintensity in bilateral frontal lobes which appear unchanged. There is minimal gliosis along the right frontal approach ventricular catheter, unchanged. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1.No significant interval change in appearance of right paramedian quadrigeminal plate cavernoma and its associative developmental venous anomaly.2.Shunted ventricles stable in size and configuration."}
{"instruction": "Generate impression based on findings.", "input": "History of liver mass. ABDOMEN:LIVER, BILIARY TRACT: There is a dominant 14.2 x 9.5 cm T2-weighted heterogeneously hyperintense mass infiltrating the right hepatic lobe with numerous adjacent smaller lesions in the right and caudate lobe. The mass extends into a branch of the right hepatic vein to the level of the IVC, compatible with tumor thrombus. The mass demonstrates restricted diffusion and thick peripheral enhancement with central nonenhancement suggesting central necrosis. On delayed imaging there is no significant washout.Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Free pelvic fluid is noted on the sagittal images. Moderate size hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Neoplastic tumor infiltration of the right hepatic lobe with right hepatic vein tumor thrombus extending to the level of the intrahepatic IVC."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status [780.97], Reason for Study: ^Reason: PT with recent bacteremia now altered mental status. Concern for CNS infection. History: PT with recent bacteremia now altered mental status. Concern for CNS infection. Motion artifacts degraded exam quality.There are restricted diffusion areas including on the left caudate nucleus head and bilateral internal capsule as well as right thalamus mesial aspect indicating acute ischemic infarct.There is no evidence of acute hemorrhagic lesion on the scan.Focal susceptibility artifacts on the left frontal lobe, no change since prior exam. Underlying brain shows minimal to mild diffuse brain atrophy which is age appropriate.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. There is opacification on the left mastoid air cell.", "output": "Acute ischemic infarcts without hemorrhagic transformation on bilateral internal capsule, left caudate nucleus and right thalamus mesial aspect as described above. "}
{"instruction": "Generate impression based on findings.", "input": " Brain MRI:The ventricles and sulci are normal in size. 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. Incidental note is made of prominent choroid plexus involving temporal horns and foramina of Luschka bilaterally which appears symmetric, without cysts or masses, and is felt to most likely represent an anatomic variant. Cervical spine MRI:Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal and morphology. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no stenoses. There is no abnormal enhancement.", "output": "Negative MRI of the brain and cervical spine including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Other visual disturbances [H53.8], Reason for Study: ^Reason: vasculitis? History: neuro deficit Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Left side basal ganglia including external capsule shows encephalomalacia with gliotic changes indicating chronic ischemic infarct, unchanged since prior scan.The left lateral ventricle shows ex vacuo changes, otherwise unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRAMotion artifact degraded exam quality. 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate irregular and small diameter of the left internal carotid artery with nonvisualization of left ACA A1 segment. Normal appearance of right ICA, MCA and ACA. Vertebrobasilar system appears to be normal. Comparing to prior scan obtained on Dec 26 2014, the intracranial portion of the left ICA especially from the level of the carotid canal appear to be recanalized. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate non visualization of the left CCA. Extracranial left carotid system is visualized at the level of carotid bifurcation with demonstration of small caliber both ICA and ECA branches.Left subclavian artery proximal portion is not demonstrated either but reconstituted at the level of left vertebral artery origin.The brachiocephalic artery also shows significant luminal stenosis.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic ischemic infarction on the left basal ganglia and external capsule.3. Multifocal both intra and extracranial arterial luminal stenosis involving brachiocephalic artery and left intracranial ICA especially cavernous sinus segment. There is also complete occlusion of the left CCA and left subclavian artery origin. These findings may suggest idiopathic arteritis such as Takayasu's disease or vasculitis. 4. Interval recanalization of the left ICA intracranial portion.Rec: Considering the feature of both extracranial and intracranial arterial system which suggest possibility of vasculitis, brain MRI with and without contrast enhancement to assess any intracranial inflammatory foci can be considered if clinically indicated. "}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with increased back pain and urinary dribbling. Evaluate for lumbar stenosis. Again seen is minimal retrolisthesis of L4 on L5 and L5 on S1which is unchanged. There is also posterior spinal instrumentation involving the L3-4 vertebral levels which is new since prior MRI from 5/2/2014 but present on the CT lumbar spine from 6/19/2015. The known caudal migration of the rods are better seen on the recent previous lumbar CT from 6/19/2015 and multiple radiographs. Again seen are degenerative marrow signal changes from L3 through S1 with unchanged severe disc height loss at the L5-S1 level. The distal spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There has been interval bilateral laminectomy, discectomy and spacer placement with improvement in the disc space height and significant improvement in the spinal canal narrowing at this level. Evaluation of the neuroforamina is slightly limited given the susceptibility artifact from the hardware but there is no high-grade stenosis.L4-5: There has been a left-sided laminectomy with increased T2/STIR signal within the disc compatible with edema. There has been interval removal of the left lateral extruded disc with decompression of the left side of the spinal canal. There remains facet hypertrophy bilaterally and right-sided thickened ligamentum flavum along with the prominent asymmetric right-sided posterior epidural lipomatosis which causes some mild narrowing and displacement of the thecal sac; but overall there is no significant central spinal canal stenosis. However, prominent anterior epidural fat just inferiorly at mid L4 level causes moderate central spinal canal stenosis at this level although this was present previously and is unchanged. The degenerative changes at the L4-5 level cause at least moderate bilateral neuroforaminal stenosis greater on the left which is caused by bony osteophytes which are better seen on the recent previous lumbar CT. On postcontrast images, there is some enhancement involving the posterior aspect of the L4-5 disc and also minimally involving the ventral epidural space which is related to granulation tissue and which does not contribute to any spinal canal narrowing.L5-S1: Again seen is advanced degenerative disc disease with facet hypertrophy and ligamentum flavum thickening. Bony spurs better seen on the recent lumbar CT contributes to at least moderate bilateral neural foraminal stenosis greater on the left. Similar to the mid L4 level, there is prominent anterior epidural lipomatosis at the mid L5 level which causes moderate central spinal canal stenosis at this level but this is unchanged from the previous exam.", "output": "1.Multilevel degenerative disease of the lower lumbar spine with a posterior spinal fusion involving L3-L4 with discectomy and spacer placement at the L3-4 level and left lateral discectomy at the L4-5 level, all of which results significant improvement in the previous spinal canal stenosis at these levels. There are no findings to indicate disc reherniation.2.There is moderate spinal canal stenosis involving the mid L4 and mid L5 levels where there is prominent anterior epidural lipomatosis. There is also some asymmetric posterior epidural lipomatosis at the L4-5 level which along with right-sided ligamentum flavum thickening mildly displaces the thecal sac but there is no overall spinal canal stenosis at L4-5 disc level.3.There remains and at least moderate left greater than right L4-5 and L5-S1 neural foraminal stenosis related to degenerative changes and osteophytic components which are better seen on the lumbar CT from 6/19/2015.4.The known caudal migration of the vertical rods are better seen on the recent previous lumbar CT and lumbar radiographs."}
{"instruction": "Generate impression based on findings.", "input": "Right thumb pain; Male 20 years old Reason: evaluate for right thumb MCP ulnar collateral ligament tear LIGAMENTS: No significant abnormality noted. Specifically, the ulnar collateral ligament is intact.TENDONS: There is a mild amount of fluid surrounding the flexor pollicis longus tendon at the level of the MCP joint. Otherwise no significant abnormality noted. BONES: There is a nondisplaced fracture of the base of the second metacarpal with intra-articular extension. Additional areas of increased signal are noted within the base of the third and the underlying carpal bones likely relating to contusions.ADDITIONAL", "output": "1. Nondisplaced subacute fracture of the base of the second metacarpal with intra-articular extension.2. Probable contusions of the base of the third metacarpal and the underlying trapezium and trapezoid.3. Mild tenosynovitis of the flexor pollicis longus.4. Collateral ligament is intact"}
{"instruction": "Generate impression based on findings.", "input": "Twisted knee playing football. Pain and swelling MENISCI: Bilateral menisci appear intact without abnormalityARTICULAR CARTILAGE AND BONE: Minimal signal abnormality in the medial facet of the patellar cartilage without discrete focal degeneration or contour irregularity. The peel and lateral compartments are also intact. Red marrow replacement without additional marrow signal abnormality or significant degenerative changesLIGAMENTS: Mild thickening and increased signal in the ACL with otherwise intact fibers running throughout; specifically no discrete findings to suggest a tear. Remaining ligaments are intact and well visualizedEXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Increased signal and mild thickening of the ACL may correlate with inflammation and acute injury without evidence of an associated tear. No additional acute internal abnormalities, specifically the menisci are intact."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old male with a right thigh mass. Evaluate for rectus tear versus neoplasm. Presents with pain to right thigh mass. Note is made of 3 vitamin E capsules overlying the anterior aspect of the right thigh presumably representing the patient's reported palpable area of concern. Note is made of an irregular enhancing lesion within the muscle belly of the rectus femoris muscle with associated T1 and T2 prolongation measuring approximately 2.0 x 1.4 cm, corresponding to the area of decreased attenuation seen on recent CT examination. There is associated focal fatty infiltration of the rectus femoris muscle in the surrounding area. These findings are nonspecific but remain suspicious for neoplasm including a vascular malformation. The remainder of the musculature is normal in appearance. No bone marrow signal abnormality is identified.", "output": "2 cm irregular enhancing lesion within the muscle belly of the rectus femoris which is nonspecific but remains suspicious for neoplasm including a vascular malformation."}
{"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 \u201ctime-out\u201d form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 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\u2019s 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: 20 seconds.", "output": "Successful fluoroscopic guided injection of dilute gadolinium into the right hip for subsequent MR arthrogram examination."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for PCA stroke History: Persistent dizziness, nausea, and vomiting1/11/194967 yearsFemale MRI of the brainOn diffusion-weighted imaging some subtle signal hyperintensity projecting along the thalami and centrum semiovale and frontal lobes is most likely related to artifact.Examination is mildly degraded due to patient motion.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.On T2 and FLAIR MRI there is a high signal intensity focus involving the posterior limb of the right internal capsule extending to the right centrum semiovale. There are punctate T2 and FLAIR hyperintense foci present in the brainstem and thalami.On susceptibility weighted imaging there are multiple punctate and medium-sized foci of signal loss throughout the brainstem and thalami.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is a 2 mm aneurysm present along the distal right internal carotid artery at the origin of the right posterior communicating artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are very small. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. A weblike defect present within the proximal left internal carotid artery is suspected to be artifactual .", "output": "1.A weblike defect present within the proximal left internal carotid artery is suspected to be artifactual , however, it does give the appearance of the dissection flap. As a result of follow-up exam such as ultrasound or CT angiography may be of further benefit to help confirm this is an artifact.2.Findings are suggestive of a 2 mm aneurysm at the right posterior communicating artery origin. This can be confirmed via CT angiography.3.There are multiple microhemorrhages present throughout the brainstem and thalami whose pattern suggests these are associated with hypertension.4.Findings are compatible with an old lacunar infarct in the right posterior limb of internal capsule.5.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": " Redemonstration of an enhancing dural based metastatic lesion along the left frontal convexity which appears intimately associated to the cortical surface; there may be subtle underlying parenchymal invasion. The lesion now measures up to 1.4 cm in thickness, previously 7 mm, and causes mass effect on the underlying frontal lobe with new low T1 signal within the surrounding white matter consistent with vasogenic edema. The lesion extends along the dura anteriorly and inferiorly involving the left temporal convexity with mild mass effect of the underlying temporal lobe. There is non-suppression of CSF on the FLAIR sequence along the frontal cortical sulci which may represent congestion or leptomeningeal disease. There is also minimal leptomeningeal enhancement in this region. There is susceptibility associated with the extra-axial lesion as well as trace susceptibility involving the left frontotemporal sulci. No frank intraperitoneal hematoma is evident. There otherwise is no evidence of acute infarct or intracranial hemorrhage. Mild nonspecific periventricular and subcortical abnormal T2 signal is again noted. There is no midline shift or herniation.The low T1 signal, low T2 signal, and enhancing lesion within the left calvarium overlying the dural metastasis appears increased in size in the longitudinal dimension. Although there is no large destructive component, CT would be more sensitive in evaluating for bony destruction. There is mildly increased thickening and enhancement involving the left temporalis muscle and along the left scalp overlying the lesion in the bone.", "output": "1. Interval progression of disease with increasing size of the dural based metastatic lesion with new mass effect and vasogenic edema within the left frontotemporal lobe, larger calvarial lesion, and increased scalp thickening. 2. Susceptibility effect is noted with above lesion including within the adjacent left frontoparietal sulci related to mineralization and/or blood products. Consider noncontrast head CT to exclude the possibility of acute hemorrhage associated with this lesion."}
{"instruction": "Generate impression based on findings.", "input": " There is no evidence of pathologic enhancement, parenchymal edema, or mass effect to suggest intracranial metastases.Scattered foci of T2 hyperintensity within the bilateral cerebral white matter are seen, nonspecific, and not significantly changed when compared to prior MRI. There is no diffusion abnormality. No evidence of intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricles and sulci are prominent compatible with mild age-related volume loss. Bone marrow signal intensity is within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.", "output": "1. No evidence of intracranial metastases.2. Mild, chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 38 years old Reason: please define margins of plexiform neurofibroma of abdomen History: young man with NF1 who has what appears to be a superificial plexiform neurofibroma on right side of abdomen CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Multiple small neurofibromas are noted in the pleural space adjacent to the spine. These are mildly T2 hyperintense. CHEST WALL: There multiple T2 hyperintense lesions in the skin representing neurofibromas. The index lesion in the left pectoralis major muscle measures 1.7 x 1.0 cm (image 14/series 16). There are other smaller neurofibromas in the posterior body wall musculature.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal morphology. No suspicious hepatic lesions. The gallbladder is filled with gallstones. No pericholecystic fluid. No biliary ductal dilatation.Hepatic vasculature are patent.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.BONES, SOFT TISSUES: Multiple small T2 hyperintense lesions in the skin compatible with small neurofibromas. No dominant lesion.In the pelvis, the neurofibromas are widen the neural foramina.Plaque-like lesion in the right lateral body wall (image 39 is used 25)Multiple small neurofibromas are present in the body wall musculature.OTHER: No ascites.", "output": "1.Multiple small skin and muscular neurofibromas.2.Cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 81 years old, with dissection, headache, temporal pain. Evaluate for ischemia. MRI brain:No restricted diffusion is seen. Scattered small foci of T2 hyperintensity are seen within the cerebral hemispheres. No edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits. The cerebellar tonsils are noted to be low-lying given that they descend as much as 5 mm below the foramen magnum.MRA brain:No significant intracranial vascular stenosis or occlusion is seen. No aneurysm or vascular malformation is suspected.MRA neck:Mild atherosclerotic narrowing is seen at the right carotid bifurcation. No evidence of significant stenosis by NASCET criteria is seen in either carotid distribution. The origins of great vessels are patent.Again seen is an area of narrowing with the suggestion of extrinsic compression affecting the right vertebral artery at the C3-4 level. More distally, an area of narrowing is also redemonstrated affecting the V3 segment on the right just prior to its passing intracranially. Please note that fat-suppressed T1 precontrast images were inadvertently omitted.MRI C-spine:Alignment is anatomic. Vertebral body heights are preserved allowing for endplate irregularity. No evidence of pathologic marrow replacement or marrow edema is seen. The spinal cord is impinged at the C3-4 level due to degenerative findings, discussed more fully below. However, no areas of abnormal spinal cord signal are observed. No evidence of pathologic enhancement is seen.C2-3: Unremarkable. C3-4: Facet arthropathy. Posterior disc-osteophyte complex formation with ligamentum flavum thickening. Moderate spinal canal stenosis with slight flattening of the ventral spinal cord. Moderate bilateral foraminal narrowing. Of note, no specific cyst or mass is evident to account for the apparent narrowing and mass effect on the right vertebral artery. C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the left paracentral zone. Mild spinal canal stenosis with slight flattening of the left ventral cord. Mild left foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation and ligamentum flavum thickening. Mild spinal canal stenosis with minimal flattening of the ventral cord. Moderate to severe left foraminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.", "output": "1.No evidence of acute ischemia is seen intracranially. There are findings compatible with mild chronic microvascular ischemic disease. The cerebellar tonsils are low-lying which is likely an incidental finding.2.No significant vascular compromise is detected intracranially. No definite aneurysm or vascular malformation is seen.3.Narrowing of the distal right V3 segment is seen correlating with findings on prior CTA. No additional information is obtained on this examination to support the possibility of a dissection at this site.4.Again seen is focal narrowing of the right vertebral artery at the C3-4 level. No obvious cyst or mass is demonstrated to account for this finding.5.Multilevel disc degeneration is seen. The C3-4 level is most severely affected where there is a moderate spinal canal stenosis and some degree of cord impingement. No cord edema is observed. Mild narrowing of the spinal canal is also evident at C5-6."}
{"instruction": "Generate impression based on findings.", "input": " Contrast is seen opacifying the joint space of the wrist there is no discrete contrast extravasation to suggest TFCC or lunotriquetral ligament disruption however please refer to the subsequent MRI report for further information.Exposure time: 35 seconds", "output": "Successful right wrist arthrogram in preparation for MRI."}
{"instruction": "Generate impression based on findings.", "input": "Glioblastoma status post resection and chemoradiation. There are postoperative findings related to right frontotemporal craniotomy. There is no significant change in the irregular peripherally-enhancing mass in the right temporal, with apparent elevated perfusion in the enhancing component, although, the extent of adjacent ependymal enhancement has increased. There is no significant interval change in the irregular peripherally-enhancing mass in the right frontal lobe, but the more lateral adjacent solidly-enhancing tumor has decreased in size. The presence of susceptibility effect in this region limits assessment of the perfusion characteristics. However, there is increased surrounding confluent white matter T2 hyperintensity with associated slight increase the right uncal herniation and effacement of the right lateral and third ventricles since December 2015. There is 6 mm of midline shift to the left. There is no evidence of acute intracranial hemorrhage or infarction. There is unchanged nonspecific patchy cerebral white matter hypoattenuation in the left cerebral hemisphere. The orbits, paranasal sinuses, and scalp soft tissues are grossly unchanged.", "output": "1. No significant change in the irregular peripherally-enhancing mass in the right temporal, with apparent elevated perfusion in the enhancing component, although, the extent of adjacent ependymal enhancement has increased2. No significant interval change in the irregular peripherally-enhancing mass in the right frontal lobe, but the more lateral adjacent solidly-enhancing tumor has decreased in size. 3. Confluent white matter abnormality surrounding the tumor foci has increased since December 2015, which may represent tumor infiltration and/or edema related to treatment."}
{"instruction": "Generate impression based on findings.", "input": "Male, 64 years old, with GBM, status post two cycles immunotherapy. Postoperative changes are again seen in left occipital lobe. A small area of encephalomalacia is unchanged. Enhancing nodules are redemonstrated, including two small nodules and a dominant nodule with associated rim-enhancing cyst. The smaller nodules are stable or at most minimally increased in size. The dominant nodule, however, has mildly increased in size, now measuring up to 20 mm in axial short axis, previously 17 mm. As before, enhancement from this lesion spreads to the ependyma of the left atrium. Susceptibility artifact somewhat limits evaluation on perfusion sequences, but there is clear elevated rCBV correlating to the dominant nodule and at least one of the smaller nodules.T2 hyperintensity surrounding this lesion has progressed with further extension of this signal abnormality anteriorly into the temporal lobe. The left splenium of the corpus callosum is involved, but no definite contralateral spread is seen. The left lateral ventricle is partially effaced similar to prior. The remaining ventricles are unremarkable.", "output": "Multiple nodular enhancing lesions are redemonstrated within the left parieto-occipital junction. The dominant lesion demonstrates a mild interval increase in size. Extensive T2 hyperintensity surrounding these lesions has also progressed. Given that subtle progressive findings were suspected on the prior examination, the possibility that this represents slowly growing tumor is raised."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with right knee instability and giving way episodes. Evaluate right knee for loose body versus unstable meniscal tear. MENISCI: There is marked signal abnormality and degeneration of the medial meniscus. A portion of the medial meniscus appears partially adherent along the posterior and anterior insertion. There is a horizontal tear through the body of the lateral meniscus with continuation into the posterior horn. The tear extends to the inferior articular surface with fraying of the inner edge. ARTICULAR CARTILAGE AND BONE: There is minimal bone marrow edema along the medial tibial plateau. The articular cartilage is absent along the medial compartment. There is abnormal signal and thinning within the articular cartilage of the lateral compartment with numerous defects throughout. The articular cartilage of the patellofemoral compartment is thinned with abnormal signal and fraying.LIGAMENTS: There is degeneration of the ACL with complete tear. The PCL is thickened with increased signal. The PCL appears deformed with buckling. The MCL is intact, however, there is increased signal within it. The lateral collateral ligament appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "Complete tear of the ACL with cartilage and meniscal defects as above."}
{"instruction": "Generate impression based on findings.", "input": "With history of mesothelioma. Status post radiation please evaluate for disease Using mesothelioma protocol and compared to previous study ABDOMEN:LUNG BASES: Linear scarring at the right lung baseLIVER, BILIARY TRACT: Hepatic cyst is unchanged. Fat deep air, free of the right lobe. There is a linear large hypodense area associated with nodular enhancement measuring 18 x 19 mm bested on image number 34, series number 3. This is more prominent compared to previous CT. MRI of the liver is recommended to differentiate between perfusion artifact versus intrahepatic or perihepatic lesion.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Linear large hypodense area at the periphery of the right lobe and possible focal enhancing lesion in the right lobe. MRI of the liver is recommended for further characterization of this heterogeneous area of the liver. Differential diagnosis includes perfusion abnormality, intrahepatic lesion versus perihepatic involvement in this patient with mesothelioma."}
{"instruction": "Generate impression based on findings.", "input": "68 years, Male, Reason: liver lesion ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is increased intrahepatic biliary ductal dilatation extending from the Klatskin point. This is particularly prominent in the left hepatic lobe. A hypointense lesion identified on the prior exam is not evident on this exam and in that region of the left hepatic lobe, there is now increased ductal dilatation. There may be subtle ill-defined T2 signal within the hepatic hilum at the Klatskin point, however no discrete mass can be identified. The common bile duct in this region appears mildly irregular and there appears to be mass effect on the left portal vein.Small amount of debris in the gallbladder. Cirrhotic nodular liver contour.SPLEEN: Splenomegaly is unchanged.PANCREAS: Prominent pancreatic duct measuring up to 6 mm. Normal appearing pancreatic parenchyma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right upper pole hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: Mildly enlarged periportal node measuring 1.4 x 1.5 cm (7/60).BOWEL, MESENTERY: Mild bowel wall thickening of the ascending colon is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Diffuse abdominal ascites is unchanged.", "output": "1.Increased intrahepatic biliary ductal dilatation. While this may be due to progression of patient's known primary sclerosing cholangitis, the degree of change raises concern for an obstructing lesion at the Klatskin point. A discrete lesion is not identified on this exam, however there may be subtle T2 abnormality and findings suggesting mass effect.2.Hypointense lesion identified on the prior exam is not evident.3.Stable ascites.4.Colonic wall thickening is stable and may be secondary to portal colopathy."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with history of HCC, status post TACE/RFA. Assess for recurrence of HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Stable small ablation cavity in hepatic segment 5 (series 10 image 142) without evidence of arterial hyperenhancement or washout. Capsular rim enhancement on the delayed phase (series 11 image 37) is unchanged and likely represents fibrous tissue.A subcentimeter focus of arterial enhancement in the peripheral hepatic segment 6 (series 10 image 26) is isointense on the remaining series and favored to represent a perfusional variant.Abutting a punctate cyst in hepatic segment 6 (series 7 image 21) is a sub 5 mm T2 hyperintense enhancing focus that persists on the delayed phase (series 11 image 45). The cyst is unchanged since the 2014 MRI exam, however this small area of enhancement abutting the cyst is new.No intra or extrahepatic biliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral breast prostheses noted.OTHER: No significant abnormality noted.", "output": "1.Stable small hepatic segment 5 ablation cavity without evidence for local recurrence or new enhancing lesion with washout.2.Abutting a punctate cyst in hepatic segment 6 is a sub 5mm T2 hyperintense enhancing focus that persists on the delayed phase. The cyst is unchanged since the 2014 MRI exam, however the small area of adjacent enhancement is new. This may represent a vascular flow effect but unlikely to represent hemangioma as not seen on prior. Attention on follow-up imaging is recommended."}
{"instruction": "Generate impression based on findings.", "input": "cT1N0 nasopharynx squamous cell carcinoma status post treatment. There are post-treatment findings in the neck. The right nasopharyngeal mass is no longer measurable. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical arterial flow voids appear to be intact. The osseous structures are unchanged. The imaged intracranial structures are unremarkable.", "output": "Post-treatment findings in the neck without measurable residual nasopharyngeal carcinoma. "}
{"instruction": "Generate impression based on findings.", "input": "22-year-old with paresthesias. Concern for multiple sclerosis. Brain:No abnormal signal is seen on the T2 or FLAIR images. There is no abnormal enhancement. There is no evidence of mass or edema. The cerebral volume is preserved.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:Marked motion artifact limits evaluation of the cervical spine.Straightening of the cervical lordosis likely related to positioning. Vertebral body and intervertebral heights are maintained. No significant neural foraminal or spinal canal stenosis. The spinal cord is normal in signal and morphology throughout. No abnormal enhancement is present on the postcontrast images.", "output": "1. Normal contrast enhanced MRI of brain. No evidence of demyelinating disease or findings to account for the patient's symptoms.2. Normal contrast enhanced MRI cervical spine within the limitations of extensive motion artifact. No evidence of demyelinating disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 21 years old Reason: Hx of pancreatic cyst, recent CT showing enlargement History: Pancreatic cyst ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: There is a 4.7 x 5.3 cm T2 hyperintense lesion centered on the distal pancreatic body/pancreatic tail which does not demonstrate definite communication with the pancreatic duct. There is a 1.1-cm nonenhancing nodular focus on the nondependent wall (series 7, image 23) that is isointense to the remainder of the lesion. This is nonspecific but may represent a mucin globule. There is a nonenhancing septation in the inferior aspect (series 4, image 16). There is no debris within the lesion. There is no pancreatic duct dilatation. Post administration of secretin the pancreatic duct demonstrates normal physiologic response. The pancreatic parenchyma upstream from the cystic lesion demonstrates loss of normal intrinsic T1 hyperintensity, mildly increased T2 signal and is relatively hyperenhancing and appears to retain contrast relative to the remainder of the pancreas. There are no surrounding peripancreatic inflammatory changes.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent juxtaphrenic lymph node is nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "1.Cystic pancreatic lesion with nonenhancing internal nodule and septation. The appearance is worrisome for a mucinous cystic neoplasm. While pancreatic pseudocyst is a differential consideration, given the absence of a definite history of prior acute pancreatitis this is felt to be much less likely. 2.Abnormal signal in the upstream pancreas is likely due to a combination of edema and perfusional variation secondary to element and an element of obstruction from the above described cystic lesion. While very early acute pancreatitis could have a similar appearance this is felt much less likely given the absence of peri-pancreatic inflammatory changes."}
{"instruction": "Generate impression based on findings.", "input": "Bifrontal glioblastoma treated with RT/TMZ+TMZ, but off all treatment currently. There are post-surgical findings in the left frontal lobe. There is a subcentimeter focus of enhancement along the surface of the left middle frontal gyrus., which appears to be new. Otherwise, there is no significant change in the confluent areas of T2 hyperintensity surrounding the left frontal lobe resection cavity and elsewhere in the right cerebral white matter. There is no evidence of intracranial hemorrhage or 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, and scalp soft tissues are unchanged. There is a left maxillary sinus retention cyst.", "output": "Nonspecific subcentimeter focus of enhancement along the surface of the left middle frontal gyrus, which appears to be new. Otherwise, no significant change in the confluent areas of T2 hyperintensity surrounding the left frontal lobe resection cavity and elsewhere in the right cerebral white matter."}
{"instruction": "Generate impression based on findings.", "input": "Subdural hematomas. 73-year-old female Patient is status-post of left and right craniotomies.There is redemonstration of bilateral subdural hematomas which have decreased in density since previous exam.. These are unchanged in thickness since the prior exam measuring approximately 9 mm in the right and 13 mm on the left. There is an intracranial pressure monitor present.Along the left inferior frontal gyrus and anterior temporal lobe. There is hypodensity present. This was also present on the prior CT exam. It is suspicious for infarction.Some blood products are present in the occipital horn of the right lateral ventricle. The temporal horns the lateral ventricles are mildly dilated. The sulci are not effaced. In general, the lateral ventricles are larger on the current exam versus the prior CT exam. They are similar in size to the recent MRI exam of 12/30/09.There is opacification of the mastoid air cells and middle ears status-post intubation.There is mucosal thickening along the sphenoid sinus and ethmoid air cells.Opacification of a mastoid air cells is and partial opacification of paranasal sinuses is associated with intubation. Atherosclerotic calcifications of a moderate to marked degree are present in the distal internal carotid arteries.", "output": "1.The bilateral subdural hematomas have gradually decreased in size since exams dating back to 12/16/09.2.The lateral ventricles are mildly dilated, as described above.3.Findings are compatible with a foci of infarction in the left frontal lobe and temporal lobe."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with pain in left ASIS and left iliac crest after fall in June 2015. Evaluate for occult fracture. The anterior superior iliac spine as well as the sartorius origin and the iliotibial band appear intact. The bone marrow signal intensity is within normal limits. Evaluation of the acetabular labrum is limited due to the lack of intra-articular contrast, however, there is a thin band of intermediate signal intensity traversing the anterior labrum at approximately the 2 o'clock position, suggestive of a tear. There is mild degeneration of the articular cartilage of the hip. There is a small focus of heterotopic ossification seen within the gluteus minimus muscle, lateral to the femoral head, which may reflect old trauma. The gluteus minimus tendon itself appears intact. The sacroiliac joints are within normal limits. There are mild peritrochanteric inflammatory changes identified bilaterally which are not necessarily of clinical significance. There is a collection of near fluid signal intensity, posterior to the uterus, which may represent an adnexal cyst, but this is nonspecific on this nonenhanced examination.", "output": "1. Mild osteoarthritis of the left hip with a tear of the anterior labrum. We see no occult fracture or other findings to account for the patient's left iliac crest or ASIS pain.2. Nonspecific collection of near fluid signal intensity posterior to the uterus, which may represent an adnexal cyst, but is nonspecific on this nonenhanced exam. Further evaluation with dedicated transvaginal pelvic ultrasound examination is recommended.3. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Check MPFL, trochlear dysplasia, measure TT-TG distance, check for loose bodies History: R patellar instability Multiple sequences are degraded by patient motion artifact resulting in suboptimal image quality.MENISCI: The medial and lateral meniscus appear intact. There is a subcentimeter lobulated focus of fluid signal intensity along the posterior aspect of the posterior horn of the medial meniscus which likely represents ganglion formation.ARTICULAR CARTILAGE AND BONE: Signal abnormality within the medial aspect of the patella and lateral aspect of the lateral femoral condyle indicating bone contusions from prior lateral transient patellar dislocation. The femoral trochlea appears shallow superiorly and the medial facet appears diminutive, indicating femoral trochlear dysplasia. There is near full-thickness chondromalacia affecting the articular cartilage along the lateral facet of the patella. No full-thickness defects are identified. The articular cartilage of the medial and lateral tibiofemoral compartment appears relatively spared.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact.ADDITIONAL", "output": "1. Findings indicating prior lateral transient patellar dislocation with bone contusions and complete disruption of the distal fibers of the medial retinaculum.2. Femoral trochlear dysplasia and edema within the superolateral aspect of Hoffa's fat pad can be seen in patients with patellofemoral instability.3. The tibial tubercle to trochlear groove distance and Insall Salvati ratio are within normal limits.4. Moderate size joint effusion. No definite loose bodies are identified.5. Chondromalacia affecting the patellofemoral articulation, however, no full-thickness or near full-thickness articular cartilage defects are seen."}
{"instruction": "Generate impression based on findings.", "input": "Female, 21 years old, with paresthesias and history of multiple sclerosis. Multiple scattered corpus callosum, periventricular and juxtacortical T2 hyperintense lesions are again seen. The lesions have not significantly changed in size, distribution or signal characteristics. Most are associated with mild to moderate T1 hypointensity. No definite new lesions are seen. The corpus callosum is of normal thickness and the volume of the cerebral hemispheres is preserved. No evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial collections are detected. The ventricles are normal in size and morphology.", "output": "Stable size and distribution of lesions compatible with multiple sclerosis."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Normal cavernous sinus pathology/posterior communicating artery aneurysm. Signs and symptoms: Right retro-orbital pain, head CT from outside hospital showed the right frontal hyperdense area. None infuse CT of brain:Examination demonstrates a small area of approximately 8mm times 8mm increased density within the cortex of right frontal lobe. This is not associated with any detectable edema or mass effect. The finding is believed to represent subtle calcification and likely a cavernoma. Further evaluation with a dedicated MRI examination is recommended.Examination the right no additional area of abnormal density, edema, hemorrhage, mass-effect, midline shift or hydrocephalus. Images at the level of the cavernous sinuses demonstrate no pathology. Calvarium, limited real paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. CTA of intracranial circulation:Carotid system.Supraclinoid internal carotids, bilateral anterior and middle cerebral arteries and their branches are visualized and no evidence of abnormality.There is no evidence of aneurysm of the posterior communicating arteries as clinically is questioned. Very small bilateral posterior communicating arteries can be detected only on MIP 2-D images and is not visualized on reformatted 3-D images.Vertebral basilar system:There is no evidence of aneurysm. Both intracranial vertebral arteries are visualized and unremarkable. Basilar artery is widely patent. Bilateral superior cerebellar arteries and posterior cerebral arteries are also unremarkable.Extensive motion artifact obscures some of the detail in both carotid systems and vertebral basilar system. The motion artifact causes significant irregularity and apparent narrowing of intracranial vertebral arteries bilaterally and irregularity of basilar artery.This examination demonstrates no detectable abnormality of cavernous sinuses as clinically is questioned. However note should be made that cavernous sinuses can be significantly better evaluated by an MRI examination read in the CTA. If clinical concern for cavernous sinus abnormality persist an MRI examination of brain is recommended which will also help for further evaluation of small calcific lesion in the right frontal lobe.", "output": "1.Small area of cortical increased density in the right frontal lobe is highly suspected of calcification of a small cavernoma. Follow-up with an MRI exam is recommended. Unremarkable CT of brain without contrast otherwise.2.Essentially unremarkable CTA of intracranial circulation.3.Motion artifact in particular through the images of posterior fossa creates significant irregularity and apparent stenosis of vertebral arteries.4.MRI examination is recommended for further evaluation of a small calcific lesion within the right frontal lobe (likely a cavernoma) as well as cavernous sinuses which cannot be properly Vater that on CTA."}
{"instruction": "Generate impression based on findings.", "input": "44 year old with history of right breast biopsy with results of ADH and LCIS. Family history of breast cancer in her mother at age 42. There is extreme amount of fibroglandular tissue in both breasts. A few scattered cysts are seen in each breast.Moderate parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Biopsy clip artifacts in the right outer breast again noted. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Multiple sclerosis. Transient alteration of awarenessClinical question: Assess status of MS, identify possible lesions that may have caused seizures or confusion in generalSigns and Symptoms: History of MS, acute confusional state The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical white matter T2 and FLAIR hyperintense lesions present some of which are perpendicularly oriented to the lateral ventricles. Additional lesions are present in the brainstem and cerebellar hemispheresNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a cystic lesion just beneath the floor of the left maxillary sinus which this forms the floor of the left maxillary sinus and is associated with patient's dentition.", "output": "1.There are multiple lesions scattered in both hemispheres of the brain as well as the brainstem and cerebellum which are compatible patient's clinical diagnosis of demyelinating disorder. No enhancing lesions are appreciated to suggest acute demyelination.2.Findings are suggestive of a radicular cyst involving the left maxillary dentition."}
{"instruction": "Generate impression based on findings.", "input": " The thoracic spine is in normal alignment. The vertebral body and disk heights are well maintained. There is diffuse T1 hypointensity involving the bone marrow without a discrete destructive osseous lesion evident. Small T1 hyperintense foci are compatible with fat or small hemangiomas. There is a 7 mm enhancing focus at the junction of the transverse process and lamina at the right T6 level, possibly atypical hemangioma but nonspecific. The spinal cord is of normal caliber and signal. There are minimal degenerative changes in the thoracic spine including a small right central disc protrusion at T10-T11 which partially effaces the right ventral aspect of the thecal sac. There is otherwise no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.Multiple renal cysts, better assessed on prior abdominal MRI.", "output": "1. No significant spinal canal stenosis at any level or cord signal abnormality.2. Diffuse T1 hypointense marrow signal which is nonspecific but compatible with history of myelofibrosis."}
{"instruction": "Generate impression based on findings.", "input": "46 years Female (DOB:10/16/1969)Reason: Having back pain with radiculopathy down to big toe, assessment for disc disease History: back pain with radiculopathyPROVIDER/ATTENDING NAME: TARIQ M MALIK SERVICES ANCILLARY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level. There is a disc bulge present associated with disc desiccation. There is T2 hyperintensity along the posterior aspect of the annulus of the disc. Since the prior exam there is greater desiccation of the disc.At L4-5 there is loss of disc space height, disc desiccation and a broad-based left lateral recess disc extrusion associated with effacement of the fat at the left lateral recess. Some disc material extends behind the superior endplate of L5 at the left lateral recess and compresses the nerve roots at the left lateral recess. Disc extends across the midline to the right lateral recess and mildly encroaches on the nerve roots of the right lateral recess. These findings were present on the prior exam however there is a little more desiccation of the extruded fragment on the current exam versus the prior exam. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.Since the prior exam the main differences somewhat more disc desiccation the current versus the prior exam as detailed above. There is redemonstration of a left lateral recess broad-based disc extrusion at L4-5 which encroaches on the nerve roots at the left lateral recess."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old woman with history of abdominal pain, altered bowel habits, and elevated inflammatory markers. ABDOMEN:LIVER, BILIARY TRACT: The dome of the liver is not included within the field-of-view. The visualized liver is unremarkable. There is no intrahepatic biliary duct dilatation. The patient is status post cholecystectomy. The common bile duct appears normal.SPLEEN: There is a 54 x 51 mm, lobulated, septated T2 intense, nonenhancing lesion in the spleen (series 4, image 8). The splenic vein is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The small bowel including the terminal ileum appears normal without wall thickening, dilation, or abnormal enhancement. The colon is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus and adnexa appear normal and there is a right ovarian cyst.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small Tarlov cysts are noted.OTHER: No significant abnormality noted.", "output": "1.No abnormality of the small bowel or colon. Specifically, normal terminal ileum.2.Benign-appearing cystic lesion in the spleen, probably a lymphangioma."}
{"instruction": "Generate impression based on findings.", "input": "Female, 61 years old, with left-sided weakness. Evaluate for stroke. A large region of restricted diffusion is evident in the right MCA territory involving portions of the posterior frontal lobe, the parietal lobe, the temporal lobe and the insula. No significant associated hemorrhage is suspected on the basis of the T1-weighted images. Also noted is a single 3 mm focus of restricted diffusion in the right cerebellum.", "output": "Large right MCA distribution acute infarct with a single punctate focus of acute ischemia in the right cerebellum."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Eval progressive grade III oligodendroglioma s/p recent resection w/ adenoviral vector injection on clinical trial.Signs and Symptoms: grade III oligodendroglioma.Comments: Grade III oligodendroglioma s/p resection w/ adenoviral vector injection 2 weeks ago on a clinical trial. | The patient status post right frontal craniotomy for removal of a right frontal lobe mass. There is signal hyperintensity present along the right frontal lobe within the subcortical and periventricular white matter adjacent to the right superior middle and inferior frontal gyrus as well as the right external capsule. The extent of the white matter signal abnormality remains stable and compared to the previous exam from October 6, however, this white matter signal change appears to be more extensive than on the 7/23/2015 exam. Compared to the 9/15/2015 exam - which is preoperative- the outer extent of the white matter signal change appears very similar. There are punctate foci of susceptibility effect present within the white matter signal change adjacent to the resection site. These were also present on the 9/15/2015 exam. There is redemonstration of ill-defined enhancement were these punctate foci of susceptibility are surrounding the surgical margins .Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "Since the previous exam is no substantial change. There is redemonstration of status post right frontal lobe surgery. The possibility of a residual neoplasm in the remaining right frontal lobe cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": " Brain MRI:There are a few bifrontal subcortical foci of T2 hyperintensity, which although present with FLAIR technique, when correlating with their appearance on proton density demonstrate a linearity that is most suggestive of a lack of fluid suppression within a perivascular space. There is a solitary focus of linear T2 hyperintensity within the leftward anterior corpus callosal body. The ventricles and sulci are normal in size. 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. Cervical spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: UnremarkableC6/7: There is a shallow right paracentral disc protrusion which causes minimal anterior right hemicord flattening without intrinsic cord signal abnormality or resulting stenosis.C7/T1: Unremarkable", "output": "1.There are a few bifrontal subcortical foci of T2 hyperintensity, which although present with FLAIR technique, when correlating with their appearance on proton density demonstrate a linearity that is most suggestive of a lack of fluid suppression within a perivascular space. 2.There is a solitary focus of linear T2 hyperintensity within the leftward anterior corpus callosal body which is nonspecific in appearance.3.C6/7: There is a shallow right paracentral disc protrusion which causes minimal anterior right hemicord flattening without intrinsic cord signal abnormality or resulting stenosis."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old woman with history of high-risk neuroblastoma, jaundice, pruritus, and increasing bilirubin levels. ABDOMEN:LIVER, BILIARY TRACT: Diffusely low parenchymal signal in the liver is noted. No focal hepatic lesion is identified.There is moderate intrahepatic biliary ductal dilatation. The peripheral common bile duct measures up to 9 mm in diameter and terminates in the hepatic hilum (401/22). Within the hepatic hilum, there is confluent soft tissue measuring approximately 65 x 37 mm. The portal vein, splenic vein, and superior mesenteric vein are also attenuated by this confluent soft tissue.No significant intra or extrahepatic biliary ductal dilatation. The gallbladder contains sludge but appears otherwise normal.SPLEEN: Diffusely low parenchymal signal is noted without focal splenic lesion.PANCREAS: 19 x 14 mm T2 hyperintense lesion in the pancreatic body (401/22). The T1 signal of the pancreas is diffusely decreased and heterogeneous suggestive of infiltrative tumor.ADRENAL GLANDS: The patient is status post left adrenalectomy. The right adrenal gland appears normal.KIDNEYS, URETERS: There is soft tissue invading the hilum of the left kidney. The right kidney appears normal.RETROPERITONEUM, LYMPH NODES: Numerous enlarged bilateral retroperitoneal lymph nodes noted.BOWEL, MESENTERY: Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: There is abnormal heterogeneous signal throughout the pelvis and vertebral bodies.OTHER: Moderate bilateral pleural effusions are seen and there is nodularity along the pleural surfaces.", "output": "1.Confluent porta hepatis malignant lymphadenopathy resulting in moderate intrahepatic biliary ductal dilatation with occlusion of the common bile duct.2.Portal vein, SMV, and splenic vein also occluded by malignant lymphadenopathy.3.Additional findings of diffuse metastatic disease involving retroperitoneal lymph nodes, bones, and pleural surfaces."}
{"instruction": "Generate impression based on findings.", "input": "20 years, Female, Reason: History of Crohn's, assess for small bowel inflammation History: abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or dilatation. No abnormal enhancement or diffusion restriction. No abscesses or fistulaes identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "No evidence of active inflammation or complications of Crohn's disease."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with headache. Evaluate for stroke. Foci of hypoattenuation in the left cerebellar hemisphere compatible with known infarcts seen on MRI. Periventricular hypoattenuating foci are consistent with minimal ischemic small vessel disease, age indeterminate. The cerebral and cerebellar hemispheres and the brain stem are otherwise normal morphologically and have normal CT attenuation. The ventricles are normal volume.No abnormal extra axial fluid collections, mass, intracranial hemorrhage. The calvaria and skull base are radiographically normal. Bilateral opacification of the maxillary sinuses. The mastoid air cells are normally pneumatized.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "No acute intracranial abnormality. If there is clinical concern for an acute stroke, an MRI may be obtained."}
{"instruction": "Generate impression based on findings.", "input": "Eval growth of anaplastic astrocytoma. Pt on Avastin+CCNU. Along the posterior right superior frontal gyrus, there is increased extent and confluence of DWI hyperintensity with ADC isointensity in the location of previous focal DWI hyperintensity. This lesion measures 1.8 x 1.3 cm (series 11 image 27). There is corresponding increase in FLAIR/T2 signal and enhancement of this lesion. Questionable mild hyperperfusion conforming to the signal abnormality.There is mild residual patchy speckled enhancement remaining of the previously seen left paracentral lobule lesion. There is corresponding focal diffusion restriction appearing similar to prior study. Compared to more remote prior exams there is increase confluence of the T2/FLAIR hyperintensity in the left centrum semiovale. Compared to most recent prior exam, this region appears similar without enhancement or hyperperfusion.There is redemonstration of a small focus of enhancement with associated T2/FLAIR hyperintensity laterally adjacent to the left occipital horn, with stable post-contrast appearance, and stable to minimally progressed FLAIR abnormality. There is more conspicuous progression when compared to remote exams. It is associated with a faint susceptibility.Ill-defined gyriform enhancement along the posterior aspect of the left temporal lobe appears similar to the most recent comparison, with associated ill-defined FLAIR hyperintensity which is overall decreased immediately in the area of enhancement, although appears similar with gyral thickening as well as focal sulcal effacement just inferiorly.There are two new tiny nodular foci of enhancement seen adjacent to the left occipital periventricular and left posterior temporal lobe lesions with FLAIR abnormality, as seen on 11/15.Other scattered non-enhancing foci of FLAIR hyperintensity in the bifrontal and right parietal subcortical white matter appear unchanged, and are nonspecific. Susceptibility artifacts along the left frontal craniotomy site and left thalamus, stable from prior study. There is stable intrinsic T1 hyperintensity along the left thalamus, with subtle minimal superimposed enhancement especially along the medial left thalamus.Right ethmoid mucous retention cyst.", "output": "Redemonstration of multiple scattered ill-defined enhancing lesions scattered in both cerebral hemispheres of the brain, with some findings stable, although there are others which are progressed such as in the posterior right superior frontal gyrus with mild diffusion restriction and questioned hyperperfusion, as well as a few new tiny lesions in the left temporo-occipital white matter."}
{"instruction": "Generate impression based on findings.", "input": "Status post craniectomy for resection of brain metastasis. There has been interval evolution of postoperative findings related to right parietal craniotomy for resection of a right parieto-occipital region mass. There is persistent confluent cerebral white matter T2 hyperintensity surrounding the resection cavity, which appears to communicate with the atrium of the right lateral ventricle. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are unchanged punctate foci of susceptibility in the cerebral white matter, which are likely treatment-related. There is unchanged encephalomalacia in the right cerebellar hemisphere. The ventricles are unchanged in size and configuration. There is an unchanged nonspecific background of scattered white matter T2 hyperintensity. There is no midline shift or herniation. There skull and scalp appear unchanged. There is a small right maxillary sinus retention cyst.", "output": "Stable post-treatment findings in the right parieto-occipital lobe region without definite evidence of recurrent tumor, although the assessment is limited by the lack of contrast administration."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male with known hepatic carcinoma now with recurrent fevers presents with right thigh pain and mass on recent CT examination. Note is made of a lobulated heterogeneous collection within the muscle belly of the biceps femoris measuring 8.7 x 4.9 x 6.7 cm (TR x AP x CC). There are foci of increased signal intensity on T1-weighted imaging consistent with blood products. Additional smaller collections are identified more superiorly within the muscle belly of the biceps femoris. There is minimal, if any, thin peripheral enhancement on postcontrast sequences. These findings are most consistent with a hematoma, however, follow-up examination is recommended to establish interval resolution/evaluate for interval change. The remainder of the imaged musculature of the right thigh demonstrates diffuse fatty infiltration. There is nonspecific subcutaneous edema about the thigh. No bone marrow signal abnormality is identified. A marker is in place along the posterior aspect of the right thigh presumably corresponding to the patient's palpable area of concern.", "output": "Large heterogeneous collection within the muscle belly of the biceps femoris appearing most consistent with a hematoma, however, follow-up examination is recommended to establish resolution/evaluate for interval change."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatocellular carcinoma status post TACE RFA. ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic liver morphology. The segment 5 ablation cavity measures 3.4 x 3.1 cm, unchanged. Intrinsic high T1 weighted signal intensity is compatible with proteinaceous/hemorrhagic debris.Just inferior to the ablation cavity there is a new conglomerate of enhancing nodules measuring up to 3.7 x 3.0 cm extending inferiorly. There are multiple additional arterially enhancing nodules in both lobes of the liver which are new and/or more conspicuous than on the prior study. These are associated with mild T2 weighted hyperintensity and restricted diffusion. No definite washout is seen of these lesions.The more central segment 5 lesion demonstrates peripheral nodular discontinuous enhancement which gradually increases centrally measuring 3.0 x 3.0 cm, compatible with a hemangioma.The hepatic vasculature is patent.Distended gallbladder without specific evidence of gallbladder inflammation.No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Normal splenic size with perisplenic varices.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple new and more conspicuous arterial enhancing lesions in both lobes of the liver including a 3.7 x 3.0 cm conglomerate of small nodules adjacent to the ablation cavity are highly suspicious for multifocal hepatocellular carcinoma, however these do not meet imaging criteria for HCC as there is no definite washout of these arterial enhancing lesions."}
{"instruction": "Generate impression based on findings.", "input": "Weakness [R53.1] / Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery [I63.512], Reason for Study: ^Reason: stroke History: weakness There are restricted diffusion areas on the left frontal operculum indicating acute ischemic infarct. There is no evidence of hemorrhagic conversion.Underlying brain shows scattered high signal intensity lesions on periventricular white matter and centrum semiovale, suggesting underlying nonspecific small vessel ischemic disease.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. 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": "Acute ischemic infarct, left frontal operculum without evidence of hemorrhagic conversion.Underlying nonspecific small vessel ischemic disease, minimal to mild."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Muscle weakness (generalized)Clinical question: Hand weaknessSigns and Symptoms: weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are predominantly adjacent to the trigones of the lateral ventricles. They're likely of little clinical significanceNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There are small nodules present within the parotid glands bilaterally which could represent small lymph nodes.", "output": "No evidence for intracranial mass lesion to explain the patient's weakness"}
{"instruction": "Generate impression based on findings.", "input": "Demyelinating cervical cord lesions, left leg weakness and neuropathic pain. Evaluate for progression. Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is some loss of cervical lordosis and mild retrolisthesis of C5 on C6 similar to prior. Degenerative changes are seen in the cervical spine relatively worse at the C5-C6 level where there is a disc osteophyte complex and bilateral uncovertebral hypertrophy producing moderate right and mild left neural foraminal stenosis as well as mild spinal canal stenosis. There is also moderate right C6-C7 neural foraminal narrowing. Bone marrow signal is benign. Paraspinous soft tissues are unremarkable.Multiple T2 hyperintense lesions are again seen in the cervical cord. These include left lateral aspect of the cord at the C3-C4 level, left lateral C4-C5 level, and the right ventral C3 level. There is no appreciable change compared to 1/16/2010. No new lesions.Thoracic: Thoracic cord is normal in signal and contour. Thoracic vertebral body heights are maintained. Alignment is maintained. No significant spinal canal or neural foraminal stenosis is seen. Bone marrow signal is benign with no suspicious lesions. T1 hyperintense lesion at the T2 vertebral body is consistent with a hemangioma. Mild multilevel degenerative changes are seen including a small left paracentral disc protrusion at T6-T7 with mild indentation on the left ventral cord. Dorsal thecal sac is widely patent at this level.", "output": "1. No significant change in appearance of the multiple T2 hyperintense lesions within the cervical cord compatible with chronic demyelinating plaques. No new lesion in the cervical cord. No thoracic cord lesions.2. Degenerative changes in the cervical spine with mild spinal canal stenosis at C5-C6 and moderate right neural foraminal stenosis at C5-C6 and C6-C7."}
{"instruction": "Generate impression based on findings.", "input": "30 year old with history of DVT and pulmonary embolism with associated right ventricular dysfunction presenting for cardiac evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 208 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 81 ml (normal range 31+/-10), the LV mass index is 42 g/m2 (normal range 67+/-11), and the LV mass is 105 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial T2-star.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 217 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 98 ml (normal range 35+/-13). 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 FindingsSmall axillary lymph nodes are noted. 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. Normal LV size and systolic function (LVEF 61%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 55%).3. Mild mitral and tricuspid valve regurgitation.4. See extra-cardiac findings."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male, evaluate for deltoid abscess.IMAGE ACQUISITIONS: Contrast enhanced CT of the left shoulder was performed after the administration of IV contrast (120 cc of Omnipaque 350 at two cc/sec). Axial, coronal, and sagittal images were reviewed. Low-attenuation mass within the deltoid muscle is consistent with a multi-lobulated fluid collection with slight rim enhancement compatible with an abscess. No underlying evidence of osteomyelitis. If clinically warranted, this may be better evaluated by MRI.", "output": "Low-attenuation mass with slight rim enhancement within the deltoid muscle compatible with an abscess as described above. An MRI may be obtained for better evaluation if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified dementia with behavioral disturbance [F03.91] / Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: please evaluate for contrast enhancing lesions History: progressive dementia, metastatic History: Unspecified dementia with behavioral disturbance [F03.91] / Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: please evaluate for contrast enhancing lesions History: progressive dementia, metastatic There are multiple lesions present involving gray and white matter scattered in both hemispheres of the supratentorial brain but in asymmetric locations. Some are located along the medial aspects of the frontal lobes, the insular cortex bilaterally as well as a lesser degree the lateral aspects of the frontal and parietal lobes and temporal lobes. These are best appreciated on the FLAIR MRI images. There is no associated contrast enhancement. There is no associated susceptibility effect with these lesions. There is associated vasogenic edema on some of these lesions. Diffusion restriction is less conspicuous on the current exam versus the prior exam. There is no involvement of the thalami.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Postcontrast imaging and susceptibility weighted imaging are degraded by patient motion which may obscure more subtle abnormalities.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a small cystic lesion present in the right parotid gland measuring 7 mm in diameter. It is not entirely included on this exam.", "output": "1.There are multiple lesions scattered throughout the cortex of the supratentorial brain. Differential considerations include Creutzfeldt-Jakob disease, encephalitis due to another cause, paraneoplastic encephalitis, multiple late subacute ischemic events and hypoglycemic encephalopathy. There is no progression when compared to the prior exam.2.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.3.Postcontrast imaging and susceptibility imaging are degraded by patient motion which may obscure more subtle abnormalities.4.There is a small peripherally based lesion in the right parotid gland which is not entirely included on this exam. It is nonspecific"}
{"instruction": "Generate impression based on findings.", "input": "History of neuroblastoma: daily headaches. The images are partly degraded by dental artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are secretions in the right posterior ethmoid sinuses. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable.", "output": "No evidence of intracranial hemorrhage, mass, or ventriculomegaly, within the limitations of dental artifact. "}
{"instruction": "Generate impression based on findings.", "input": "Left vertebral artery and proximal basilar artery occlusion. Right sided weakness. Acute brainstem stroke.IMAGE ACQUISITIONS: Precontrast head CT followed by dynamic bolus contrast enhanced CTA of the head 0.9-mm source images. Sagittal and coronal and 3-D reformats were also obtained. There is complete occlusion of the dominant left vertebral artery. Right vertebral artery is congenitally small and predominantly supplies PICA with minimal if any contribution to basilar flow. Right V4 segment is very small. There is questionably a very thin lumen along the right side of the proximal basilar artery, possibly supplied by the right V4 segment. Most of the flow to the mid and distal basilar artery appears to be from posterior communicating arteries from the carotid arteries.There is intraluminal thrombus of indeterminate age in the left vertebral artery to the level of the proximal basilar artery.There is no other evidence of intracranial arterial stenosis. There is no evidence of intracranial aneurysm or intracranial pseudoaneurysm. There is no acute intracranial hemorrhage. Brain stem and corpus callosum infarcts that were demonstrated on MRI are not yet demonstrable on CT.", "output": "Complete occlusion and thrombosis of dominant left vertebral artery to the level of the proximal basilar artery, with minimal if any antegrade flow from the distal right vertebral artery and likely substantial retrograde collateral flow from posterior communicating arteries.Findings were discussed by telephone with Dr. Yallapragada on 06/06/2009 approximately 1930 hrs."}
{"instruction": "Generate impression based on findings.", "input": "Headache and dizziness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants and myopic deformity of the globes. There is mild mucosal thickening in the right maxillary sinus.", "output": "1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Scattered cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "2-year-old previously healthy male with a recent history of abdominal lymphovascular resection 4 weeks ago, who presents with new onset focal seizures (left arm stiffening, staring, drooling). Please evaluate for brain malformation or abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears within normal limits, including bilateral terminal zones of myelination in the posterior cerebral hemispheres. No findings to suggest seizure focus are appreciated. Specifically, there is no evidence of gray matter heterotopia or cortical dysplasia. The bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal mucosal thickening.", "output": "No findings to suggest seizure focus are appreciated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Right progressive unilateral sensorineural hearing loss. Per EPIC: Previous MRI imaging and audiogram was completed at OSH, which did not demonstrate any abnormal pathology on imaging and a very Mild Right SNHL. Along with the previous mentioned symptoms, the patient admits to intermittent symptoms of Right tragal pain. Currently patient denies any otorrhea, dizziness, imbalance, history of chronic ear infection, and current illness. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.", "output": "No evidence of retrocochlear tumor, inner ear anomalies, or cochlear nerve deficiency."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Assess for cause of instability and mechanical block to ROM History: Left shoulder pain, ROM deficit, mechanical block ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: We see no fluid or gadolinium within the subacromial subdeltoid bursa. The acromioclavicular joint appears normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. The glenoid labrum is normal in appearance.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL", "output": "Normal appearing shoulder MR arthrogram without findings to account for instability, pain, or mechanical block."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with right hip pain, limp. ACETABULAR LABRUM: The acetabular labrum is suboptimally visualized on this study. ARTICULAR CARTILAGE AND BONE: There is severe osteoarthritic disease of the right hip including severe joint space narrowing, subchondral sclerosis, and subchondral cyst formation in the acetabulum, as well as osteophytosis at the femoral head/neck junction.SOFT TISSUES: There is mild fatty atrophy affecting the gluteus muscles as well as the vastus lateralis. ADDITIONAL", "output": "Severe osteoarthritis of the right hip."}
{"instruction": "Generate impression based on findings.", "input": "Left shoulder pain ROTATOR CUFF: There is increased intermediate signal intensity and thickening of the supraspinatus and infraspinatus tendons, indicating moderate tendinosis. The increased signal intensity within the supraspinatus tendon extends to the articular surface fibers, suggesting undersurface fraying but we see no discrete tear. There is a small focus of signal abnormality in the underlying humeral head. The supraspinatus and infraspinatus muscles appear normal. The teres minor muscle and tendon appear normal. There is focal increased signal within the undersurface of the subscapularis tendon at its insertion, likely representing tendinosis with a small focus of signal abnormality of the underlying humeral head but we see no discrete tear.SUPRASPINATUS OUTLET: There is an os acromiale. The acromioclavicular joint appears otherwise normal. There is no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. There is a small amount of fluid in the joint but there is no large effusion. There is perhaps mild fraying of the superior glenoid labrum, however we see no discrete tear.BICEPS TENDON: There is a small amount of fluid within the biceps tendon sheath, raising the possibility of mild tenosynovitis. On the axial sequences there appears to be a longitudinal split in the superior fibers of the biceps tendon but the true clinical significance of this is uncertain.", "output": "1. Rotator cuff tendinosis and possible undersurface fraying of the labrum without discrete rotator cuff tear.2. Os acromiale.3. Findings suggestive of a longitudinal split tear of the biceps tendon at its transition from the bicipital groove to the rotator interval.3. Other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for mass, obstruction. History of cancer. Now with headaches. Nonenhanced MRI of brain: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 for patient stated age of 73.Calvarium is intact. Visualized orbits are unremarkable. Visualized paranasal sinuses and mastoid air cells are unremarkable.Prominence of right jugular fossa is believed to represent an anatomical variation and with no evidence of any destructive bony changes. This appears was noted on prior exam from 2003 and with no change.", "output": "Negative nonenhanced CT of brain and calvarium."}
{"instruction": "Generate impression based on findings.", "input": "Back pain with radiculopathy, status post laminectomy Five lumbar type vertebral bodies are presumed to be present. Small Schmorl's nodes are noted involving the superior endplates of L1 and L2 vertebral bodies with mild anterior vertebral body wedging, without bone marrow edema to suggest a recent compression fracture. Vertebral body heights are otherwise within normal limits. There is some loss of lumbar lordosis. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Postsurgical changes are evident including posterior spinal fusion hardware extending from L3 to S1 with pedicle screws and bilateral paraspinous rods. Interbody fusion device is also noted at the L3-L4 level. Note integrity of hardware can be better assessed with CT or radiographs, but appears grossly in adequate position. Spinal canal is surgically well decompressed at L3-L4, L4-L5, and L5-S1.Individual levels, as described below:T12-L1: Small disc bulge without significant spinal canal or neural foraminal stenosis.L1-L2: Small disc bulge, with ligamentum flavum thickening, and mild facet arthropathy result in mild narrowing of the spinal canal. Neural foramina are patent.L2-L3: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy contribute to mild central spinal canal narrowing just above the level of the laminectomy. Neural foramina are patent.L3-L4: Spinal canal is well decompressed. Neural foramina also appear patent with susceptibility artifact from hardware slightly limiting examination. L4-L5: Spinal canal is well decompressed. Mild to moderate right neural foraminal stenosis is suspected related to endplate osteophytes and facet arthropathy. Minimal left neural foraminal narrowing. Small dorsal annular fissure.L5-S1: Spinal canal is well decompressed. Disc bulge with dorsal annular fissure and small protrusion. Mild to moderate right and mild left neural foraminal stenosis is suspected with susceptibility artifact from hardware limiting examination.", "output": "1. Postoperative changes as described above. Spinal canal is well decompressed at L3-L4, L4-L5, and L5-S1.2. There is mild spinal canal stenosis at L1-L2 and L2-L3. There is mild to moderate neural foraminal stenosis involving the right L4-L5 and right L5-S1 levels and to a milder degree at left L5-S1."}
{"instruction": "Generate impression based on findings.", "input": " There are numerous scattered areas of diffusion restriction with high T2 signal and swelling involving both grey and white matter of the left cerebral hemisphere, most prominent in the left occipital and parietal lobes, where there are also punctate foci of susceptibility effect. The right cerebral hemisphere and infratentorial structures are unremarkable. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is scattered mucosal thickening in the paranasal sinuses.", "output": "1. Numerous areas of acute infarction in the left cerebral hemisphere, which may be secondary to synthetic marijuana use and less likely secondary to trauma. Head and neck neurovascular imaging may be useful to evaluate for the possibility of underlying dissection. While there may be petechial hemorrhages in the affected left occipital and parietal lobes, there is no evidence of gross intracranial hemorrhage.2. Paranasal sinus disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic nasopharyngeal cancer status post treatment. There is interval decrease in size of the enhancing lesion in the anterior left temporal pole, but a subcentimeter enhancing lesion in the right anterior temporal pole is slightly larger. There are scattered foci of high T2 signal in the cerebral white matter bilaterally. 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. There is mucosal thickening and fluid within the right maxillary sinus. There are post-treatment findings in the nasopharynx, with diffuse mucosal enhancement, but no definite tumor, although the exam is not optimized for assessment of this region. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable.", "output": "1. Interval decrease in size of the enhancing lesion in the anterior left temporal pole, but a subcentimeter enhancing lesion in the right anterior temporal pole is slightly larger. These lesions likely represent evolving radiation necrosis.2. Scattered foci of high T2 signal in the cerebral white matter bilaterally may represent chronic small vessel ischemic disease, but no evidence of acute infarct. 3. Findings suggestive of acute right maxillary sinusitis.4. Post-treatment findings in the nasopharynx, with diffuse mucosal enhancement, but no definite tumor, although the exam is not optimized for assessment of this region. "}
{"instruction": "Generate impression based on findings.", "input": " Again demonstrated are numerous ill-defined regions of cortical/subcortical T2 hyperintensity in both cerebral hemispheres without interval change in size or number of lesions. The posterior fossa is spared. None of these lesions demonstrates any definite enhancement.Multiple periventricular nodules are again noted and not significantly changed in size or number. These show intrinsic T1 hyperintensity on precontrast imaging and no convincing additional signal change after contrast is administered. Some of these are associated with strong susceptibility which correlates with mineralization/calcification seen on prior CT.There is no evidence of parenchymal mass effect. No intracranial hemorrhage or abnormal extra-axial fluid is present. Ventricles are normal in size. No evidence of restricted diffusion. Subcentimeter right parotid gland T1 hypointense foci which demonstrate contrast enhancement; findings most likely represent lymph nodes.", "output": "Stable multiple cortical/subcortical and subependymal lesions compatible cortical tubers and subenedymal nodules which are stigmata for tuberous sclerosis."}
{"instruction": "Generate impression based on findings.", "input": " There is mild anterolisthesis of L4 on L5, measuring approximately 5mm, which is unchanged. The vertebral body heights are preserved. There is loss of disc height and disc desiccation at L3-L4 and L4-L5. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The tip of the conus medullaris terminates at the level of L1-L2. The paravertebral soft tissues are unremarkable.T11-T12: Bilateral facet arthropathy and thickening of the ligamentum flavum. No significant disc bulge, spinal canal or foraminal stenosis. T12-L1: Bilateral facet arthropathy and thickening of the ligamentum flavum. No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Mild disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild left foraminal stenosis. No significant spinal canal or right foraminal stenosis. L2-L3: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild right and moderate left foraminal stenosis. L3-L4: Disc bulge eccentric to the left, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to moderate spinal canal stenosis and mild right and moderate left foraminal stenosis. L4-L5: Disc bulge with slightly progressed superimposed disc protrusion, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis and moderate to severe right and moderate left foraminal stenosis.L5-S1: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum. No significant spinal canal or foraminal stenosis.", "output": "Degenerative spondylosis of the lumbar spine, most pronounced at L4-L5 with disc bulge and slightly progressed superimposed disc protrusion, contributing to severe spinal canal stenosis and moderate to severe right and moderate left foraminal stenosis. The degree of spinal canal and foraminal stenosis at the other levels of the lumbar spine appear unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Back pain. There is no significant spinal canal or neural foramen stenosis in the lumbar spine. There is straightening of the lumbar vertebral column in the sagittal plane. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is no evidence of mass lesions. The paravertebral soft tissues are unremarkable.", "output": "No evidence of spinal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: HypopituitarismClinical question: hypogonadotropic hypogonadismSigns and Symptoms: decreased libido MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small periventricular white matter lesion present adjacent to the left lateral ventricle. It is high signal on FLAIR and T2 imaging. In isolation it is likely of little clinical significance.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The left Meckel's cave appears asymmetrically larger than the right Meckel's cave. No particular lesion is identified in the Meckel's cave.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery is very small. The right transverse sinus is larger than the left transverse sinus.The visualized portions of the paranasal sinuses demonstrate minimal mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally. There is an ill-defined focus of T1 signal hyperintensity present within the right half of the pituitary gland measuring approximately 4 mm in size which is associated with some hyperenhancement on the postcontrast images and on the dynamic sequence.", "output": "1.There is a ill-defined lesion in the right half of the pituitary gland which is nonspecific. It does not appear to be typical of an adenoma. It is possible this represents some local hypervascularity or blood products but is unclear what it represents.2.There is a small periventricular white matter lesion present adjacent to the left lateral ventricle. In isolation it is likely of little clinical significance."}
{"instruction": "Generate impression based on findings.", "input": "Lateral and anterior knee pain after running 3 miles MENISCI: Globular degenerative signal is noted in the posterior horn of the medial meniscus, without discrete linear component extending to the articular surfaces. The lateral meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. The cartilage and bones are normal in appearance.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Mild degenerative changes of the medial meniscus, without specific abnormality otherwise to account for the patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "Female; 24 years old. Reason: 24 yo F with history of chronic abdominal pain, s/p cholecystectomy in 4/2013, with severe chronic RUQ pain. MRI with gadolinium to assess pancreatic parenchyma, MRCP with secretin to assess bile ducts and pancreatic ducts History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. Status post cholecystectomy. No biliary ductal dilation. SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilation. Normal physiologic response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "Reason: met renal cell ca History: c/o right hip pain Mild osteoarthritis affects the right hip. Note is made of a focus of enhancing increased signal abnormality on fluid sensitive sequences within the medial aspect of the inferior acetabulum which likely represents an enhancing subchondral cyst. A small chronic erosion is considered a less likely differential consideration. There is thin synovial enhancement on postcontrast sequences which is likely within normal limits and of no current clinical significance. Otherwise no bone marrow signal abnormality is identified. Additionally, note is made of a 1.4 cm focus of fluid signal intensity along the posterior superior aspect of the acetabulum which may reflect paralabral cyst formation indicating degeneration and probable degenerative tearing of the acetabular labrum at the 11:00 position, within the limitations of this non arthrogram study. The imaged musculature of the right hip is unremarkable.", "output": "Osteoarthritis of the right hip. No evidence of osseous metastatic disease. Findings indicating degeneration and degenerative tearing of the acetabular labrum with probable small paralabral cyst formation."}
{"instruction": "Generate impression based on findings.", "input": " BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there are inflammatory changes in the left maxillary and bilateral ethmoid sinuses.CERVICAL SPINE: There is lack of the usual cervical lordosis. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. There is mildly diminished T2 signal in the C3-C4, C4-C5 and C5-C6 discs. The vertebral body and disk heights are otherwise well-maintained. The vertebral bone marrow signal is unremarkable. There is no abnormal enhancement within the spine. The paravertebral soft tissues are unremarkable.", "output": "1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of cervical spinal canal stenosis or spinal cord lesions.3. Inflammatory changes in the paranasal sinuses. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for disc herniation, nerve root compression or central stenosis History: back pain, le weakness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disk dessication present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height and a mild disk bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level. There is a small central disk protrusion at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "There are mild degenerative changes in the lumbar spine without compromise to lumbar spinal canal or neural foramina."}
{"instruction": "Generate impression based on findings.", "input": " This exam is mildly degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered small foci of T2 hyperintensity throughout the supratentorial white matter that are most compatible with mild chronic small vessel ischemic disease. There is mild global volume loss that is slightly more prominent in the parietal lobes. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is a left lens implant. There is mucosal thickening throughout the paranasal sinuses.", "output": "1.No evidence of mass or acute ischemia.2.Mild chronic small vessel ischemic disease.3.Mild global volume loss that is slightly more prominent in the parietal lobes."}
{"instruction": "Generate impression based on findings.", "input": "Aneurysm yearly surveillance imaging. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a left middle cranial fossa arachnoid cyst that measures up to approximately 40 mm overlying the flattened left anterior temporal pole, which is unchanged. There is also an unchanged subcentimeter cystic focus in the right frontal lobe white matter adjacent to the frontal horn of the right lateral ventricle. 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, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst that measures up to 15 mm in width. MRA: There is an unchanged outpouching along the medial aspect of the left internal carotid artery along the anterior genu that measures up to 3 mm, with a 2 mm wide neck. There is also an unchanged 2 mm wide outpouching with a 2 mm wide neck along the inferomedial aspect of the ophthalmic segment of the right internal carotid artery. There is an unchanged punctate outpouching along the left aspect of the ACOM complex. There is no evidence of significant steno-occlusive lesions.", "output": "1. Unchanged aneurysm along the medial aspect of the left internal carotid artery along the anterior genu that measures up to 3 mm.2. Unchanged 2 mm wide outpouching along the inferomedial aspect of the ophthalmic segment of the right internal carotid artery.3. Unchanged punctate outpouching along the left aspect of the ACOM complex. 4. Unchanged left middle cranial fossa arachnoid cyst. 5. Unchanged subcentimeter cystic focus in the right frontal lobe white matter adjacent to the frontal horn of the right lateral ventricle."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Forpe is a 68-year-old female with a personal history of left breast lumpectomy in 2000 for IDC followed by radiation and right breast lumpectomy in 2011 for DCIS followed by radiation. Patient received Tamoxifen. History of breast cancer in maternal great aunt diagnosed at the age of 70 and paternal aunt diagnosed at the age of 60. No current breast complaints. Initial cancer was mammographically occult. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Intact bilateral retropectoral silicone implants.No suspicious enhancement is seen in either breast. Stable post-surgical distortion, T2 low density and volume loss in the left breast. There is mild motion artifact, not limiting the study overall, but creating some artifacts on the kinetic analysis. No abnormal axillary lymph nodes are identified in either axillary region.Stable high T2 signal hepatic lesion compatible with a benign cyst or hemangioma.", "output": "No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with left lower extremity erythema and warmth with elevated CRP, evaluate for abscess or osteomyelitis. Multiple foci of signal void within the soft tissues presumably correspond to surgical staples seen on prior radiographs. Review of previous imaging studies reveals a history of chronic lymphedema, and there is generalized subcutaneous edema within the soft tissues of the knee and ankle. There is a paucity of subcutaneous fat between the knee and ankle, which is presumably due to prior surgery. There is generalized thickening and enhancement of the skin consistent with cellulitis. There is also reticular enhancement of the subcutaneous fat of the knee and ankle consistent with cellulitis. There is diffuse enhancement musculature of the leg with relative sparing of the flexor hallucis longus likely reflecting additional inflammation. There is also fatty infiltration of much of the musculature of the leg. Although we see no discrete abscess, within and along the posterior aspect of the tibialis anterior muscle is a poorly defined thin elongated collection of nonenhancing tissue which could represent a phlegmon or developing abscess. Marrow signal intensity is within normal limits without evidence of osteomyelitis.", "output": "1.Findings consistent with lymphedema and postoperative changes as described above.2.Findings consistent with severe cellulitis as described above.3.Muscular inflammation as described above. Although there is no discrete abscess, poorly defined non-enhancing tissue along the posterior aspect of the tibialis anterior could represent a phlegmon or developing abscess. Although no soft tissue gas is evident on yesterday's CT scan, we cannot exclude the possibility of a necrotizing infection.4.No evidence of osteomyelitis."}
{"instruction": "Generate impression based on findings.", "input": "Status post left knee arthroscopy with microfracture. Continued pain and mechanical symptoms. MENISCI: There is abnormal signal intensity within the anterior horn and body of the lateral meniscus extending to the tibial articular surface. There is heterogenous signal intensity anterior to the anterior horn of the lateral meniscus that likely reflects parameniscal cyst formation. There is also thin linear horizontal signal within the posterior horn extending to the free edge of the lateral meniscus. These findings are compatible with degenerative tearing although could in part represent residual intrameniscal signal following partial meniscectomy. There is also thin horizontally oriented intermediate signal within the posterior horn of the medial meniscus extending to the free edge, as well as increased signal intensity within the body of the medial meniscus extending to the tibial articular surface. Again, these findings suggest degenerative tearing, although could conceivably represent residual intrameniscal signal following partial meniscectomy.ARTICULAR CARTILAGE AND BONE: There is near full thickness degeneration of the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus with relatively mild degeneration of the articular cartilage of the lateral tibial plateau beneath and anterior to the posterior horn of the meniscus. There is relatively mild degeneration of the articular cartilage of the medial tibiofemoral compartment. There is full thickness fissuring/delamination of the articular cartilage of the femoral trochlea superiorly with superficial degeneration of the articular cartilage of the patella. There are small tricompartmental osteophytes but we see no bone marrow edema or cysts. LIGAMENTS: Cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact. ADDITIONAL", "output": "1. Articular cartilage degeneration as described above, most prominently affecting the femoral trochlea and the lateral compartment.2. Medial and lateral meniscal abnormalities suggestive of degenerative tearing, although could conceivably reflect residual signal following partial meniscectomy.3. Moderate sized joint effusion."}
{"instruction": "Generate impression based on findings.", "input": "16-year-old male with knee pain with joint instability. Evaluate for meniscal tear. MENISCI: There is linear increased signal in the posterior horn of the medial meniscus that extends to the inferior articular surface, consistent with a tear. Diminutive anterior horn of the medial meniscus. No abnormality of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: Again noted is fragmentation of the tibial apophysis. Mildly increased T2 signal of the fragmented portions.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact without evidence of increased signal to suggest inflammatory changes. ADDITIONAL", "output": "1.Fragmentation of the tibial apophysis with evidence of inflammation suggestive of apophysitis. 2.Tear of the posterior horn of the medial meniscus.3.Moderate knee joint effusion."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate palpable soft tissue mass incompletely evaluated on ultrasound. Abnormal LFTs. Evaluate liver. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in contour and morphology. A 1.0 x 0.6 cm T2 hyperintense lesion abuts the gallbladder and additional punctate T2 hyperintense lesions are identified, probably cysts but too small to characterize. No enhancing lesion is identified. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are a few bilateral subcentimeter T2 hyperintense lesions, most likely cysts, but too small to characterize. No hydronephrosis or enhancing renal lesion is identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No lesion is identified at the site of clinical concern. No acute abdominal MR findings."}
{"instruction": "Generate impression based on findings.", "input": "History of multiply recurrent ganglioglioma. There are stable postoperative findings with no significant interval change in the confluent T2 hyperintensity surrounding the resection cavity in the left temporo-occipital region. There is no evidence of tumoral enhancement, acute intracranial hemorrhage, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unchanged. The orbits are unremarkable.", "output": "No evidence of tumor progression."}
{"instruction": "Generate impression based on findings.", "input": "Headache. There are unchanged low-lying cerebellar tonsils, right more than left, with associated pointed morphologies. There is unchanged asymmetric enlargement of the left Meckel's cave, which measures up to 10 mm in width. There is a partially-empty sella. There is prominence of the bilateral optic nerve sheaths and flattening of the optic nerve heads. There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged protrusion of the right posterior cingulate gyrus across the right tentorial leaflet. There is also protrusion of a portion of the inferior right temporal gyrus into an arachnoid granulation along the right transverse sinus. In addition, the bilateral transverses sinuses appear to be constricted. There is minimal nonspecific white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift.", "output": "Unchanged enlargement of the left Meckel's cave, low-lying cerebellar tonsils, partially-empty sella, as well as optic nerve sheath prominence. The constellation of findings may indicate pseudotumor cerebri perhaps superimposed upon Chiari I malformation. "}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with history of right proximal humerus lesion. Redemonstrated is a heterogeneous lesion within the right proximal humeral metaphysis extending into both the epiphysis and diaphysis. This lesion measures 6.6 cm in maximal sagittal dimensions, previously 6.6 cm (image 18 series 1001). This lesion demonstrates decreased T1 and increased T2 signal with mild irregular enhancement. There are scattered foci of signal void corresponding to calcifications appreciated on plain film. There is no evidence of cortical breakthrough or extraosseous extension. Overall this lesion appears similar to the prior exam.The rotator cuff is grossly intact without evidence of tear. There is a trace amount of fluid within the subacromial bursa as well as mild AC joint osteoarthritis. The anterior and posterior glenoid labrum are grossly intact.", "output": "1.Stable right humeral lesion as above likely corresponding to a benign enchondroma.2.Mild AC joint osteoarthritis."}
{"instruction": "Generate impression based on findings.", "input": " There is no abnormal signal within spinal cord. There is multilevel spondylosis in cervical spine with apparent neural foraminal narrowing at several of these levels; however, this cannot be completely characterized on this limited study. There is also slight indentation upon the cervical spinal cord at the C3-4 level secondary to a disc-osteophyte complex. There are scattered small disc-osteophyte complexes in the upper thoracic spine with mild eccentric right indentation upon the spinal cord at T5-6. There are small disc bulges at multiple levels in the lumbar spine. In particular, at L5-S1, a disc bulge results in moderate bilateral neural foraminal stenosis. There are subcentimeter hemangiomas or areas of focal fat in the thoracic and lumbar vertebral bodies at T3, L1, and L3. High T2 signal within the inferior aspect of T8 and superior aspect of T9 are likely related to endplate degenerative changes. The vertebral heights and alignment are preserved. The paraspinal soft tissues are unremarkable.", "output": "1.Multilevel degenerative cervical spondylosis with slight indentation upon the spinal cord at the C3-4 level.2. Scattered small disc-osteophyte complexes in the upper thoracic spine with mild eccentric right indentation upon the spinal cord at T5-6. 3. Multilevel spondylosis with moderate bilateral neural foraminal stenosis at L5-S1, but no evidence of cauda equina compression.4. No evidence of spinal cord signal abnormality."}
{"instruction": "Generate impression based on findings.", "input": "47 year old female patient with rectal cancer and rectal bleeding/pain. Evaluate staging. Overall image quality: ExcellentPELVIS:UTERUS, ADNEXA: There are bilateral ovarian cysts, which are likely physiologic in a premenopausal female. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Sub-centimeter nodes (at-least 6)Lymph nodes outside the mesorectal fascia: Three subcentimeter left pelvic sidewall.BOWEL, MESENTERY: Rectal Tumor:Size: 3.3 x 3.8 x 1.8 cm (image 56/series 1601)Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensityTumor location: Upper-third(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): N/ADistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 9 cmCircumference of the rectum involved: 360Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): Close but no definite invasion.MRI T-stage: T3b - Tumor invades 0.5cm to 1cm into perirectal fat or extramural.Tumor Distance to Mesorectal Fascia: 0cm (tumor abuts the fascia with areas of thickening and focal invasion (image 47/series 1101).BONES, SOFT TISSUES: Red marrow reconversion possibly due to anemia. Lower lumbar posterior spinal fixation hardware is noted. OTHER: Small amount of pelvic ascites.", "output": "Rectal mass with staging information as provided above. "}
{"instruction": "Generate impression based on findings.", "input": "Left ankle pain / weakness with plantar flexion, evaluate for Achilles tear TENDONS: The Achilles tendon appears normal. There is minimal fluid in the tendon sheath of the tibialis posterior, which is unlikely of clinical significance. The peroneal tendons appear normal. The extensor tendons are within normal limits.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibia-fibula syndesmotic complex is intact. The visualized components of the deltoid ligament appear normal.ARTICULAR SURFACES AND BONE: Bone marrow signal is within normal limits. There is no osteochondral defect. There is a small amount of fluid within the joint without a frank joint effusion.ADDITIONAL", "output": "Normal appearing Achilles tendon without specific findings to account for the patient's pain/weakness."}
{"instruction": "Generate impression based on findings.", "input": "Patellar instability MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity and irregularity of the articular cartilage of the medial patellar facet however no full-thickness defects are appreciated. Otherwise no significant abnormality noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact.ADDITIONAL", "output": "Edema within Hoffa's fat pad with irregularity of the of the articular cartilage of the medial patellar facet. These findings can be seen in cases of patellar impingement. The Insall Salvati ratio and TT to TG distance are elevated although there is no evidence of trochlear dysplasia."}
{"instruction": "Generate impression based on findings.", "input": "Low back pain for 2 years and urinary incontinence 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 normal in position at the mid L1 level. There is minimal fatty infiltration of the filum terminale at the L5-S1 level measuring 1 to 2 mm in thickness. Prone images demonstrate appropriate ventral motion of the conus.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. Paraspinous soft tissues are within normal limits. Please refer to separate report for findings in the pelvis.", "output": "1. There is no clear imaging evidence of tethered cord. Conus is in normal position at the mid L1 level, and there is appropriate ventral motion of the conus on prone images. There is however thin fatty infiltration of the filum terminale at the L5-S1 level, which is favored to be an incidental finding.2. No significant spinal canal or neural foraminal stenosis within the lumbar spine."}
{"instruction": "Generate impression based on findings.", "input": "97-year-old male with neck pain, new onset.? Mass exam. Also with weight loss. Evaluate for mass,? Malignancy Enhanced CT of soft tissues of neck:Images through the skull base, cavernous sinuses, orbits, paranasal sinuses and petrous bones are unremarkable.There is no evidence of a mass or pathologic adenopathy in the neck. Multiple small nonenhancing, non-necrotic and nonpathologic by CT size criteria lymph nodes are noted on the right side of neck and to a lesser degree on the left. The largest of these nodes measures 12 mm x 9.8-mm in the right neck at the level of right thyroid lobe (axial image 71). The vasculature of the neck is intact. No evidence of erosive bony or cartilaginous lesions. He limited images of the apices of the lungs are unremarkable.Extensive degenerative changes of the cervical spine with slight reversal of cervical lordosis is noted. Degenerative changes are more pronounced at C5 -- C6 level. There is multi-level neural foramina compromise at C2 -- C3 on the right, C3 -- C4 bilaterally, C4 -- C5 bilaterally, C5 -- C6 bilaterally (most severe) and C6 and C7 levels. There is also highly suspected central spinal stenosis at multiple levels which can be further evaluated with a dedicated MRI of the cervical spine. CT examination is insensitive to detect central spinal stenosis due to soft tissue hypertrophic changes (disk material or hypertrophic soft tissue changes of the ligaments).80 CC of Omnipaque 350 was utilized for the above study.", "output": "1.No evidence of a mass in the soft tissues of the neck.2.Multiple small nonenhancing, non-necrotic and nonpathologic by CT size criteria lymph nodes as detailed above.3.Extensive degenerative changes of cervical spine with multilevel bilateral neural foramina compromise and highly suspected central spinal stenosis. Further evaluation with an MRI is recommended considering patient's provided clinical data of neck pain. "}
{"instruction": "Generate impression based on findings.", "input": "70 years Female (DOB:11/3/1945)Reason: stroke evaluation History: L leg weaknessPROVIDER/ATTENDING NAME: RAYMOND ROOS JAMES A. MASTRIANNI MRI of the brainThere are punctate foci of diffusion restriction present along the inferior aspect of the right cingulate gyrus adjacent to and involving the corpus callosum. Additionally couple punctate foci are present along the right paracentral lobule.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are small foci of encephalomalacia in the right centrum semiovale.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. There are mild foci of narrowing along the carotid siphon bilaterally but no significant stenosis or occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is smaller than the left A1 segment. There is fetal origin of the right posterior cerebral artery with a hypoplastic right P1 segment. The left posterior communicating artery is not readily identified. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries, however, the origins of the vertebral arteries are not adequately imaged due to artifact. The origins of the vertebral arteries are mildly tortuous. There is only mild atherosclerotic narrowing at the left common carotid artery at the bifurcation.", "output": "1.There are multiple acute to subacute microinfarcts present along the distribution of the right pericallosal artery.2.There is no intracranial cerebral vascular occlusion appreciated.3.Small foci of encephalomalacia in the right periventricular white matter suspected to be related to prior vascular events4.Multiple foci of atherosclerotic narrowing are present in the carotid artery distribution without significant stenosis5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "18-year-old male with history of left knee pain. Evaluate for ACL/PCL tear. MENISCI: The lateral meniscus is completely torn with the anterior horn avulsed from its insertion on the tibia and flipped posteriorly with the meniscal fragments located in the posterior aspect of the lateral tibiofemoral joint space. There is longitudinal and branching fluid signal abnormality within a body of the medial meniscus extending to the articular surfaces compatible with a complex tear.ARTICULAR CARTILAGE AND BONE: Artifact from intramedullary rod limits evaluation of the distal tibia. There is edema type signal about the anterolateral aspect of the tibial plateau and the medial femoral condyle. The articular cartilage is relatively intact. There is no evidence of fracture.LIGAMENTS: There is complete disruption of the PCL. The majority of the ACL fibers are not well visualized with a few intact fibers compatible with at least a partial tear. The fibular femoral ligament is not visualized and may be also torn. The IT band and biceps femoris tendon are intact. The MCL is unremarkable.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1.Complex and extensive tearing of the lateral meniscus as above.2.Longitudinal tear of the body of the medial meniscus.3.Complete tear of the PCL with a high grade partial tear of the ACL.4.Nonvisualized fibular femoral ligament may indicate tear.5.Other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "History of pancreatic necrosectomy with high drain output. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size and signal intensity without a focal lesion.There is moderate dilatation of the common duct which measures up to 1.2 cm. Mild central intrahepatic biliary ductal dilatation. The common bile duct tapers smoothly at the level of the ampulla.The gallbladder has been surgically removed with a remnant cystic duct and cholecystectomy clips better seen on recent CT.In the gallbladder fossa there is a thick-walled heterogeneous predominantly T2-hyperintense fluid collection measuring 6.7 x 4.4 cm with regions of susceptibility artifact indicating air foci suggestive of superinfection.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates heterogeneous decreased intrinsic T1 weighted signal intensity. The parenchyma demonstrates postcontrast enhancement with focal parenchymal loss of the anterior pancreatic body compatible with necrosis. No specific evidence of hemorrhage.There is a peripancreatic fluid collection adjacent to the pancreatic tail measuring 4.4 x 2.3 cm (series 1 103/63) which is relatively in T2-weighted signal intensity. This communicates with a T2-weighted hyperintense peripherally thick-walled enhancing fluid collection extends along the left retroperitoneum along the pararenal space craniocaudally and involves the abdominal wall musculature inferiorly. There is a surgical drain in the inferior aspect of this collection.Adjacent to the inferior aspect of the pancreatic body is a 7.9 x 6.0 cm heterogeneous collection (image 68). This communicates with a more inferiorly located heterogeneous mesenteric collection measuring 6.3 x 2.6 cm (image 85). This communicates with an additional homogeneous fluid collection measuring 6.7 x 2.9 cm (image 86) anterior to the right pararenal fascia. There is a drainage catheter in the right pararenal space collection.The main pancreatic duct is mildly prominent at the tail with regions of focal narrowing at the pancreatic body measuring 2.1 cm in length (series 3/26 and series 6/92) and minimal narrowing at pancreatic head measuring approximate 7 mm in length (3/28 and series 6/112).No evidence of arterial pseudoaneurysm formation. There is moderate to severe narrowing of the SMV and splenic vein proximal to the portal vein confluence. The portal vein is patent. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral extrarenal pelvis. No hydronephrosis or focal lesion. Mild right perinephric fluid.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace left pleural effusion.", "output": "Multiple peripancreatic fluid collections are noted in the abdomen and retroperitoneum. The fluid collection in the gallbladder fossa is more homogeneously T2-hyperintense with gas foci more suggestive of a pseudocyst with possible super-infection. The bilateral pararenal space collections are more homogeneously T2-hyperintense suggestive of pseudocysts. The fluid collections adjacent to the pancreatic body and tail are more heterogeneous in signal intensity and are more suggestive of internal hemorrhage/proteinaceous products (i.e. walled-off-necrosis).Focal narrowing of the main pancreatic duct at the pancreatic body level. No evidence of parenchymal necrosis/hemorrhage.Moderate to severe narrowing of the SMV and splenic vein prior to the portal vein confluence. These were better opacified on the same day CT. "}
{"instruction": "Generate impression based on findings.", "input": "Impingement The exam is limited by motion artifact.ROTATOR CUFF: There is full-thickness tearing of the supraspinatus tendon with approximately 2 cm of retraction and what appears to be a small stump of tissue remaining on the greater tuberosity. There is also interstitial tearing within the retracted supraspinatus tendon more posteriorly. The aforementioned full-thickness tear extends posteriorly to involve the infraspinatus tendon anteriorly. There is additional interstitial tearing of the infraspinatus tendon along the myotendinous junction more proximally. There is mild to moderate fatty atrophy of the supraspinatus muscle with little if any atrophy of the infraspinatus muscle. The teres minor tendon and muscle are intact. There is full-thickness tearing of the subscapularis tendon superiorly with approximately 1 cm of retraction. There is delamination of the subscapularis which extends more proximally into the muscle although the muscle signal intensity is maintained.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. A small amount of fluid is noted in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild to moderate osteoarthritis of the glenohumeral joint with a slightly high riding humeral head. There is degenerative tearing of the labrum. There is a moderate joint effusion with scattered subcentimeter foci of low signal which may represent small loose bodies.BICEPS TENDON: There is increased signal and enlargement of the long head of the biceps within the rotator interval reflecting tendinosis. Irregularity of the margin of the biceps also suggests partial-thickness tearing. Fluid is present within the biceps tendon sheath reflecting extension from the glenohumeral joint.", "output": "1. Full-thickness rotator cuff tears and tendinosis further detailed above.2. Osteoarthritis of the acromioclavicular and glenohumeral joints.3. Tendinosis of the biceps tendon. Other findings are described above."}
{"instruction": "Generate impression based on findings.", "input": "Right knee pain status post knee arthroscopy and microfracture. MENISCI: Fraying of the inner edge of both menisci is observed with mild loss of the apex of the posterior horn of the lateral meniscus. As abnormalities may be partially exaggerated due to artifact from the overlying osseous cartilaginous abnormality. Both menisci are properly anchored posteriorlyARTICULAR CARTILAGE AND BONE: Diffuse scattered cartilaginous changes representing progressing diffuse and focal abnormalities. The discrete focal lesion involving thearticular cartilage of the lateral femoral condyle anteriorly now demonstrates a more discrete defect with underlying bone changes and small cysts. This lesion measures 8 mm approximately. There is less pronounced abnormal signal in the articular cartilage of the medial femoral condyle which also may represent a partial-thickness defect and progressing changes in the undersurface of the patella and trochlea, specifically involving the medial aspects. Mild to moderate osteoarthritic changes are otherwise observedLIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL", "output": "Progressing degenerative changes and or post operative changes. Previously observed cartilaginous lesions, most pronounced in the lateral compartment along with an underlying change of the posterior horn of the lateral meniscus, see details provided.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o tendon / muscle / ligament tear History: pain, swelling TENDONS: The flexor and 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: Degenerative changes affect the first MTP joint. Metallic susceptibility artifact is identified within the first metatarsal head indicating postsurgical change. Otherwise no bone marrow signal abnormality is identified. ADDITIONAL", "output": "Nonspecific subcutaneous edema along the anterior and lateral aspect of the ankle. No evidence of ligamentous injury. Osteoarthritis and surgical changes of the first MTP joint."}
{"instruction": "Generate impression based on findings.", "input": "Painful bony prominence adjacent to tooth #16, prior history of pre-cancerous changes of left lateral tongue. There appears to be mild torus maxillaris internus bilaterally. Otherwise, assessment of the structures surrounding tooth number 16 is limited due to dental amalgam artifact. There is no discernible gross tumor in the oral cavity region, within this limitation. There is also no evidence of significant cervical lymphadenopathy and the salivary glands and thyroid are unremarkable. The imaged intracranial structures and orbits are also unremarkable.", "output": "Apparent mild torus maxillaris internus bilaterally. Otherwise, assessment of the structures surrounding tooth number 16 is limited due to dental amalgam artifact. "}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Other symptoms and signs involving the musculoskeletal systemDiagnosis Edits: Clinical question: LE weakness, incontinence, and gait instability, evaluate for myelopathySigns and Symptoms: see above Cervical spine: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.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is left-sided facet hypertrophy presentAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this levelAt C4-5 there is no significant compromise to the spinal canal. There are some endplate and uncovertebral osteophytes present at this level which narrow the neural foramina bilaterally but worse on the right side were there is some mild encroachment of the exiting nerve roots. This has not changed substantially since the prior exam.At C5-6 there is no significant compromise to the spinal canal . There is loss of disc space height at this level. There is a right lateral recess disc protrusion present at this level which encroaches on the right-sided exiting nerve roots within the neural foramina. This is associated with some uncovertebral osteophytes.At C6-7 there is a diffuse disc bulge associated with endplate and uncovertebral osteophytes and ligamentum flavum hypertrophy. There is partial effacement of spinal fluid surrounding the spinal cord at this level with mild narrowing of the spinal canal at this level. This narrowing has progressed a very little amount since the prior examAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are large cysts present along both kidneys which can also be seen on abdomen CT from 11/20/2014. The one in the left kidney appears to be more complex than the one on the right because it does not follow spinal fluid on all MRI pulse sequences. There are smaller cystic lesions scattered in the kidneys. There is another lesion present along the inferior pole of the right kidney which is complex and hemorrhagic which measures 6 cm x 5.2 cm and has calcifications along its wall as identified on the prior CT.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal. There is bilateral facet hypertrophy present at this level which is worse on the left when compared to the right side. There are some encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At L4-5 there is a diffuse disc bulge present associated with the loss of disc space height, disc desiccation and endplate reactive changes. The endplate reactive changes are bright on T1. The endplates are irregular. There is effacement of the fat at the lateral recess on both left and right side. There is narrowing of the neural foramina present at this level with some mild to moderate encroachment of the exiting nerve roots within the neural foramina. Overall there is a moderate degree to marked degree of spinal stenosis at this level.At L3-4 there is loss of disc space height, diffuse disc bulge, posterior subluxation of L3 on L4 by several millimeters and a diffuse disc bulge. There is effacement of the fat at the lateral recess on both the left and the right side. There is bilateral facet and ligamentum flavum hypertrophy at this level. Some endplate reactive changes are also present at this level. Overall there is a moderate degree to marked degree of spinal stenosis at this level. There is mild encroachment of the exiting nerve roots within the neural foramina at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disc bulge present at this level associated with loss of disc space height and some endplate reactive changes. There is partial effacement of fat at the lateral recess bilaterally at this level. Overall there is mild narrowing the spinal canal at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.There is encroachment of the right-sided exiting nerve roots within the right C5-6 neural foramen and to a lesser degree right-sided exiting nerve roots at C4-5. This was also present on the 4/10/2009 exam and has not progressed2.There are multilevel degenerative changes present in the cervical spine with some mild narrowing of the spinal canal at the C6-7 level.3.There are multilevel degenerative changes present in the lumbar spine with moderate to marked spinal stenosis at L3-4 and L4-5 associated with encroachment of exiting nerve roots at L4-5 and on the left side at L5-S1. There is mild osseous subluxation of L3 on L4.4.Multiple complex appearing cystic lesions in the kidneys. Please refer to CT of the abdomen from 5/3/2015 and 11/20/2015."}
{"instruction": "Generate impression based on findings.", "input": "Female 74 years old Reason: NSCLC History: headache. There are multiple foci of T2 hyperintensity in the periventricular and subcortical white matter. There is a prominent left inferior basal ganglia perivascular space. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage or mass effect. The ventricles and basal cisterns are normal in size and configuration. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right maxillary and sphenoid sinuses.", "output": "1. No evidence of enhancing intracranial metastases.2. Probable chronic small vessel white matter ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Headaches of changing character and history of thyroid cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "No evidence of intracranial hemorrhage, mass, or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "NF3: visual field defect, diplopia, and numbness and weakness bilaterally of arms and hands. Orbits: There is slight interval increase in size of the tumor along the right optic nerve sheath that encases and compresses the optic nerve. The tumor now measures 22 mm width and 16 mm in height, previously 20 mm and 14 mm, respectively. The tumor compresses the right medial rectus muscle and results in proptosis. The right globe is otherwise intact. The left orbit is unremarkable. The left parotid and left cheek subcutaneous tumors have not significantly changed. Brain: There are postoperative findings related to right retrosigmoid craniotomy, with encephalomalacia in the right lateral cerebellum. The remaining portion of the right vestibular schwannoma in the right cerebellopontine angle cistern is perhaps minimally larger, measuring up to 9 mm, previously 8 mm. Likewise, the residual tumor within the skeletonized right internal auditory canal appears to be slightly more prominent. There is a 2 mm wide enhancing nodule within the left internal auditory canal, which is more conspicuous. The right geniculate fossa tumor is not significantly changed, measuring 9 x 7 mm in axial cross-section. Likewise, a tumor centered in the right Meckel's cave and along the bilateral oculomotor cisternal segments have not significantly changed. There are multiple supratentorial and infratentorial dural-based enhancing tumors, which do not appear to have changed significantly. For example, the largest tumor along the right frontal convexity measures 18 mm in height and 22 mm in width, previously also 18 mm and 22 mm, perspectively. There are several unchanged punctate foci of T2 hyperintensity in the cerebral white matter. There is no midline shift or herniation. There is no evidence of acute infarction. The ventricles are unchanged in size and configuration. There is a subcentimeter right ethmoid retention cyst.Cervical Spine: There is an enhancing extramedullary mass within the left aspect of the spinal canal at C4-5 with marked compression of the spinal cord. The tumor extends through the left C4-5 neural foramen and along the brachial plexus. The tumor measures up to 15 mm in width and 45 mm in length and displaced and perhaps narrows the left vertebral artery flow void. There minimal T2 hyperintensity within the spinal cord at the C4-5 level. There is also an enhancing lesion within the right C5-6 neural foramen. In addition, there is a 3 mm wide enhancing nodule within the left spinal canal at the C2-3 level. There are dural-based enhancing lesions along the posterior spinal canal at the C2 level that measure up to 3 and 5 mm in thickness and indent the spinal cord. There also appears to be a punctate posterior dural -based lesion at the C5 level, with minimal mass-effect upon the spinal cord. The cervical spine alignment is straightened in the sagittal plane, but there is no spondylolisthesis. The vertebral body hei8ghts are preserved.", "output": "1. Stigmata of neurofibromatosis type 2 with multiple intracranial meningiomas that appear to not have significantly changed, cervical spine meningiomas, a right optic nerve sheath meningioma that has slightly increased in size, multiple intracranial schwannomas, including slight increase in size of the residual right vestibular schwannoma and a punctate left vestibular schwannoma, and a large schwannoma at C4-5 that compresses the spinal cord and extends beyond the left neural foramen. The posterior spinal canal meningiomas at the C2 level also indent the spinal cord.2. Unchanged nonspecific cerebral white matter lesions, but no evidence of acute infarct."}
{"instruction": "Generate impression based on findings.", "input": "Orbital cellulitis possible orbital abscess: left orbital pain and blurry vision. There is secretions and moderate mucosal thickening diffusely throughout the left frontal anterior ethmoid, and maxillary sinuses. There is a defect in the left lamina papyracea with mild protrusion of the orbital contents, which is more conspicuous on the recent CT. There is high T2 signal and enhancement within the medial left orbital fat, mainly confined to the extraconal space. There is no evidence of intraorbital fluid collection. The left superior opthalmic vein demonstrates normal enhancement and the left globe and optic nerve appear to be intact. The right orbit appears unremarkable. The right maxillary and ethmoid sinuses and bilateral sphenoid sinuses appear unremarkable. There are several subcentimeter retention cysts in the adenoids. The imaged intracranial contents appear unremarkable.", "output": "Left osteomeatal unit pattern of sinusitis and medial left orbit cellulitis associated with a lamina papyracea defect, but no evidence of orbital abscess."}
{"instruction": "Generate impression based on findings.", "input": " There is a more prominent left frontal dural based homogeneously enhancing focus measuring approximately 6 x 11 x 11 mm in the axial plane (series 1301 image 19, series 1401 image 14) which appeared on prior exams to be smaller and more like a prominent vessel. There is no significant associated mass effect and no edema within the adjacent brain parenchyma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, and there are no areas of abnormal signal. The midline structures and craniocervical junction are within normal limits. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. No abnormal extra-axial fluid collection is identified. The major cerebral flow voids are intact. Diffuse low T1 signal involving the visualized osseous structures, compatible with known sickle cell disease is again noted . The paranasal sinuses and mastoid air cells are clear.MRA HEAD", "output": "1.There is a more prominent left frontal dural based homogeneously enhancing focus measuring approximately 6 x 11 x 11 mm in the axial plane (series 1301 image 19, series 1401 image 14) which appeared on prior exams to be smaller and more like a prominent vessel. The differential diagnosis most likely includes a meningioma, especially given its slow growth over the interval 13 months. Recommend follow-up imaging in 6 months to evaluate progression. Otherwise negative brain MRI.2.Normal MR angiography of the brain, without flow limiting stenosis or aneurysm identified.3.Normal MRV of the brain, without occlusion or stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Benign neoplasm of cerebral meninges. Brain lesion. Preoperative planning for brain tumor resection The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an extra-axial mass adjacent to the medial aspect of the left precentral gyrus which measures 22 x 18 mm sagittal dimensions on the current exam and is unchanged since the prior exam. Findings suggest infiltration of the lesion to the dura and possibly into the superior sagittal sinus.There is diffuse pachymeningeal enhancement presentNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Examination is performed for the purpose of stereotactic guidance. This is a limited exam.2.There is redemonstration of an extra-axial mass adjacent to the left precentral gyrus which is suspected to infiltrate into the superior sagittal sinus."}
{"instruction": "Generate impression based on findings.", "input": "On neoadjuvant therapy for known left breast cancer. I-Spy research MRI #2. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Bilateral retropectoral silicone implants are present.In the left inner breast, the index enhancing mass near 8:00 now measures 1.4 x 2.1 x 2.8 cm, previously 2.0 x 2.7 x 2.8 cm (LM x CC x AP). Previously noted adjacent small foci/areas of non-mass enhancement are not clearly visualized. Biopsy clip artifact is seen in the mass. This index mass extends posteriorly close to the thin pectoralis muscle overlying the implant. The abnormal non-mass enhancement surrounding a cyst in the lower outer left breast now measures 2.3 x 2.8 x 5.1 cm, previously 2.7 x 3.2 x 5.7 cm. This is also decreased in degree of enhancement. These areas together currently measure 4.4 x 5.2 cm, previously 5.2 x 6.5 cm in the axial plane.No abnormal enhancement is seen in the right breast. The representative node adjacent to the pectoralis minor again measures 1.1 cm in the axial plane. Other lymph nodes are slightly decreased in short axis dimensions. No abnormal axillary lymph nodes are identified in the right axillary region.A port-a-cath is present in the right upper chest wall. A high T2 signal hepatic lesion is partially visualized, likely a benign cyst.", "output": "Decrease in size and degree of enhancement of proven malignant lesions as detailed above. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old woman with history of pancreatic pseudocyst status post drainage. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder appear normal. There is no intra or extra hepatic biliary duct dilatation.SPLEEN: The spleen appears normal.PANCREAS: The cystgastrostomy tube has been removed. The pancreatic parenchyma is atrophic. The parenchyma and pancreatic tail has decreased T1 signal and enhances poorly. Additionally, there is mild pancreatic tail duct dilatation. No pseudocyst or abnormal fluid collection is identified. No focal pancreatic lesion is identified.The duodenum distends normally on the secretin augmented images suggesting normal exocrine function.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: The kidneys appear normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: Small peripancreatic lymph nodes are noted, however there is no significant lymphadenopathy.BOWEL, MESENTERY: Loops of small bowel and colon are partially visualized.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Resolved pancreatic pseudocyst and cystgastrostomy removed.2.Findings suggestive of chronic tail pancreatitis with mild ductal dilatation, likely due to stricture or chronic ductal injury."}
{"instruction": "Generate impression based on findings.", "input": "HCV cirrhosis. HCC surveillance. ABDOMEN:LIVER, BILIARY TRACT: Liver contour: The liver contour is smooth. Hypertrophic left hepatic lobe suggestive of chronic liver disease.Features of portal hypertension: None.Portal vein: Patent.Hepatic veins: Patent.Hepatic artery: Conventional.Lesions:No suspicious arterially enhancing parenchymal lesions. Stable small right hepatic cysts.Status post cholecystectomy.SPLEEN: Status post splenectomy. Nodular enhancing foci in the left upper quadrant are stable and again suggestive of splenosis. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts bilaterally. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes consistent with gastrojejunostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No suspicious focal hepatic lesions to suggest HCC."}
{"instruction": "Generate impression based on findings.", "input": "Male 19 years old Reason: Patella dislocation. Evaluate MPFL and for loose body History: Recurrent dislocations MENISCI: Medial and lateral menisci are intact. ARTICULAR CARTILAGE AND BONE: There is T2 hyperintense bone marrow edema signal in the lateral femoral condyle and the lateral tibial plateau. Lateral trochlear inclination measuring 4 degrees consistent with trochlear dysplasia.LIGAMENTS: Increased signal and attenuation of the medial patellofemoral ligament consistent with history of patellar dislocation. Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL", "output": "1.Sequelae of patellar dislocation including injury of the medial patellofemoral ligament, and lateral femoral condyle bone contusion. 2.Large joint effusion. 3.Findings consistent with trochlear dysplasia."}
{"instruction": "Generate impression based on findings.", "input": "Male, 69 years old, with history of thoracic angiosarcoma status post resection, follow-up examination. Evidence of laminectomy is again seen from T4 through T7 for resection of prior intraspinal tumor. Epidural and soft tissue scarring appears similar to prior and does result in partial effacement of the dorsal thecal sac. Areas of signal abnormality are also redemonstrated within the left aspect of the T5 and T6 vertebral bodies related to prior tumor involvement. These also show no significant interval change. Within the limitations of a noncontrast examination, there are no findings to suggest recurrent or growing tumor.The sagittal alignment of the thoracic spine is within normal limits. Vertebral body height and morphology are unremarkable. Except as above, marrow signal characteristics are benign. There is mild narrowing of the spinal canal between T5 and T7 due to epidural scarring, but no high-grade spinal canal stenosis is seen at any level. Disc protrusions are evident at multiple levels, most notably at T8-9 where there is mild cord impingement, without significant interval change.", "output": "1.Demonstration of findings related to intraspinal tumor resection.2.Dorsal epidural and soft tissue scarring is again seen extending from T4 through T7.3.There is no evidence of recurrent or growing tumor.4.A disc protrusion with mild cord impingement at T8-9 is unchanged."}
{"instruction": "Generate impression based on findings.", "input": "23 year old man with history of heart transplant in 2011, presenting for annual evaluation.MEDICATIONS: Pravastatin, tacrolimus, prednisone, cellcept, tricor, glipizide, metformin, synthroid. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVEDV is 150 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 43 g/m2, and the LV mass is 71 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is consistent with prior transplant.. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 116 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 53 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with prior transplant.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 mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. The main PA is 28 mmVenous AnatomyThe SVC and IVC 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. No perfusion defects/ \"ischemia\" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Depth electrode for seizures. There is a left transparietal depth electrode that terminates in the left medial temporal lobe region, a left transtemporal depth electrode that also terminates in the left medial temporal lobe region, and another depth electrode that terminates in the left thalamus region. There is new diffuse T2 hyperintensity along the left hippocampal tail, adjacent to an electrode. There is also a newly apparent T2 hyperintense lesion in the splenium of the corpus callosum. The ventricles are unchanged is size.", "output": "1. Multiple left cerebral hemisphere depth electrodes in position and new edema along the left hippocampal tail, adjacent to an electrode, which may be related to seizure activity.2. Newly apparent lesion in the splenium of the corpus callosum, which may be related to seizure activity, antiepileptic medications, or viral infection, for example."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral L4, L5 radiculopathy. Evaluate for nerve root impingement. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild loss of lumbar lordosis. Alignment is otherwise maintained. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Multilevel degenerative changes are seen with disc desiccation and height loss at multiple levels, relatively worst at the L4-L5 level and T12-L1 levels, where there is at least moderate degree of disc height loss with suggestion of vacuum phenomena. Fatty endplate marrow changes at L4-L5. Multilevel degenerative changes are seen, as described below:T12-L1: Mild disc bulge without significant spinal canal or neural foraminal stenosis.L1-L2: Mild disc bulge. Mild effacement of the lateral recesses. No central spinal canal or neural foraminal stenosis.L2-L3: There is disc bulge, ligamentum flavum thickening, prominence of the dorsal epidural fat, and mild facet arthropathy. There is resulting mild spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: Mild disc bulge with partial effacement of the lateral recesses. No significant central canal stenosis. Minimal narrowing of the neural foramina. Mild to moderate bilateral facet arthropathy.L4-L5: Disc bulge, ligamentum flavum thickening, and moderate bilateral facet arthropathy. There is no significant central canal stenosis. There is moderate right and moderate to severe left neural foraminal stenosis, where there may be impingement of the exiting L4 nerve roots. There is also effacement of the lateral recesses which may be affecting the descending L5 nerve roots.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild to moderate bilateral facet arthropathy.", "output": "1. Multilevel degenerative changes in the lumbar spine, relatively worse at the L4-L5 level where there is moderate right and moderate to severe left neural foraminal stenosis. There is also effacement of the lateral recesses. There may be impingement of the L4 and L5 nerve roots at this level as described above.2. No high-grade spinal canal stenosis at any level. Central spinal canal stenosis is relatively worse at L2-L3, and is mild in degree."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female rule out CVA. Left finger-to-nose dismetrix. Unstable gait, falling to left x 1 week This examination is within normal limits for patient's stated age of 52. In particular no evidence of stroke, hemorrhage, mass-effect, hydrocephalus or midline shift is detected. The ventricular system and cortical sulci and all CSF cisterns are within normal limits. Images through posterior fossa remains essentially unremarkable. Considering the provided clinical data an MRI examination is recommended.The bony message of calvarium, pneumatization of paranasal sinuses and mastoid air cells are also unremarkable.", "output": "Negative CT examination of brain without infusion."}
{"instruction": "Generate impression based on findings.", "input": "8 year-old former 32 week premie with significant developmental delays. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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, and scalp soft tissues are grossly unremarkable. There is moderate left maxillary sinus mucosal thickening.", "output": "No evidence of acute intracranial hemorrhage, mass, or infarction."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: 29-year-old female with sudden onset of headaches 2 weeks ago. Signs and symptoms: As above. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted images.Examination demonstrate prominence of the vermian folia for patient's stated age of 29. Correlate with history and risk factors.Slight asymmetry of the lateral ventricles (right larger left) midline is believed to represent an anatomic variation areaThe anatomical and morphology and the signal intensity of brain parenchyma is otherwise within normal on all MRI sequences.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses remain unremarkable.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.", "output": "1.No acute intracranial process and negative diffusion weighted series.2.Prominence of vermian folia for patient of stated age.3.Unremarkable nonenhanced brain MRI otherwise as detailed above.4.Unremarkable visualized orbits and well pneumatized all paranasal sinuses and mastoid air cells."}
{"instruction": "Generate impression based on findings.", "input": "Seizure/epilepsy. History of left subdural hemorrhage. Susceptibility artifact in the left parietal region slightly limits evaluation of the adjacent parenchyma. There is evidence of encephalomalacia involving the left inferior parietal lobule with evidence of remote left-sided craniotomy. Minimal herniation of brain parenchyma is noted via the craniectomy site. There are additional smaller areas of encephalomalacia involving the left occipital lobe including the lingual gyrus and the left inferior temporal lobe involving primarily the left parahippocampal gyrus. Volume loss involving the left hippocampus is noted. There is FLAIR hyperintensity involving the left hippocampus and to a much greater degree in the left parahippocampal gyrus. Old right temporal burr hole is also noted.Few scattered T2 hyperintense foci in the white matter are nonspecific. No intracranial mass or mass effect. Mild ex vacuo dilatation of left lateral ventricle. No hydrocephalus. No abnormal parenchymal or leptomeningeal contrast enhancement. Major intracranial vessels are patent. The orbits are normal. Mild ethmoid and maxillary mucosal thickening. Mastoid air cells are clear.", "output": "1.Multifocal encephalomalacia involving the left parietal, left temporal, and left occipital lobes which may represent sequela of prior trauma.2.Asymmetric volume loss involving the left hippocampus with mild FLAIR hyperintensity, which may be related to direct injury seen more extensively in the adjacent left parahippocampal gyrus versus secondary mesial temporal sclerosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "BRCA2 positive, strong family history of breast cancer and ovarian cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. There are a few scattered enhancing foci, and these can also be seen on prior studies. 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": "89-year-old female, Jehovah's Witness, status post 2 falls at home yesterday. Evaluate for bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse hyperdensities within a periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Round focus of low attenuation in the left cerebellum consistent with previous stroke.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": "Chronic changes as described above, no acute findings. If there is clinical concern for acute ischemia, an MRI may be considered"}
{"instruction": "Generate impression based on findings.", "input": " Multiple sequences are degraded by motion artifact. As on the previous exams the left aspect of the sella is empty. The pituitary stalk leads to a homogeneously enhancing tissue within the right aspect of the sella which likely represent pituitary gland unchanged in size and appearance. No new or enlarging mass within the sella.MRA HEAD", "output": "1.Motion degraded current and prior MRA studies demonstrate a 2-3 mm right supraclinoid ICA aneurysm which is not significantly changed dating back to 8/15/2012. 2.Motion degraded current and prior pituitary studies demonstrate no new or enlarging mass within the sella. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 38 years old. Reason: Patient with hypercalcemia and hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 5.6 x 1.7 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.3 x 1.0 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous echotexture, without focal lesion.LEFT LOBE: Heterogeneous echotexture, without focal lesion.ISTHMUS: Heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: A hypoechoic structure posterior to the inferior pole of the left thyroid lobe measures 0.8 x 0.4 x 0.4 cm, solid, with minimal internal vascularity.LYMPH NODES: Benign-appearing cervical lymph nodes are identified.OTHER: No significant abnormality noted.", "output": "A hypoechoic structure posterior to the inferior pole of the left thyroid lobe correlates with the area of possible increased uptake seen in this location on prior nuclear medicine scan, and may represent a parathyroid adenoma."}
{"instruction": "Generate impression based on findings.", "input": "Other specified disorders of brain [G93.89], Reason for Study: ^Reason: evaluate for residual tumor History: s/p posterior fossa tumor resection Redemonstration of post resection findings of the posterior fossa lesion including occipital craniotomy site suboccipital fluid collections, residual air within 4th ventricle, some blood products and dilated but much improved ventricular system, unchanged since prior scan.Nodular and somewhat linear shaped enhancing lesions seen on prior scan at the superior and posterior aspect of the resection cavity are again seen on this scan, unchanged since prior. Diagnostic possibilities including focal residual tumor and adjacent venous structures. Follow up imaging is recommended.There is no evidence of another abnormal enhancing lesion on this scan.There is no evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are dilated but unchanged since prior scan. The midline structures and cranial-cervical junction are normal except about 5.8mm downward herniation of cerebellar tonsils which is unchanged since prior scan. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "1. Redemonstration of focal nodular and somewhat linear enhancing lesions on the superior and posterior aspect of the posterior fossa lesion resection cavity as described above, unchanged since prior scan.2. Postoperative no unusual finding.3. No evidence of new abnormal enhancing lesion. No acute ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: R sacral mass--abscess vs leukemic infiltrate History: low back pain, CML in blast crisis, mass on CT Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the sacral lesion.", "output": "Sacral bone biopsy of a right sided sacral lesion under CT guidance. A total of 9 samples were delivered for analysis as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "History of urothelial cancer status post right nephroureterectomy. Surveillance examination. 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: Status post right nephroureterectomy. There is a stable large left renal sinus cysts measuring 11.1 cm in maximum dimension, previously 11.2 cm. Previously noted hydronephrosis has resolved. No enhancing or suspicious genitourinary mass lesion.RETROPERITONEUM, LYMPH NODES: No significant interval change in infrarenal aortic aneurysm which measures 3.9 x 3.7 cm, previously 4.0 x 3.3 cm.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No focal suspicious osseous lesion.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: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No suspicious osseous lesion.OTHER: No significant abnormality noted.", "output": "1.Post surgical changes from right nephroureterectomy without evidence of recurrent or metastatic disease.2.Stable infrarenal abdominal aortic aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "A 63 year old male with history of Lymphoma, s/p chemotherapy 20 years ago, intersitial lung disease, paroxysmal atrial fibrillation, chronic systolic heart failure. Referred to cardiac MRI for evaluation of function and etiology. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 48 ml/m2 (normal range: 74+/-15), the LVEDV is 96 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 49 ml (normal range 47+/-19), the LV mass index is 20 g/m2 (normal range 85+/-15), and the LV mass is 40 g (normal range 164+/-36). There is mild hypokinesis at the basal to apical segments of the inferoseptal and inferior walls. There is dys-synchronic myocardial contraction. There is late gadolinium enhancement at the inferior and inferoseptal walls at the mid and apical segments in a mid wall/subepicardial pattern These gadolinium enhancements are atypical for myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.T1 times were mildly increased at the mid and apical septum (range between 1080-1100).No iron overload was noted.No intracavitary thrombus was noted.Left AtriumThe left atrium is normal in size (90ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 137 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 72 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is question of trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (35 x 37 mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (27 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is prominent pericardial fat.Extracardiac FindingsCalcified mediastinal lymph nodes, specifically within the anterior mediastinum, most consistent with treated lymphoma.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. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 48%. There is mild hypokinesis at the basal to apical segments of the inferoseptal and inferior walls. There is dys-synchronic myocardial contraction. 2. There is mild late gadolinium enhancement at the inferior and inferoseptal walls at the mid and apical segments in a mid wall/subepicardial pattern. These gadolinium enhancements are atypical for myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. T1 times were mildly increased at the mid and apical septum.3. No iron overload was noted.4. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 48%."}
{"instruction": "Generate impression based on findings.", "input": "Reason: stage IVb lung adenocarcinoma EGFR exon 21 L858R mutation, on Tarceva, evaluate response. History: h/o small brain mets There are subcentimeter foci of subtle enhancement in the right superior frontal gyrus (series 11 image 26), right posterior cingulate sulcus (series 11 image 23), and right sylvian fissure (series 12 image 9). These lesions have mild intrinsic T1 hyperintensity and questionable susceptibility artifact. There is no associated edema of the adjacent brain parenchyma, which may suggest that these lesions are leptomeningeal in location. Nonspecific scattered punctate FLAIR hyperattenuation is noted in the subcortical and periventricular white matter.There is a round, intrinsically T1 hyperintense, 7 mm lesion in the anterior sella situated above the pituitary gland. The lesion does not enhance beyond its intrinsic T1 hyperintensity. The native pituitary gland is evident inferior to this lesion.No abnormal diffusion restriction. No gross intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. The ventricles, sulci, and cisterns are normal in size without evidence of hydrocephalus. Gray-white matter differentiation is preserved. Nonspecific mucosal thickening of the left ethmoid air cells. Otherwise paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.", "output": "There are subcentimeter foci of subtle enhancement in the right superior frontal gyrus, right posterior cingulate sulcus, and right sylvian fissure. These lesions have mild intrinsic T1 hyperintensity and questionable susceptibility artifact. There is no associated edema of the adjacent brain parenchyma. Findings are suspicious for the presence of intracranial metastases, potentially leptomeningeal in nature.Incidental note is made of an intrinsically T1 hyperintense lesion within the anterior sella situated above the native pituitary gland. This could represent a Rathke cleft cyst, or perhaps an adenoma which has undergone proteinaceous or hemorrhagic degeneration."}
{"instruction": "Generate impression based on findings.", "input": "Pain, flexion unable to be performed Mild scattered osteoarthritic changes, more pronounced involving the thumb, radiocarpal joint and triquetrolunate articulation. Specifically no focal additional abnormalities to suggest a soft tissue lesion, however serial imaging and/or even MRI may be needed given patient history", "output": "Mild osteoarthritic changes"}
{"instruction": "Generate impression based on findings.", "input": "Viral hepatitis C, cirrhosis, please evaluate for HCC ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Not well seen on prior study is curvilinear hypointense signal in main portal vein extending towards confluence with SMV, see postcontrast image 145 series 9 and image 242 series 9 as well as image 22 series 6 (in latter case, normal T2 signal void at this level appears compromised). Status post cholecystectomy.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: Prominent cardiophrenic and periportal lymph nodes most likely reactive in setting of cirrhosis.BOWEL, MESENTERY: Thick-walled hepatic flexure of colon likely reflects underlying portal colopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate ascites.", "output": "1. Cirrhotic liver morphology. No suspicious liver lesion.2. Not well seen on prior study is curvilinear hypointense signal in main portal vein extending towards confluence with SMV, suspicious for nonocclusive portal vein thrombus, may be further evaluated with dedicated ultrasound imaging. 3. Additional findings as above. "}
{"instruction": "Generate impression based on findings.", "input": "History of metastatic prostate cancer. Pathology demonstrated left base medial and left mid medial carcinoma. PELVIS:PROSTATE:Prostate Size: 3.3 x 5.1 x 4.3 cmPeripheral Zone: Dominant lesion in the posterior left apex measuring 1.3 x 1.0 cm (series 801/14) extending into the left mid gland demonstrating T2 weighted hypointensity, restricted diffusion and early arterial enhancement. The lesion abuts the posterior fibromuscular stroma without definite extracapsular extension.Central Gland: No significant abnormality.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The dominant left apex to left mid gland lesion abuts the left posterolateral capsule without definite 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": "1.3 cm left lesion compatible with carcinoma extending into the left mid gland without definite extracapsular extension."}
{"instruction": "Generate impression based on findings.", "input": " There are multiple segmentation anomalies throughout the cervical spine including butterfly and hemivertebrae as well as multiple vertebrae that are shortened in the AP dimension but are only partially imaged on the counting scout view. There is also 4 level segmentation anomaly involving the mid thoracic spine with 2 hemivertebra. There is a mild apex rightward curvature centered at the cervicothoracic junction and there appear to be 12 ribs bilaterally. Please note that the presence of multiple segmentation anomalies makes accurate level counting difficult and close attention on follow-up imaging and any future potential procedures is recommended. There is a single midline pelvic kidney. There are postoperative findings related to prior cord untethering. When counting from below, the conus terminates at the inferior L2 level. The filum measures 3 mm in thickness and demonstrates T1 hyperintensity extending from L3 through L4 (again when counting from below). There is anterior translation of the conus upon prone positioning. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.", "output": "1.Multiple partially imaged cervical as well as mid thoracic segmentation anomalies without associated cord abnormality. Please note these anomalies limit accurate level counting.2.Postoperative findings related to prior cord untethering. There is filar thickening and fibrofatty infiltration but anterior translation of the conus upon prone imaging. The conus terminates at the inferior L2 level when counting from below.3.Single pelvic kidney."}
{"instruction": "Generate impression based on findings.", "input": "72 year old woman with new heart failure, referred for further ischemic evaluation.MEDICATIONS: ASA, Coreg, lisinopril First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact was noted. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%, the LV end diastolic volume index is 123 ml/m2 (normal range: 65+/-11), the LVEDV is 194 ml (normal range 109+/-23), the LV end systolic volume index is 88 ml/m2 (normal range 18+/-5), the LVESV is 139 ml (normal range 31+/-10), the LV mass index is 85 g/m2, and the LV mass is 135 g. LV dysfunction is global with regional variation. The native myocardial T1 relaxation time is 1150ms, suggesting the presence of mild, diffuse underlying interstitial fibrosis.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 68 ml/m2 (normal range 69+/-14), the RVEDV is 108 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The thoracic aorta is severely tortuous. 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 FindingsThe hepatic T1 time is reduced suggesting that there may be hepatic iron overload present. 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. No perfusion defects/ \"ischemia\" present during hyperemia; however, the diagnostic sensitivity of vasodilator stress testing may be reduced in patients with severe LV dysfunction.2. No prior myocardial infarction. The entire myocardium is viable.3. Severely dilated with severely reduced systolic function (LVEF 28%) without evidence of late gadolinium enhancement. Increased native myocardial T1 relaxation times are noted and suggest that there may be mild diffuse interstitial fibrosis present.4. Normal RV size with mildly reduced systolic function (RVEF 48%).5. Severe left atrial dilation.6. Mild to moderate mitral regurgitation.7. Mild aortic regurgitation.8. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male with cavernous malformation. There is a 6 mm diameter lesion with extensive peripheral susceptibility effect and punctate central T1 and T2 hyperintensity in the white matter anterior to the frontal horn of the left lateral ventricle, unchanged in appearance, without perilesional edema. There is perhaps a tiny adjacent developmental venous anomaly. There are no other similar appearing lesions. Redemonstrated are a few scattered punctate foci of T2 hyperintensity in subcortical white matter locations without mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The brainstem and cerebellum appear 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The right globe is elongated with a scleral buckle and lens implant.", "output": "1.Stable 6 mm diameter lesion in the white matter anterior to the frontal horn of the left lateral ventricle likely represents a cavernous malformation. 2.Stable minimal punctate white matter T2 hyperintense foci, statistically most likely due to small vessel disease."}
{"instruction": "Generate impression based on findings.", "input": "H/o strokes. The previously seen right occipital hypoattenuation appears less when compared to prior exam. There appears hypoattenuation in the right cerebellum, which is compatible with findings on the prior MRI. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.", "output": "Stable right posterior cerebral artery territory subacute stroke. Otherwise unremarkable CT head. "}
{"instruction": "Generate impression based on findings.", "input": "Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: CCM Protocol, 3T Scanner, QSM/permeability, known DVA and cavernoma, please evaluate History: tingling in hands, feet, weakness in L arm, numbness on L side of tongue, severe pain About 8mm sized round T2 low signal intensity, T1 iso intensity with significant susceptibility artifacts indicating cavernous malformation at the right inferoanterior basal ganglia and adjacent developmental venous anomaly. There is no evidence of surrounding edema of the lesion.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no other abnormal enhancement except the DVA.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRISpinal cord signal intensity is normal.The spine alignment is anatomic.Bone marrow and spinal cord signal intensity are normal.There is central focal disc protrusion which abuts thecal sac at the level of C56 with mild bilateral ligamentum flavum thickening result minimal spinal canal narrowing. No neuroforaminal stenosis is seen at this level.Diffuse bulging of disc is seen at the level of C45.Other cervical disc levels appear to be within normal limits.", "output": "1. About 8mm sized right inferoanterior basal ganglia cavernous malformation associated with DVA.2. No other lesion is seen.3. Central disc herniation (focal protrusion) at the level of C56 and diffuse bulging of disc at the level of C45 as described above. "}
{"instruction": "Generate impression based on findings.", "input": " There is stable reversal of the normal cervical lordosis. There is mild disk narrowing at C5-6. The vertebral body and disk heights are otherwise well-maintained. There is mild multilevel disc desiccation. No worrisome focal marrow signal abnormality is appreciated. There is no pathological cord enhancement.There is a small left intradural extramedullary mass likely meningioma at the C1 level (image 33, series 709) measuring 9 x 5 mm, unchanged from prior exam. At the right C2-C3 neural foramen, there is an enhancing mass measuring approximately 17 x 8 mm, also stable (image 26, series 2001). Along the left C3-C4 neural foramen, there is an enhancing dumbbell-shaped mass approximately measuring 25 x 10 mm, previously 26 x 10 mm. The medial lobule measures 10 mm. Overall, the lesion is stable from most recent comparison, but demonstrates mild interval increase in size when compared to more remote study from 6/23/2014. In particular, the lobulated intraspinal component demonstrates increased convexity and measures 10 mm, previously measured 7 mm. There is again significant mass effect on the cord at this level.There is stable disc osteophyte complex at C5-C6 causing mild effacement of the ventral thecal sac and mild-moderate central spinal canal stenosis. There is mild left greater than right foraminal narrowing. There is persistent trace T2/STIR hyperintensity within the right ventral cord, likely minimal myelomalacia. There is also a minimal disc bulge with central prominence at C6-C7 with mild impression on the ventral thecal sac. No significant spinal canal or neural foramina narrowing. Remaining levels demonstrate no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. There are multiple small nodular lesions within the soft tissues of the neck bilaterally; majority of them likely reflect lymph nodes, although some of them may relate to schwannomas, grossly unchanged from the prior exam. Redemonstration of previously demonstrated pontine encephalomalacia, partially imaged. There is a partially imaged left vestibular schwannoma measuring 7 x 7 mm, grossly unchanged from prior. There is a partially visualized left infratentorial plaque-like dural-based enhancing lesion measuring 13 x 8 mm, previously 14 x 8 mm may likely represent meningioma unchanged.At the left T4-T5 foramen, there is a 6 x 6 mm enhancing T2 hyperintense likely schwannoma, unchanged from prior.There is a small enhancing T1 hypointense, T2 hyperintense anterior right chest wall lesion, which appears slightly higher than the expected location of the nipple.The right submandibular gland demonstrates questionable hyperenhancement, nonspecific.MRI brachial plexus: There is no significant asymmetry or abnormal signal involving the brachial plexus on the right. There are no masses or lymphadenopathy identified. There are no compressive masses demonstrated. There is no axillary lymphadenopathy. There are no signal abnormalities along the course of the right brachial plexus or neurovascular bundle. There is trace fluid in the glenohumeral joints.", "output": "1. Stable schwannoma involving right C2-C3 neural foramen. The left C3-C4 neural foramen schwannoma appears grossly unchanged compared to the prior exam, but interval more rounded configuration and mild enlargement of the medial intraspinal component compared to 6/23/2014 study.2. Stable left C1 intradural extramedullary meningioma.3. Partially imaged stable left infratentorial meningioma and grossly stable left vestibular schwannoma.4. Mild spondylotic changes in the cervical spine, without significant neural foraminal narrowing. Mild-moderate spinal canal stenosis at C5-C6 with right ventral minimal myelomalacia.5. No definite abnormality involving the right brachial plexus.6. Questionable mild hyperenhancement of the right submandibular gland, nonspecific. Please correlate clinically for possible recent sialadenitis.7. Enhancing nodule along right anterior chest wall, which appears slightly higher than the expected location of the nipple. Correlate clinically with direct inspection for possible dermal lesion."}
{"instruction": "Generate impression based on findings.", "input": "Female 14 years old Reason: evaluation of ischiorectal abscess History: ischiorectal abscess PELVIS:UTERUS, ADNEXA: Uterus is normal in appearance and is anteverted. Bilateral ovarian cysts are noted, likely physiologic.BLADDER: The bladder is distended and normal in appearance.LYMPH NODES: No adenopathy.BOWEL, MESENTERY: Stool is present throughout the visualized colon and rectum.BONES, SOFT TISSUES: Perianal soft tissues there is T2 hyperintense reticular signal consistent with edema. In the right ischiorectal fat there is a 1.3 x 0.8 cm peripherally enhancing collection consistent with small abscess (image 52 series 401).OTHER: Small amount of free pelvic fluid, likely physiologic.", "output": "1.Small peri-anal abscess in the right ischiorectal fat.2.Edema in peri-anal soft tissues, which could be due to cellulitis."}
{"instruction": "Generate impression based on findings.", "input": "58 year old male with history of complex coronary disease with previous PCI to the LAD and PDA, with known anomalous left circumflex coronary artery and persistent stable angina, referred for cardiac MRI vasodilator stress testing. MEDICATIONS: aspirin, metoprolol, rosuvastatin, ticagrelor, amlodipine, ranolazine First Pass PerfusionDuring hyperemia, a small transmural perfusion defect is noted in the basal anterolateral wallViability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 33 g/m2, and the LV mass is 67 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 70%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 45 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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. A small transmural perfusion defect/ \"ischemia\" present in the basal anterolateral wall during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with low normal systolic function (LVEF 54%).4. Normal RV size and systolic function (RVEF 70%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Assess integrity of R thumb UCL History: R thumb pain over UCL, ligament laxity, history of injury 3/2016 The ulnar collateral ligament appears intact. The radial collateral ligament proper can be followed from the first metacarpal head to the base of the proximal phalanx, however, there is increased signal intensity within its dorsal fibers as well as mild edema within the adjacent base of the proximal phalanx. These findings suggest a partial tear of the ligament and perhaps a small avulsion fracture. The collateral ligaments of the interphalangeal joint of the thumb appear normal. The remaining visualized bone and soft tissue structures appear normal.", "output": "Abnormal signal intensity within the dorsal fibers of the radial collateral ligament as well as edema within the adjacent base of the first proximal phalanx suggesting a partial-thickness tear and perhaps an avulsion fracture. This could be further evaluated with radiographs. The ulnar collateral ligament appears normal."}
{"instruction": "Generate impression based on findings.", "input": " MRI brain:The patient is status post Chiari I decompression surgery with resection of the C1 arch and posterior fossa craniectomy. CSF flow at the level of foramen magnum is appropriate and stable.There is patchy T2 and FLAIR signal hyperintensity within the pons. This is unchanged since the prior exam.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is redemonstration of a small right paramedian disc protrusion at the T11-T12 level which is stable compared to prior exam. There is a Schmorl's node present at T11-T12.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a well-circumscribed lesion present within the L3 vertebral body which is bright on T1 and suppresses on the inversion recovery images which most likely represents a vertebral body hemangioma. It is stable compared to the prior exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "1.The patient is status post Chiari I decompression.2.There is no evidence for syrinx or ventriculomegaly.3.There are mild degenerative changes present in the lower thoracic spine. These are stable compared to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: History of ovary and cancer with brain metastases. Status post resection and cavity SRS. Interval evaluation. Signs and symptoms: As above. Pre-and post-enhanced brain MRI: No diffusion weighted abnormalities.Significant interval improvement in postoperative changes of left parietal tumor resection.There is also decrease in edema surrounding the surgical cavity since prior exam. A collapsed surgical cavity containing blood product and minimal fluid measures at approximately 6.6 x 18-mm. It demonstrate thin linear loculated internal enhancement. The measurements of the enhancement are at 12 times 22.6-mm. The measurements of the enhancing lesion on sagittal post enhanced (series 1203) on image 60 are at 19 x 22 mm.There is no detectable new foci of parenchymal signal abnormality or abnormal enhancement or parenchymal/leptomeninges.New since prior exam is a small left frontal and parietal subdural collection measuring approximately 5.9 mm in the frontal and approximately 3 mm in parietal region.", "output": "1.Significant interval improvement of postoperative changes of tumor resection of left parietal lobe.2.Interval significant decreased size of the surgical cavity which demonstrate thin linear loculated enhancement as detailed/measured above.3.New since prior exam is a thin left frontal and parietal subdural collection measuring approximately 5.9 mm in frontal and 3mm in parietal."}
{"instruction": "Generate impression based on findings.", "input": "SCLC treated with 6 cycles chemotherapy. There is a well-circumscribed, diffusely enhancing pineal lesion measuring up to 8 mm in diameter, which is not significantly changed from the prior exam. There is minimal cerebral white matter T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. There is otherwise no intracranial hemorrhage or 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": "1. Stable appearing enhancing pineal mass, which may represent a lung cancer metastasis versus a primary pineal tumor. No new intracranial enhancing lesions are identified.2. Minimal non-specific cerebral white-matter T2 hyperintensity suggestive of chronic microvascular ischemia.3. No evidence of intracranial hemorrhage or acute infarct."}
{"instruction": "Generate impression based on findings.", "input": "Female, 52 years old, with bilateral arm weakness and pain. With lumbosacral spondylosis and myelopathy. Cervical:Straightening of the cervical lordosis is seen. Vertebral body heights are preserved. Mild scattered degenerative endplate signal alteration is evident. No worrisome marrow signal abnormality or evidence of marrow edema is seen.The visualized spinal cord demonstrates normal caliber, morphology and signal characteristics. No epidural collections are seen.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis.C5-6: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Incidental noted is made of a cystic space in the left insula/basal ganglia. A partially empty sella is also demonstrated.Lumbar:Spinal alignment is anatomic. Vertebral body heights are preserved. No concerning marrow signal abnormality is detected.Visualized spinal cord, conus and cauda equina are within normal limits. No epidural collections are suspected.T11-12: Mild endplate degenerative signal abnormality. No spinal canal or foraminal stenosis.T12-L1: Unremarkable.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Facet hypertrophy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L4-5: Facet hypertrophy with a small effusion on the right. Ligamentum flavum thickening. Disc bulging. Mild spinal canal narrowing without nerve root crowding. Mild bilateral foraminal narrowing. L5-S1: Facet hypertrophy. Small right foraminal disc protrusion. No significant spinal canal or foraminal stenosis.", "output": "1.Mild degenerative disc findings in the cervical spine without significant canal stenosis or foraminal narrowing.2.Mild degenerative findings in the lower lumbar spine. This results in a mild generalized spinal canal stenosis and mild bilateral foraminal narrowing at L4-5."}
{"instruction": "Generate impression based on findings.", "input": "Reason: knee pain History: pain MENISCI: There is increased signal within the lateral meniscus indicating intrasubstance degeneration. Horizontally oriented signal within the lateral meniscus extends to both the femoral and tibial articular surfaces suggesting degenerative horizontal tears. There is also thinning of the free edge of the posterior horn of the lateral meniscus likely representing additional chronic attritional tearing. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Residual red marrow within the distal femur, proximal tibia and fibular head may reflect changes secondary to the patient's anemia. Small cysts are seen posteriorly within the intercondylar eminence of the tibia.LIGAMENTS: There is a tiny focus of cartilage degeneration along the posterior aspect of the medial femoral condyle but we see no fluid-filled defects. There is also mild degeneration of the articular cartilage of the lateral tibial plateau with mild degenerative signal abnormality in the underlying subchondral bone. EXTENSOR MECHANISM: There is edema within the subcutaneous fat anterior to the patella and proximal tibia.ADDITIONAL", "output": "1. Degeneration and degenerative tearing of the lateral meniscus.2. Mild osteoarthritis.3. Nonspecific soft tissue edema anteriorly and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 63 years old, with breakthrough seizures and bilateral spasticity due to prior intracranial hemorrhage, ischemic stroke and microhemorrhages. An 8 mm mildly diffusion restricting lesion is seen within the left corona radiata. A larger region of mild restricted diffusion, spanning approximately 2 cm, is seen in the anterior medial right occipital lobe.Extensive patchy and focal areas of T2 hyperintensity are seen within the cerebral hemispheres and the cerebellum with a distribution which is overall similar to the prior examination. Very mild local edema is seen in the anterior medial right occipital lobe. Otherwise, no significant mass effect is detected.No evidence of acute intracranial hemorrhage is seen. Numerous scattered punctate foci of susceptibility are seen throughout the brain compatible with chronic microhemorrhage appearing similar to prior. A more extensive region of hemosiderin staining along the right thalamic contour may relate to a prior hemorrhagic lesion. Ventricular size and contour are unchanged.", "output": "1.An area of late acute or subacute right PCA distribution ischemia is seen involving the anterior medial occipital lobe.2.A late acute or subacute small vessel ischemic stroke is evident in the left corona radiata.3.Evidence of extensive prior ischemia with scattered microhemorrhage is grossly unchanged."}
{"instruction": "Generate impression based on findings.", "input": "48 year old female for breast cancer screening. History of left excisional biopsy 7/2009 for benign papilloma. Family history of breast cancer diagnosed in mother age 49. There is extreme amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.Again seen are stable multiple bilateral enhancing masses and foci, including two reference mid 10 o'clock and anterior 4 o'clock left breast enhancing lesions. Multiple bilateral small cysts are also stable. No new or suspicious abnormal enhancement 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": "Other symptoms and signs involving cognitive functions and awareness [R41.89], Reason for Study: ^Reason: ICH History: ICH Brain MRIThere is ventricular shape right basal ganglia ICH (18.1 mm: RL x 20.8 mm: AP x 23.6 mm: CC) with the surrounding edema and minimal mass effect toward the right lateral ventricle. On gradient echo images, there are multifocal round susceptibility lesions on bilateral basal ganglia, bilateral thalami bilateral parietal lobe and temporal lobes which may indicate chronic petechial hemorrhage lesions.There is also linear shape susceptibility lesion on the left external capsule indicating chronic hemorrhagic lesion with focal encephalomalacia.There is no evidence of acute ischemic lesion.Underlying brain shows scattered patchy FLAIR high signal intensity lesions on bilateral periventricular white matter indicating non specific small vessel ischemic disease.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.", "output": "1. Acute ICH at the right basal ganglia, posterior aspect of the putamen with surrounding edema with minimal mass effects toward right lateral ventricle.2. Multifocal brain parenchymal chronic hemorrhagic lesions (hemosiderin deposition) including left external capsule lesion as described above.3. Non specific small vessel ischemic disease.4. No evidence of acute ischemic lesion.5. Normal brain MRA. "}
{"instruction": "Generate impression based on findings.", "input": "Pain in right shoulder Mild osteoarthritic changes with minimal narrowing and sclerosis. Small osteophytes. Questionable mild flattening of the humeral head is demonstrated. Correlation with the opposite shoulder or even MRI may be helpful if early AVN is a consideration. Similar mild changes of AC joint are also observed with associated possible widening. Dissociation cannot be excluded and weighted views following physical exam and correlation may be indicated.", "output": "Mild osteoarthritis with minimal flattening of the humeral head shape raising concern for early AVN. Please see detail provided"}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Multiple sclerosis. Please perform dedicated multiple sclerosis protocol (Dr.Javed). Signs and symptoms: Tremor, fatigue and paresthesia. Pre and post enhanced brain MRI:There are no prior exams for comparison.Examination demonstrates normal anatomical development, morphology and signal intensity of brain parenchyma on all acquired MRI sequences. There is no finding to suggest demyelinating disease. Post contrast images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.", "output": "Negative pre and post enhanced brain MRI utilizing dedicated multiple sclerosis protocol."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Hx of urinary retention with known adnexal mass. Also with urethral lesions on cystoscopy. Eval for urethral mass. History: As above Please note that postcontrast images were not obtained due to low GFR.PELVIS:UTERUS, ADNEXA: Fat containing right adnexal lesion measures 4.6 x 3.5 cm in transverse dimension and 5.1 cm in craniocaudal dimension (601/30, 901/26), similar in size to the prior CT. Small nabothian cysts.BLADDER:There is been interval placement of a Foley catheter and decompression of the bladder. The kidneys are not visualized, however there is decreased ureteral dilatation compared to the prior CT.There is significant dilatation of the urethra with lobulated periurethral increased T2 signal measuring approximately 3.8 x 4.1 cm in transverse dimension (701/17) and 3.0 cm and craniocaudal dimension, possibly fluid. This abnormal signal extends from the proximal urethra inferiorly. There is a fistulous communication with the mid to lower vagina, which contains a small amount of fluid.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Significant urethral dilatation with lobulated periurethral increased T2 signal which is of uncertain etiology, neoplasm cannot be excluded. Postcontrast images were not obtained due to low GFR.2.There is fistulous communication between the anterior vagina and urethra."}
{"instruction": "Generate impression based on findings.", "input": "Male, 79 years old, with neck pain and radiculopathy. The normal cervical lordosis is mildly reversed. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen.Except as discussed below, the visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected. Multiple bilateral perineural root sleeve cysts are seen within the neural foramina in the lower cervical spine.C2-3: Mild facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Mild to moderate generalized spinal canal stenosis with slight deformation of the spinal cord but no cord signal abnormality. Mild left foraminal narrowing. C4-5: Facet hypertrophy. No significant spinal canal stenosis. No significant foraminal narrowing. C5-6: Mild posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis with slight flattening of the ventral cord but no cord signal abnormality. Mild bilateral foraminal narrowing. C6-7: No significant spinal canal or neuroforaminal stenosis. C7-T1: No significant spinal canal or neuroforaminal stenosis.", "output": "Multilevel degenerative findings are seen, most notably at C3-4 where there is a mild to moderate generalized spinal canal stenosis, and at C5-6 where there is a mild generalized spinal canal stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Toe nodule Within the interspace between the first and second toes at the level of the first proximal phalanx is a lobulated soft tissue lesion measuring approximately 3 x 1.4 x 2.9 cm in the greatest AP, transverse, and craniocaudal dimensions. This lesion abuts the surface of the proximal phalanx however there are no discrete osseous changes. This does not appear to arise from the joint space although this is unclear. Following contrast administration, there is thin multilobulated peripheral enhancement without discrete solid focus. There is associated soft tissue edema and fluid surrounding the lesion within the interspace and along the dorsum of the head of the proximal phalanx. No additional lesions are identified. There is mild subcutaneous edema of the foot particularly dorsally along the heads of the proximal phalanges but also within the plantar soft tissues. The remaining bone marrow signal is normal. Osteoarthritis affects the first MTP joint. There is a mild amount of fluid signal surrounding the flexor hallucis longus tendon.", "output": "Nonspecific multilobulated cystic lesion within the interspace of the first and second toes demonstrating thin peripheral enhancement without discrete solid focus."}
{"instruction": "Generate impression based on findings.", "input": "60 years Male (DOB:3/9/1956)Reason: hx brain cyst by CT. Eval cyst or abnormality History: none- surveillance post CTPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is a cystic lesion present within the posterior aspect of the lumen are positive. This splays the internal cerebral veins and displaced the vein of Galen. It measures approximately 21 x 23 x 22 mm in size. It follows spinal fluid on all pulse sequences including diffusion. There is no associated contrast enhancement. This was also present on the CT from 8/16/2016 and is unchanged in sizeNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst along the superior aspect of the left maxillary sinus. This mucous retention cyst is associated with hyperdense appearance on CT and a central hypointense appearance on T2 with a mildly hyperintense appearance on T1. This most likely represents some inspissated secretions.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Arachnoid cyst within the velum interpositum.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "new daily headache, prior surgical clipping of the right PICA aneurysm. No evidence of acute ischemic or hemorrhagic lesion on this scan.There is prior ventriculostomy tube track through the right frontal lobe.Significant metallic artifacts on the distal right vertebral artery area indicating prior surgical clip related artifacts. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.The right maxillary sinus shows fluid collection.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the distal right VA, thus evaluation of the prior surgical clip area cannot be evaluated.Otherwise, normal ICAs, MCAs and ACAs. Left VA and basilar artery appear to be normal.", "output": "1. No evidence of new ischemic or hemorrhagic lesion.2. Evaluation of the distal right VA is not possible due to metallic artifacts.3. Otherwise no evidence of intracranial arterial aneurysm or arterial luminal stenosis or irregularity on this MRA.4. Opacification of the right maxillary sinus. "}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status. Gait abnormalities. Question CVA. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is strong clinical concern for an acute stroke, an MRI may be considered for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift. Vascular calcification is noted of the intracranial carotid arteries.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": "Small vessel ischemic disease, age indeterminate. If there is strong clinical concern for acute stroke, an MRI may be considered for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Back pain, trauma and 2010, Limited evaluation of the cervical spine on the scout sagittal T1 sequence unremarkable.Thoracic: Vertebral body heights in the thoracic spine are normal. Alignment is normal. Bone marrow signal is within normal limits. There is no significant disk disease, spinal canal, or neural foramina stenosis within the thoracic spine. Thoracic cord is normal in signal and contour.Lumbar:For the purposes of numbering, there are 5 lumbar type vertebral bodies. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L5 on S1. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the T12-L1 level.Mild multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disk desiccation and minimal bulge. Mild right neural foraminal stenosis. No significant spinal canal or left neural foraminal narrowing. L3-L4: There is an annular fissure and small right foraminal disk protrusion. There is mild to moderate narrowing of the right neural foramina and contact of the right exiting L3 nerve root. No significant spinal canal or left neural foraminal stenosis.L4-L5: Minimal disk bulge. No significant spinal canal or neural foraminal stenosis.L5-S1: Minimal disk bulge. Mild anterolisthesis. There is mild right and mild to moderate left neural foraminal stenosis. The left foraminal disc contacts the left L5 nerve root. No spinal canal stenosis. Mild fluid distention involving the posterior elements on the right. Possible pars defect can be better evaluated with CT or oblique radiographs.Paraspinous soft tissues are within normal limits.", "output": "1. No significant disk disease, spinal canal, or neural foramina stenosis in the thoracic spine. No compression fractures in the thoracic or lumbar spine.2. Mild anterolisthesis of L5 on S1. There is mild right and mild to moderate left neural foramina stenosis at L5-S1. May consider oblique lumbar radiographs or CT for evaluation of possible L5 pars defect.3. Mild degenerative changes at additional levels as detailed above with associated mild to moderate right L3-L4 and mild right L2-L3 neural foraminal narrowing."}
{"instruction": "Generate impression based on findings.", "input": "Right intranasal mass asses for intracranial invasion: right nasal congestion. There is a lobulated and heterogeneous mass within the right nasal cavity that measures up to 55 mm in length. There is mucosal thickening and fluid in the right maxillary and ethmoid sinuses, as well as mucosal thickening in the right frontal sinus, a left maxillary sinus retention cyst, and fluid in the bilateral sphenoid sinuses. There is deviation of the nasal septum to the left. There are secretions in the nasopharynx. There are bilateral lens implants. There is a chronic lacunar infarct in the right basal ganglia and scattered foci of nonspecific cerebral white matter T2 hyperintensity.", "output": "1. Preoperative planning MRI demonstrates a mass centered in the right nasal cavity with superimposed obstructed sinonasal inflammatory disease, likely both acute and chronic.2. Chronic lacunar infarct in the right basal ganglia"}
{"instruction": "Generate impression based on findings.", "input": "Reason: Pancreatic cyst surveillance surveillance plus family history History: history [prostate CA ) ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. No intra or extrahepatic biliary ductal dilatation. Gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: There is a 9 mm cystic lesion in the pancreatic body which may represent a branch type I p.m. and.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Small 9 mm pancreatic body lesion may represent a branch type IPMN."}
{"instruction": "Generate impression based on findings.", "input": "Right-sided pulsatile tinnitus. Brain:There is no evidence of acute infarct or intracranial hemorrhage. There is a 12 mm T2/FLAIR-hyperintense lesion involving the deep right parietal white-matter which is nonspecific and may reflect sequela of previous ischemia or inflammation/infection. Smaller T2/FLAIR-hyperintense lesions are present in the periventricular frontal white-matter and most probably reflect mild chronic microvascular ischemia. There is no midline shift or brain herniation.There is trace mucosal thickening in the paranasal sinuses. The skull is mildly diffusely thickened but without a focal lesion. There is a partially empty sella which is incidentally noted and a normal variant.While this study is not optimized for internal auditory canal assessment, there is no obvious mass in the cerebellopontine angles or internal auditory canals. There is also no gross vascular abnormality in the region.Cranial MRA:There is no flow-limiting intracranial arterial stenosis or aneurysm. Partially azygos A2 segments incidentally noted which is a normal variant. The posterior cerebral arteries are fetal-type in origin, which is also a common normal variation. There is an symmetric venous structure in the region of the right condylar canal which drains into the internal jugular vein. It has a flow-related signal that is higher than the adjacent right transverse sinus/internal jugular vein but lower than the arteries. This is of uncertain significance but may reflect an early draining vein if there is an underlying arteriovenous fistula.", "output": "1.There is no acute infarct or intracranial hemorrhage. Mild changes of chronic microvascular ischemia.2.Right parietal white-matter lesion is nonspecific but may reflect sequela of previous ischemia or infection/inflammation. 3.There is an asymmetrically prominent emissary vein in the region of the right condylar canal draining into the jugular vein as described above. This finding is of uncertain significance but raises possibility of early draining vein in the setting of a dural arteriovenous fistula. "}
{"instruction": "Generate impression based on findings.", "input": "Difficulty walking, limited range of motion. Patient also has history of lumbar stenosis. Cervical: Examination is slightly motion degraded. Vertebral body heights in the cervical spine are normal. There is exaggeration of the normal cervical lordosis from C2 to C4 and and mild anterolisthesis of C3 on C4 and C4 and C5. There is mild to moderate spinal canal stenosis at C3-C4 with effacement of the ventral and dorsal thecal sac. No cord signal abnormality seen. Osseous fusion involving the posterior elements at C2-C3 and C4-C5 on the left which is likely on a degenerative basis.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant spinal canal stenosis. There is moderate left neural foramina stenosis related to uncovertebral hypertrophy and facet arthropathy. No significant right neural foramina stenosis.C3-4: There is mild anterolisthesis and small central disk protrusion. There is mild ligamentum flavum thickening dorsally. There is mild to moderate spinal canal stenosis with effacement of the ventral and dorsal thecal sac at this level. There is moderate to severe left neural foraminal narrowing related to left-sided facet arthropathy and uncovertebral hypertrophy. There is mild distention of the left facet joint. No cord signal abnormality.C4-5: No significant spinal stenosis. There is intervertebral disk calcification better seen on CT. There is severe left foraminal stenosis. No significant right foraminal narrowing.C5-6: No significant compromise to the spinal canal or right neural foraminal narrowing. There is moderate left neural foraminal stenosis.C6-7: Small disk osteophyte complex with mild spinal canal stenosis. There is mild to moderate left neural foramina narrowing and minimal right neural foramina narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.Right vertebral artery flow void is diminished which may be related to proximal stenosis. Paraspinous soft tissue structures appear within normal limits.Lumbar:There are 5 lumbar type vertebral bodies. Severe multilevel degenerative changes are again seen which are similar to prior, with prior exam limited by motion degradation. Mild endplate compression deformities of L2 and L3. Severe (approximately 50%) loss of vertebral body heights at L4. There is no associated increased T2 signal to indicate a recent compression fracture. No interval also vertebral body height compared to 8/20/2014. There is grade 1 retrolisthesis of L2 on L3. Facet arthropathy affects the entirety of the lumbar spine and is most severe at L4-5. Note is made of fatty atrophy of the lower lumbar paraspinal muscles. The bone marrow is diffusely heterogeneous. The conus medullaris terminates at the L1 level. There is mild apparent clumped appearance of the nerve roots at multiple levels which is likely related to extrinsic canal stenosis.T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: Diffuse disk bulge asymmetric to the right. Minimal left and moderate right neuroforaminal stenosis. No spinal canal stenosis.L2-L3: Diffuse disk bulge with a central disk protrusion that in conjunction with ligamenta flava thickening creates moderate spinal canal stenosis. Moderate left and severe right neuroforaminal stenosis.L3-L4: Mild disk bulge and thickening of the ligamentum flavum. Mild to moderate spinal canal, mild left neuroforaminal stenosis, and mild to moderate right neuroforaminal stenosis. L4-L5: Diffuse disk bulge and ligamentum flavum thickening creates mild spinal canal and mild to moderate bilateral neuroforaminal narrowing.L5-S1: Central disk protrusion. No significant spinal canal stenosis. Minimal bilateral neural foraminal narrowing.There is mild atrophy involving the paraspinous musculature. Paraspinous soft tissues are otherwise unremarkable.", "output": "1. Multilevel degenerative changes in the cervical spine relatively worse at C3-C4 signal changes effacement of the ventral and dorsal thecal sac and mild to moderate spinal canal stenosis. No cord signal abnormality. There is mild anterolisthesis at this level. Prominent facet arthropathy and osseous fusion on the left at C2-C3 and C4-C5 are better seen on recent CT.2. There is multilevel neural foraminal narrowing at multiple levels particularly on the left as detailed above and better assessed on CT from 8/20/2014.3. Degenerative changes affect the lumbar spine most notably at L2-3 and L3-4 where there is up to moderate spinal canal stenosis. There is severe right L2-3 neuroforaminal stenosis. No significant change since 8/20/2014.4. Multiple chronic-appearing compression deformities in the lumbar spine. No interval loss of height compared to 8/20/2014 or bone marrow edema."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with a history of mycobacterium infection in the right wrist now clinically worse with increased edema, erythema, reevaluate infection. Presents with right wrist pain. Evaluation is limited due to the small area of coverage as well as poor fat suppression on the fluid sensitive sequences and poor T1 weighting. Again seen is an enhancing intramedullary mass in the distal ulna extending from the articular surface into the distal diaphysis, off of the field of view of this study, compatible with the stated history of mycobacterium infection. The infection extends through the volar cortex of the distal end of the ulna into the soft tissues forming a collection volar to the ulnar margin of the pronator quadratus. Additional foci of cortical penetration and soft tissue extension are noted both volarly and dorsally along the distal ulnar metadiaphysis. Please note that the proximal extent of this lesion is not included on the field-of-view of this study. There is additional enhancement and edema of the soft tissues surrounding the ulna, indicating inflammation. There is mild enhancement of the distal radioulnar and radiocarpal articulations indicating synovitis. Please note that we cannot exclude the possibility of a septic arthritis. There is mild enhancement of the radial styloid which may represent infection or reactive edema. There is enhancement within the medial margin of the triquetrum which may represent an erosion, although this was present on the prior study. There also appears to be mild enhancement of the midcarpal joint. Also again seen is abnormal signal intensity within the base of the third metacarpal, however, on the current study we see this signal abnormality and enhancement extend into the distal diaphysis of the third metacarpal where it penetrates the volar and medial cortex, extending into the soft tissues between the third and fourth metacarpals and deep to the flexor tendons of the middle finger.", "output": "1. Osteomyelitis of the distal ulna with extension into the surrounding soft tissues.2. Osteomyelitis of the third metacarpal with extension into the soft tissues between the third and fourth metacarpals deep to the flexor tendons of the third finger.3. Please note that the full extent of the infection is not included on the field-of-view on this study. The patient may return for additional imaging of the forearm and hand if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old male history of left parietal temporal lobe grade normal excised in 2003. Very poor quality exam due to extensive motion artifacts. Large area of encephalomalacia in the left posterior temporal with ex vacuo dilatation of the left lateral ventricle is again demonstrated with no interval change. Focal area of encephalomalacia in the right frontal lobe along its inferior aspect is again identified and with no interval change. Large left parietal craniotomy is again noted. Considering provided clinical history of malignancy an MRI examination of brain is recommended.No evidence of hemorrhage, edema, midline shift, hydrocephalus is detected. Punctate calcification within the thalamus on the left remains a stable.", "output": "No definite evidence of new finding since prior study of 2003."}
{"instruction": "Generate impression based on findings.", "input": "53 year old female with sjogren's, diabetes, hypertension and known coronary artery disease with history of chronic total occlusion of right coronary artery (s/p PCI 12/2015) presenting for evaluation post interventionMEDICATIONS: aspirin, atorvastatin, bumetanide, carvedilol, lisinopril, clopidogrel, ranolazine, spironolactone First Pass PerfusionDuring hyperemia, there is a perfusion defect (\"ischemia\") in the RCA territory, specifically there are perfusion defects in mid to basal inferior and inferolateral walls. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), the LVEDV is 185 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 74 ml (normal range 31+/-10), the LV mass index is 29 g/m2, and the LV mass is 60 g. There is basal to mid inferior and possibly inferolateral hypokinesis. Native T1 time approximately 1110 ms (LV cavity 1550 ms). There is diffuse late gadolinium enhancement noted in the subendocardial and mid myocardial region isolated to the inferior wall suggesting myocardial infarction, fibrosis, inflammation, or infiltration. This was seen on previous CMR in 2014, however it appears similar to slightly improved. This specific area is likely to be viable along with the remaining myocardium. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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. During hyperemia, there is a perfusion defect (\"ischemia\") in the RCA territory, specifically there are perfusion defects in the mid to basal inferior and inferolateral walls. 2. There is diffuse late gadolinium enhancement noted in the subendocardial and mid myocardial region isolated to the inferior wall suggesting myocardial infarction, fibrosis, inflammation, or infiltration. This was seen on previous CMR in 2014, however it appears similar to slightly improved. This specific area is likely to be viable along with the remaining myocardium. 3. Normal LV size and systolic function (LVEF 60%).4. Normal RV size and systolic function (RVEF 64%)."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with medial joint line pain. Evaluate meniscus. MENISCI: There is branching signal abnormality within the body of the medial meniscus, indicating a complex tear with a displaced flap of meniscus within the medial gutter beneath the body of the meniscus. There is globular increased signal which extends from the body into the posterior horn of the medial meniscus representing intrasubstance degeneration. The signal also extends to the femoral articular surface, indicating additional degenerative tearing. There is also intrasubstance degeneration within the anterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness degeneration of the articular cartilage along the medial facet of the patella with relative sparing of the articular cartilage along the lateral facet. There are small patellofemoral osteophytes. There is full-thickness cartilage loss along the weightbearing portion of the medial femoral condyle and near full-thickness cartilage degeneration along the weightbearing portion of the medial tibial plateau. There is mild subchondral edema type signal within the medial aspect of the medial tibial plateau and medial femoral condyle, which is likely degenerative in etiology. The articular cartilage in the lateral compartment is relatively preserved. There are small medial compartment osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL", "output": "1. Complex tear of the medial meniscus with displacement of meniscal tissue into the medial gutter as described above.2. Osteoarthritis of the knee.3. Baker's cyst."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic lung ca, with a possible L2 lesion. There is a 12 mm wide superior endplate intravertebral disc herniation at L2 with associated mild bone marrow enhancement. There is also vacuum phenomenon in the posteroinferior L2 vertebral body. Otherwise, there is no evidence of metastatic disease in the lumbar spine. There is multilevel degenerative spondylosis with up to mild spinal canal and neural foraminal stenosis at L2 through S1. The vertebral body heights are preserved and the lumbar spine alignment is anatomic. The imaged portions of the spinal cord are unremarkable. There is a partially-imaged left adrenal mass.", "output": "1. Superior endplate intravertebral disc herniation at L2 with associated mild reactive bone marrow changes in the setting of multilevel degenerative spondylosis, but no evidence of metastases involving the lumbar spine.2. Partially-imaged left adrenal mass. Please refer to the recent body CT report for additional details."}
{"instruction": "Generate impression based on findings.", "input": " There is susceptibility artifact related to patient's partial dentures which limits assessment of the right inferior frontal lobe on the diffusion-weighted sequence. There is however no evidence of acute ischemia. There are patchy foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate chronic small vessel ischemic disease. These changes are minimally worse since prior with, for example, interval increased T2 signal noted in the left parietal periventricular white matter.No intracranial mass or mass effect. Punctate focus of susceptibility consistent with chronic microhemorrhage in the left thalamus is again seen. The ventricles and sulci are within normal limits for patient's advanced age. Posterior fossa structures are grossly unremarkable. No extra-axial fluid collection is identified. Calvarium and extracranial soft tissues are grossly unremarkable.MRA HEAD", "output": "1. No evidence of acute infarct. Moderate chronic small vessel ischemic disease which is minimally worse since 3/24/2015. Brain parenchyma is otherwise unremarkable for age.2. No significant stenosis in the intracranial vasculature.3. 1 to 2 mm aneurysms involving the right A1-A2 junction and the right P1 segment. These findings are grossly unchanged since 3/24/2015."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 64 yo with biliary dilation noted on MRI History: abd pain ABDOMEN:LIVER, BILIARY TRACT: There is dilatation of the common bile duct to the level of the ampulla measuring up to 1 cm, similar to the prior exam. Soft tissue prominence at the ampulla is unchanged. Severe intrahepatic biliary ductal dilatation is unchanged. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintensities, likely 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": "Dilatation of the common bile duct to 1 cm and severe intrahepatic biliary ductal dilatation is stable. There is soft tissue prominence at the ampulla which is also unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Female, 72 years old, with history of cervical chordoma status post treatment with proton radiotherapy, under good control, but with recent neurologic decline including frequent falls and left-sided weakness and proximal lower extremity weakness. Status post C2-C7 decompression and fusion. Assess for ischemia, postoperative changes. Sequelae of recent laminectomy from C2 through C6 are demonstrated. Posterior fusion instruments have also been placed from C2 to C7. As a result of the procedure, the previously seen cervical spinal canal stenosis has been relieved and the progressive kyphotic angulation of the spine has improved. A small amount of fluid is evident within the posterior soft tissues along the dura at C2 and C3. A surgical drain is evident in the operative bed.The marrow space of the cervical spine shows diffuse fatty infiltration compatible with prior radiation therapy. Superimposed on this is marrow replacement involving C3, C4, and C5, with small foci in the remaining vertebral bodies extending down to T1.As above, the spinal canal has been well decompressed and the spinal cord is no longer frankly impinged by disc osteophyte disease. However, extensive central cord T2 hyperintensity spanning from the obex down to the upper thoracic region has not significantly changed from the recent prior exam.C2-3: Spinal canal decompression. No significant foraminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Moderate to severe foraminal narrowing. Spinal canal decompression. Note is made of a cystic lesion which appears to protrude into the paraspinal soft tissues from the right neural foramen which may represent a perineural root sleeve cyst, unchanged from prior.C4-5: Posterior disc-osteophyte complex formation. Moderate to severe foraminal narrowing. Spinal canal decompression. C5-6: Posterior disc-osteophyte complex formation. Moderate bilateral foraminal narrowing. Spinal canal decompression. C6-7: Posterior disc-osteophyte complex formation. Moderate bilateral foraminal narrowing. Spinal canal decompression. C7-T1: Posterior disc-osteophyte complex formation. Mild bilateral foraminal narrowing. No significant spinal canal stenosis.", "output": "1.Sequelae of extensive cervical spine laminectomy and posterior instrumented fusion. Previously seen spinal canal stenosis has been relieved, and the progressive cervical kyphosis has been partially corrected.2.The spinal canal is now well decompressed and no areas of spinal cord impingement are seen. However, extensive central cord T2 signal abnormality persists, similar to the prior examination, extending from the obex down to the thoracic region. The differential for this finding would include cord ischemia with or without a component of compressive myelopathy. Radiation related myelopathy would be less likely given the history of proton therapy, but correlation with radiation timing and treatment fields should be made to better judge this possibility. Additional inflammatory etiologies may also be considered as appropriate for the clinical history.3.On a background of prior radiation marrow change, patchy areas of marrow replacement persist from C3 through C5 predominantly, but with small foci in the remaining visualized cervical vertebral bodies. These lesions may reflect residual or treated chordoma."}
{"instruction": "Generate impression based on findings.", "input": "1 month of numbness/tingling pain on lateral/medial right thigh with decreased sensation noted on exam. Plain films show decreased vertebral body height of T7 tule out fracture verse infection of possible mass as cause of symptoms. There is irregularity along the superior and inferior endplates of the T7 vertebral body with slight loss of vertebral body and adjacent disc space heights, but no associated abnormal enhancement or edema. The vertebral body and disc space heights are otherwise preserved. The vertebral column alignment is within normal limits. There is no evidence of mass lesions. There is no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at the L1-2 level. The cauda equina nerve roots are unremarkable. The paravertebral soft tissues are unremarkable.", "output": "Irregularity along the superior and inferior endplates of the T7 vertebral body may represent incipient intravertebral disc herniation or may be post-traumatic in nature rather than an infectious or neoplastic process. "}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female patient with glioblastoma multiforme. Evaluate for GBM status post RT/TMZ/bev. 4 week Redemonstration of postsurgical changes related to a right parietotemporal craniotomy for partial tumor resection from the right temporal lobe. Again seen is extensive enhancement surrounding the resection cavity, with the area of thick enhancement appearing mildly increased particularly along the superior margins of the tumor within the right temporooccipital lobe and extending to the right splenium. However, there is significant interval decrease in surrounding abnormal T2 signal along with diffusion abnormality, predominantly within the superior aspect of the right temporal lobe and parietooccipital lobe. This results in decreased mass effect and midline shift which now measures approximately 4 mm, previously 13 mm. Right uncal herniation is improved. An additional satellite nodule along the lateral surface of the right lateral temporal lobe is unchanged. Prominent left temporal horn periventricular T2 signal is unchanged. Linear and nodular susceptibility artifact surrounding the resection cavity is not significantly changed.", "output": "1. Post-surgical changes in the right temporal lobe related to partial resection of known GBM. Compared to 5/1/2015, there is significant decrease in FLAIR hyperintensity/edema particularly superior to the enhancing lesion consistent with response to Avastin therapy. There is however some interval increase in thick enhancement particularly surrounding the trigone of the right lateral ventricle, which given recent radiation therapy may represent treatment change; close follow-up, however, is recommended. 2. Improvement in mass effect, midline shift, and right uncal herniation.3. Unchanged right lateral temporal lobe satellite lesion."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for changes in MRI (? Evolving CVA versus metastases). Signs and symptoms: Abnormal brain MRI. History of extra CNS breast cancer. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates interval resolution of hematoma in the left posterior temporal and parietal region with resultant resolution of subtle associated mass effect. There is resultant development of hemorrhagic encephalomalacia and with mineralization of overlapping cortex at this site. Mild interval increased size of left trigone of the lateral ventricle is also noted. There is no mild linear enhancement of the cortex at the site is present. Findings are consistent with a previously known hemorrhagic ischemic stroke and without no evidence of metastatic lesion of the brain parenchyma or the leptomeninges. Calvarium also demonstrates normal signal intensity without detectable abnormal enhancement.Diffuse periventricular and a left frontal cortical foci of FLAIR hyperintensity consistent with chronic small vessel ischemic strokes and a left frontal chronic cortical stroke remains similar to prior exam.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal signal intensity of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.", "output": "1.Interval complete resolution of left posterior temporal-parietal hemorrhage with resultant development of regional hemorrhagic encephalomalacia.2.No evidence of parenchymal, leptomeningeal or calvarial metastatic lesions.3.Negative diffusion weighted images extensive chronic small vessel ischemic strokes and chronic left frontal ischemic stroke."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Patient with large right renal mass concerning for extension into the IVC. Has new SOB and need MRI for surgical planning History: As above. ABDOMEN: Limited exam without the use of intravenous contrast.LUNG BASES: Bilateral small to moderate size pleural effusions, greater in the left. 1.1 x 1.2 cm left lower lobe pulmonary nodule (series 801 image 48) suspicious for metastases. Please see separately dictated MRI chest performed on the same day. Retrocrural lymph node measures 1.3 x 1.4 cm (series 801 image 32).LIVER, BILIARY TRACT: Several mildly T2 hyperintense intense, T1 hypointense lesions with restricted diffusion and ill-defined margins in the right lobe of the liver suspicious for metastases. The largest in segment 8 measures 2.0 x 1.9 cm (series 801 image 34). Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: In the expected location of the right adrenal gland, there is a 3.9 x 3.6 x 5.3 cm heterogeneous mass with restricted diffusion and signal characteristics similar to the separate right renal mass (series 801 image 31, series 701 image 22). The normal right adrenal gland is not visualized. The left adrenal gland is unremarkable.KIDNEYS, URETERS: In the right lower pole, there is a large heterogeneous mass with well-defined margins and restricted diffusion measuring 10.4 x 8.2 x 8.7 cm (series 801 image 16, series 701 image 22). There is extension of this mass into the left renal vein and IVC (series 801 image 23-28; series 701 image 14). The tumor extends superiorly just proximal to the level of the intrahepatic IVC and inferiorly to the level of L3. Moderate to severe left hydronephrosis that extends to the pelvis, outside the field of view. Nonspecific urothelial wall thickening of the proximal left ureter. RETROPERITONEUM, LYMPH NODES: Aortocaval lymph node measures 2.3 x 2.8 cm (series 801 image 21). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered perineural or synovial cysts. Focal T2 hyperintense, T1 hypointense lesion in the left L1 posterior vertebral body with extension into the pedicle suspicious for metastasis. OTHER: No significant abnormality noted.", "output": "1.Large right renal mass suspicious for renal cell carcinoma with extension into the right renal vein and IVC. 2.Retroperitoneal lymphadenopathy. 3.Probable hepatic, pulmonary, and osseous metastases.4.Moderate to severe left hydroureteronephrosis that extends into the pelvis. No obstructive lesion identified within the abdomen, although the pelvis is not imaged. Nonspecific proximal ureteral wall thickening. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 60 years old, with multiple sclerosis. Assess for progression. Given differences in imaging technique, there does not appear to be a substantial change in the size or number of T2 hyperintense lesions within the periventricular and juxtacortical white matter, and to a lesser extent the brainstem. As before, many of these lesions involve the corpus callosum or callososeptal interface and many are oriented radially with respect ventricles. Most correlate with moderate T1 hypointensity. No definite evidence of any new lesion is seen. Brain volume is preserved. No evidence of edema or mass effect is detected. Ventricular size and morphology remain within normal limits.", "output": "Numerous lesions are redemonstrated compatible with multiple sclerosis. No significant interval change in lesion size or number is suspected."}
{"instruction": "Generate impression based on findings.", "input": "Right knee pain MENISCI: Abnormal morphology and increased signal intensity of the posterior horn of the medial meniscus reflects complex tearing. There is increased signal within these anterior horn of the lateral meniscus which may reflect intrasubstance degeneration although no lateral meniscal tear is identified. ARTICULAR CARTILAGE AND BONE: Extensive full-thickness cartilage loss is noted within the medial femoral condyle and medial tibial plateau with associated reactive marrow change. Mild diffuse thinning of the lateral compartment articular cartilage is also noted.There is full-thickness cartilage loss of the articular surface of the lateral patellar facet with diffuse loss of the medial patellar facet. There is a full-thickness loss are also noted within the femoral trochlea, particularly medially and inferiorly.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL", "output": "1. Complex tear of the posterior horn of the medial meniscus.2. Severe articular cartilage loss of the patellofemoral and medial compartments.3. Joint effusion with possible prepatellar bursitis."}
{"instruction": "Generate impression based on findings.", "input": "72 years Female (DOB:10/23/1943)Reason: progression of WM lesions? History: gait decline history of multiple sclerosisPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON There is a moderate to marked degree of periventricular and subcortical T2 and FLAIR signal intensity lesions which were also present on the prior exam from 2012. Comparing the 2 exams a not changed substantially.There are punctate foci of T2 and FLAIR signal hyperintensity in the basal ganglia, thalami and brainstem which were also present on the prior exam and do not appear to have progressed significantly when compared.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There are multiple lesions in the brainstem and basal ganglia and thalami which are stable. Given the patient's clinical history of multiple sclerosis these could very well represent prior demyelinating plaques. Please note that the lacunar infarcts may have a similar appearance.2.There is a moderate to marked degree of periventricular and subcortical white matter lesions which were also present on the prior exam and have not changed significantly. Given patient's clinical history much of this may represent demyelination, however, vascular related lesions can have a similar appearance.3.There is no evidence for acute cerebral ischemic infarction.4.Examination is mildly degraded due to motion artifact which may obscure more subtle abnormalities."}
{"instruction": "Generate impression based on findings.", "input": " The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm. The right PCOM is larger than the left. There maybe a tiny fenestration within the ACOM.Focal cystic encephalomalacia is again noted in the left inferior parietal lobe laterally, just adjacent to the sylvian fissure.MRA NECK", "output": "1. Unremarkable MRA of the head, with redemonstration of left inferolateral parietal encephalomalacia.2. Limited MRA neck images with no gross abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Sarcoma No bony or soft tissue abnormalities visualized.", "output": "Normal radiographs of the radius and ulna."}
{"instruction": "Generate impression based on findings.", "input": "22 year old woman with history of possible PFO/ASD and PDA who presents with palpitations and dizziness. CMR done to further evaluate function and anatomy. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), the LVEDV is 118 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 47 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is evidence for a small closed muscular septal defect in the mid interventricular septum.There is a small region of midwall late gadolinium enhancement in the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. There is an atrial septal aneurysm present.ShuntThere is no clear evidence of an ASD. With the presence of an atrial septal aneurysm, the possibility of a small PFO cannot be ruled out. There is no evidence of a patent ductus arteriosis.The QP:QS is 1:1Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 74 ml/m2 (normal range 69+/-14), the RVEDV is 149 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 68 ml (normal range 35+/-13). 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 trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.There is no evidence of a patent ductus arteriosis.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 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. The left ventricle is normal in size and systolic function [LVEF 60%]2. The right ventricle is normal in size and systolic function[RVEF 54%]3. There is a small region of mid wall late gadolinium enhancement in the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. Healed muscular septal defect without other evidence for residual congenital heart disease.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 suprasellar mass with visual loss, try to identify where mass is originating from for possible neurosurgical intervention. There is a homogeneously enhancing, dural-based mass along the posterior planum sphenoidale with extension into the sella and underlying hyperostosis, which measures approximately 29 mm anteroposteriorly, 25 mm transversely, and 18 mm craniocaudally. The mass mildly indents the superior surface of the pituitary gland and the anterior surface of the infundibulum. There is no evidence of intrinsic pituitary lesions. In addition, the mass displaces the the prechiasmatic optic nerves laterally and abuts the optic chiasm and bilateral paraclinoid internal carotid arteries. There is a small patchy area of subcortical T2 hyperintensity in the posterior right gyrus rectus. There is mild diffuse periventricular white matter T2 hyperintensity, which is nonspecific, but may represent chronic small vessel ischemia. There are also small areas of encephalomalacia in the bilateral posterior occipital lobes, which may be the results of prior ischemia or trauma. There is no evidence of acute infarction. There is no midline shift or herniation. There is mild diffuse cerebral volume loss. Aside from hyperostosis along the sphenoid roofs, the paranasal sinuses are unremarkable. There is mild deviation of the anterior nasal septum to the left. There is prominence of the bilateral superior ophthalmic veins, which is nonspecific. There appears to be left frontal scalp scarring.", "output": "A dural-based planum sphenoidal mass with extension into the sella above the pituitary gland that measures up to 29 mm likely represents a meningioma. The mass mildly indents the superior surface of the pituitary gland and the anterior surface of the infundibulum, displaces the prechiasmatic optic nerves laterally and abuts the optic chiasm, and is associated with mild vasogenic edema in the posterior right gyrus rectus."}
{"instruction": "Generate impression based on findings.", "input": "History of anorectal squamous cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense restricting lesion in the right hepatic dome demonstrating peripheral enhancement and mild internal enhancement measures 3.7 x 3.1 cm (series 1501/48), compared to 1.8 x 1.6 cm previously (series 12001/5). No new lesion. No biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: See discussion below. Right adnexal T1 weighted hyperintense and T2 weighted hypointense 2.5 x 1.9 cm lesion without macroscopic fat likely represents an endometrioma, unchanged. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Between the right superior aspect of the vaginal cuff and the rectum there is a bilobed lesion measuring 3.4 x 2.4 cm (series 2 302/58) demonstrating peripheral thick walled enhancement, restricted diffusion and mild internal enhancement, significantly decreased in size from the prior outside MRI. There is mild tethering versus communication with the lateral aspect of the rectum. The adjacent lower rectum demonstrates circumferential wall thickening and hyperenhancement. A soft tissue component extends posterolaterally towards the right into the presacral space (series 2 302/72). Dorsally there is a 1.5 x 1.0 cm enhancing nodule which appears to be centered in the distal sacrum/coccyx (series 2 302/78).BONES, SOFT TISSUES: There is feathery T2 weighted hyperintensity of the lower pelvic musculature and mild enhancement without a discrete mass lesion, favoring myositis. No focal lesion corresponding to the FDG avid foci seen on PET/CT 10/24/16. OTHER: No significant abnormality noted.", "output": "1.Increasing size of the right hepatic dome lesion. No new liver lesion or other site of metastatic disease.2.The low rectal/anorectal mass is markedly decreased in size from the 6/18/2015 MRI with a residual bilobed centrally necrotic component in the rectouterine space. The disease is grossly similar to the PET/CT findings accounting for technical differences. 3.Right adnexal 2.5 cm lesion, unchanged from 06/18/2015, favor endometrioma given stability. "}
{"instruction": "Generate impression based on findings.", "input": " Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Vantin 200mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Vantin 200mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Vantin 200mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize left mid gland/base peripheral zone of the prostate at the site of the T2 hypointense enhancing lesions. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 4 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.", "output": "1. Successful core-biopsies of the left mid/base prostate gland peripheral zone lesion."}
{"instruction": "Generate impression based on findings.", "input": "Dorsalgia, unspecified [M54.9], Reason for Study: ^Reason: r/o mets History: back pain and radiculopathy For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level.The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: disc dessication, no neuroforaminal narrowing or spinal stenosis. L1-L2: disc dessication, minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L2-L3: disc dessication, minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L3-L4: disc dessication, there is focal obliteration of epidural fat at the left lateral recess indicating possible disc extrusion (series 6, image 23/39). L4-L5: disc dessication, diffuse bulging of disc with broad based disc protrusion toward central to right direction which abuts thecal sac. No spinal stenosis. Modic type 2 changes of L45 endplates.L5-S1: disc dessication, diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. Modic type 2 changes of L45 endplates.", "output": "1. Degenerative changes of lumbar spine.2. Focal disc extrusion at the level of L34 toward left lateral recess.3. Broad based disc protrusion at the level of L45."}
{"instruction": "Generate impression based on findings.", "input": "Male, 50 years old, with pain and weakness of the right arm. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is seen. No pathologic marrow enhancement is detected.The spinal cord demonstrates normal signal intensity and morphology throughout. No pathologic cord or leptomeningeal enhancement is seen. No epidural abnormalities are detected.C2-3: Unremarkable. C3-4: Right greater than left facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the left. No significant spinal canal stenosis. Mild right foraminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Mild left uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. C6-7: Disc osteophyte formation contributes to a mild spinal canal stenosis but no frank cord impingement. Mild bilateral foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis.", "output": "1.Relatively mild degenerative disease, most notably at C6-7 where there is a discussed osteophyte complex which causes a mild spinal canal stenosis. No high-grade spinal canal or foraminal stenosis is seen.2.No spinal cord abnormalities are detected. No evidence of any inflammatory process is seen."}
{"instruction": "Generate impression based on findings.", "input": "Lung cancer with metastasis. Status post radiation for cord compression. Presented with urinary retention. The vertebral column alignment is near-anatomic, aside from mild straightening of the cervical and lumbar lordosis. There are postoperative findings related to T4 and T5 partial corpectomy and posterior fixation hardware from T2 through T8, which created artifact that largely obscures the spinal canal from T2 through T3 and from T4 through T8. Otherwise, there are relatively small ventral and dorsal indentations of the thecal sac by degenerative disc-osteophyte complexes and ligamentum flavum thickening at C5-C6 and C6-C7. There is no abnormal spinal cord signal at these levels, as well as inferior to T8. There is interval increase in size of the T1 hypointense and T2 hyperintense sacral mass that markedly narrows the spinal canal and compresses the S1-S2 and S2-3 sacral foramina, especially on the left side. There is also increase in size of a T1 hypointense and T2 hyperintense lesion in the anterosuperior portion of the L3 vertebral body. There is an incompletely-imaged left thoracic soft tissue mass abutting the aortic arch.", "output": "1. Postoperative findings related to T4 and T5 partial corpectomy and posterior fixation hardware from T2 through T8, which produces artifact that largely obscures the spinal canal from T2 through T3 and from T4 through T8. 2. Mild indentation of the cervical spinal cord by disc-osteophyte complexes and thickened ligamentum flavum at multilevel level. Otherwise, assessment of the spinal canal in the mid thoracic region is limited by the artifact from the posterior fixation hardware. 3. Interval increase in size of the sacral metastasis with increased spinal canal and sacral foramina narrowing, especially on the left side. Please refer to the separate pelvis MRI report for additional details.4. Interval increase in size of a metastatic lesion in the anterosuperior L3 vertebral body. 5. The left thoracic soft tissue mass abutting the aortic arch is incompletely imaged."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Sudden syncopal episodes which patient experiences and has sudden episodes in which she falls asleep, often at the wheel. Known scleroderma.? CNS etiology for these episodes. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates patchy small varying sized confluent foci of FLAIR/T2 hyperintensity in the subcortical and periventricular white matter, minimally in bilateral basal ganglia and pons. Findings are nonspecific however in proper clinical setting could represent chronic small vessel ischemic strokes. Findings demonstrate no cortical susceptibility signal changes.There are no similar lesions within the corpus callosum, cerebellar peduncles or the cerebellum. Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces otherwise for stated age.A signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits and paranasal sinuses.", "output": "1.Negative diffusion-weighted images.2.Extensive patchy confluent FLAIR and T2 hyperintensity in periventricular and subcortical white matter and to a lesser degree in bilateral basal ganglia and pons as detailed. Findings are nonspecific however they likely representing chronic nonhemorrhagic small vessel ischemic strokes. There are no prior exams for comparison. To entirely exclude other white matter lesions follow-up with enhanced imaging is recommended.3.Unremarkable exam otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Diffuse large B-cell Lymphoma. Elevated transaminase and left acid dehydrogenase. Evaluate for cholestatic lesion amenable to ERCP stenting. Recent relapse with new diagnosis of metastatic lung cancer. Evaluation is limited by motion artifact on postcontrast series.ABDOMEN:LIVER, BILIARY TRACT: A numerable T2 hyperintense bilobar hepatic lesions are identified, probably secondary to lymphoma. There is abnormal enhancement within the left hepatic lobe, which may be due to a perfusion abnormality versus infiltrative disease. There is cut off of the proximal common bile duct (series 901, image 70). However the distal common bile duct is normal in caliber. No obstructing mass is identified.SPLEEN: No significant abnormality identified. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole renal cyst measures 2.2 x 2.1 cm, unchanged. The right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate to large left pleural effusion with adjacent atelectasis.", "output": "1.Scattered bilobar T2 hyperintense lesions and abnormal enhancement within the left hepatic lobe, suspicious for infiltrative disease.2.Large left pleural effusion with adjacent atelectasis.3.Cutoff of the proximal common bile duct, with no distal ductal dilatation. No obstructing mass is identified.Findings discussed with Dr. Thoburn at 4:30PM on January 22, 2016."}
{"instruction": "Generate impression based on findings.", "input": "11-year-old female with new onset seizures, hypodense area noted on outside hospital CT as well as abnormality University of Chicago stealth MRI performed last Friday. Redemonstrated is an ill-defined T2 hyperintense lesion primarily involving the right temporal lobe. The current diagnostic FLAIR technique better demonstrates its involvement of nearly the entire right temporal lobe as well as a portion of the immediately subjacent inferior right frontal lobe. As before abnormality is also noted in the posterior medial right thalamus. There is matching restricted diffusion with ADC hypointensity within these same regions. There is a also tiny focus of T2 hyperintensity involving the medial right frontal lobe gyrus, also with restricted diffusion and ADC hypointensity. Better defined by FLAIR technique is a very small focus of T2 hyperintensity within the anterior left temporal lobe just lateral to the temporal horn, which unfortunately lies in a region obscured on diffusion imaging secondary to skull base artifact. There is no susceptibility hypointensity to suggest the presence of hemorrhage. Also better defined by FLAIR technique is sulcal T2 hyperintensity, primarily involving right hemispheric sulci, which correlates with previously documented enhancement, with thickening of the right tentorium.", "output": "The constellation of abnormal MRI imaging features, superimposed on lesional locations (now also including the left temporal lobe), are most consistent with encephalitis/meningitis. Other inflammatory or neoplastic etiologies are felt to be less likely."}
{"instruction": "Generate impression based on findings.", "input": "47 year old woman with long QT and syncope, referred for further evaluation of underlying structural abnormalities and scar. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 42 g/m2 (normal range 67+/-11), and the LV mass is 79 g (normal range 114+/-24). There are no regional wall motion abnormalities present. The myocardial T1 time is borderline increased (1050-1100ms). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 136 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). No focal right ventricular wall motion abnormalities or aneurysms.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 trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a \"psuedo-bovine\" brachiocephalic branching pattern (normal variant). 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. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%. There are no regional wall motion abnormalities present. The native myocardial T1 relaxation times are borderline increased. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59% without MRI evidence of arrhythmogenic right ventricular cardiomyopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out leptomeningeal enhancement. Signs and symptoms: Cauda equina enhancement, gait problem. Pre and postcontrast enhanced lumbar MRI:Examination demonstrates mild diffuse uniform enhancement of cauda equina without definitive evidence of interval change since prior exam. There is no evidence of clumping of cauda equina and no detectable focal regions of thickening which is a similar observation is prior study. There is no detectable signal abnormality of the conus.Diffuse T1 hypointensity and T2 STIR hyperintensity with mild diffuse enhancement of all visualized bony structures remain similar to prior exam.Diffuse uniform marrow signal change (T1 hypointense, T2 and T2* hyperintense) and enhancement of vertebral body of T12 similar to prior examination without evidence of fracture or malalignment and suggestive of metastatic disease.Extensive degenerative changes of lumbar spine without significant interval progression. Mild to moderate central spinal stenosis at L2-L3 and L4-L5 levels remain very similar to prior exam. Also multilevel neural foraminal compromise some significantly demonstrate no definitive change.", "output": "1.No evidence of acute or convincing evidence of new finding since prior exam.2.Uniform diffuse enhancement of cauda equina without clumping or thickening of cauda equina similar to prior exam. This finding likely representing post treatment change considering its stable status since lumbar MRI exam from 2011. Correlation with CSF analysis is recommended.3.No detectable signal abnormality of the lower most visualized thoracic cord or the conus.4.Diffuse uniform marrow signal changes of the entire visualized bony structures with uniform mild enhancement likely representing posttreatment findings and without interval change.5.Increased T2 STIR signal intensity of T12 vertebra with uniform enhancement similar to prior exam and likely representing a stable metastatic lesion without interval change since prior exam.6.Stable extensive degenerative changes of lumbar spine with a spinal stenosis and neural foraminal compromise since prior study."}
{"instruction": "Generate impression based on findings.", "input": " MRI BRAIN: There is no diffusion abnormality. No intracranial mass or mass effect. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. There is developmental variant small left and nonvisualized right posterior communicating arteries. There is a small bulge from the origin of the left posterior communicating artery which is either infundibulum or artifact.MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.", "output": "1.No evidence of acute infarct or brain parenchymal abnormalities to explain the seizures.2.No abnormalities of the vasculature of the brain or neck."}
{"instruction": "Generate impression based on findings.", "input": " MRI:2 punctate foci of mild diffusion hyperintensity with corresponding iso- to mild hypointensity on ADC within the left frontal lobe (306/200 and 306/192) suspicious for subacute infarcts. There is also minimal associated T2 abnormality.Multiple scattered punctate foci of susceptibility bilaterally, most prominent in the left temporal and occipital regions, grossly similar in appearance, however, prior exam was limited by motion. New gyriform susceptibility artifact within the left frontal lobe with intrinsic T1 signal consistent with laminar necrosis in the area of prior infarct. Additional foci of prior infarcts now demonstrate expected encephalomalacia and resolved cytotoxic edema.Confluent areas of T2/FLAIR hyperintensity within the subcortical and periventricular white matter is again noted, consistent with chronic small vessel ischemic disease. Previous left temporal and occipital sulcal FLAIR hyperintensity, which is felt to be less likely artifactual given focality, is overall no longer appreciated on this exam. However there is minimal residual FLAIR hyperintensity along a left posterior temporal lobe sulcus. There is no mass effect. 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. Post-operative changes noted within the paranasal sinuses with fluid in the right mastoid. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA:Increased T1 signal is noted within the left caudate along the left frontal lobe area of cortical laminar necrosis, consistent with expected evolution of prior infarct.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The left vertebral artery is dominant. Mild focal narrowing of the left proximal P2 segment is noted. The basilar artery is normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.", "output": "1. 2 foci of mild diffusion restriction in the left frontal lobe suspicious for subacute infarcts. 2. Subtle residual FLAIR abnormality in a left posterior temporal lobe sulcus, with near complete resolution of previously seen more diffuse left temporal lobe FLAIR hyperintensity. Findings could relate to proteinaceous material or blood products. Consider post-contrast imaging for further evaluation.3. Expected evolution of prior infarcts, including cortical laminar necrosis and encephalomalacia within the left frontal lobe.4. Multiple scattered foci of susceptibility bilaterally appearing grossly similar in appearance to prior exam, overall peripheral in distribution and possibly relating to amyloid angiopathy.5. No evidence of flow-limiting stenosis or aneurysm. Mild left proximal P2 segment narrowing."}
{"instruction": "Generate impression based on findings.", "input": "Male, 58 years old, new diagnosis of adenocarcinoma, assess for metastases. A 6-mm nonenhancing focus of T2 signal abnormality is seen within the left frontal white matter. A few additional scattered punctate foci of T2 signal abnormality are evident elsewhere in the brain. None of these lesions is associated with any mass effect.No pathologic parenchymal or extra-axial enhancement is detected. No abnormal extra-axial fluid collections are seen. There is no evidence to suggest intracranial hemorrhage. The ventricular system is normal in size and morphology.", "output": "1.No evidence of intracranial metastases2.Scattered nonspecific white matter lesions are seen."}
{"instruction": "Generate impression based on findings.", "input": " There is a 2 x 7 x 3 mm mildly T2 hyperintense, T1 hypointense, slightly heterogenous lesion within the posterior aspect of the pituitary gland. The posterior pituitary bright spot is absent. The infundibulum is slightly deviated to the left. The pituitary and sella are small for age with the pituitary measuring only 3 mm in height. There is no evidence for a suprasellar mass. The optic chiasm, cavernous sinuses and intracranial portions of the optic nerves are normal in appearance.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is moderate global volume loss. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is fluid and mucosal thickening throughout the paranasal sinuses and mastoid air cells.", "output": "1.Posterior pituitary lesion that may represent a congenital cyst or a microadenoma and could be further characterized with a contrast exam when able to tolerate.2.Small pituitary gland and sella as well as global cerebral volume loss.3.Absent posterior pituitary bright spot.4.Paranasal sinus opacification and non-specific mastoid air cell fluid. Please correlate clinically."}
{"instruction": "Generate impression based on findings.", "input": "Female, 24 years old, with history of melanoma, status post left-sided craniotomy for tumor resection. Assess for residual tumor and for small posterior fossa lesion. Evidence of left calvarial craniotomy is seen encompassing portions of the frontal and parietal bone. A small amount of extradural soft tissue thickening is seen subjacent to the craniotomy, within expected postoperative limits. Minimal residual intracranial air is seen.A small resection cavity is evident within the left middle frontal gyrus at the site of the previously seen lesion. The cavity contains a small amount of fluid and blood product. The rim of the cavity demonstrates thin enhancement which is typical after surgery. No definite nodular enhancing soft tissue is seen within or around the cavity. Along the inferior margin of the cavity, there is a curvilinear area of T2 hypointensity vaguely resembling a portion of the lesional hemorrhage seen on the preoperative study (see image 22 of series 7).The degree of T2 hyperintense edema surrounding the resection cavity is similar to that seen surrounding the lesion on the preoperative study. Elsewhere no evidence of significant parenchymal edema or mass effect is evident.A 4 mm enhancing focus is seen within the far lateral right cerebellum with no significant associated edema or mass effect (see image 79 series 13).A 6 mm focus of T1 hyperintensity which suppresses on fat-suppressed images is seen along the inferior frontal lobe on the left, just above the anterior clinoid process. On review of the prior outside CT examination, this lesion is visualized as an area of fat attenuation.No additional areas of pathologic intracranial enhancement are suspected. No other abnormal extra-axial fluid collections are seen. The ventricular system is normal in size and morphology.", "output": "1. Demonstration of expected findings status post left-sided craniotomy for resection of a lesion from the left middle frontal gyrus.2. Thin rim enhancement along the margins of the resection cavity is within expected postoperative limits. No solid nodular enhancing tissue is seen to suggest residual tumor.3. Along the inferior margin of the resection cavity, there is a curvilinear region of T2 hypointensity likely representing blood product. This material vaguely resembles a portion of the lesional hemorrhage seen on the preoperative examination, though it could also reflect blood product related to surgery. Attention to this area on follow-up examinations is suggested.4. A 4 mm enhancing lesion is evident in the right far lateral cerebellum which is suspicious for a second site of intracranial disease. This lesion induces no significant edema or mass effect.5. Note is made of a small fatty lesion along the undersurface of the left inferior frontal lobe which could represent an incidental lipoma or dermoid/epidermoid cyst."}
{"instruction": "Generate impression based on findings.", "input": "Left shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "Normal MRI of the shoulder."}
{"instruction": "Generate impression based on findings.", "input": "Ovarian cancer screening for clinical trial: fatigue. There is no evidence of intracranial hemorrhage, enhancing mass, or acute infarct. There is an arachnoid cyst in the right middle cranial fossa with extension to the Sylvian fissure and associated mass effect upon the adjacent temporal and frontal lobes. There is mild scattered nonspecific cerebral white matter T2 hyperintensity, mainly in a periventricular distribution. 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": "1. No evidence of intracranial metastases. 2. Right middle cranial fossa arachnoid cyst with extension to the Sylvian fissure and associated mass effect upon the adjacent temporal and frontal lobes."}
{"instruction": "Generate impression based on findings.", "input": "Male 56 years old Reason: eval for biceps tendon tear, RTC tear History: Popeye deformity ROTATOR CUFF: There is a high-grade bursal surface tear through the anterior fibers of the supraspinatus tendon at its insertion. The tear involves the majority of the tendon thickness but appears to spare the articular surface fibers. The tear is just over 1 cm in dimension and there is minimal retraction. There is additional increased signal intensity within the distal supraspinatus tendon indicating tendinosis and perhaps surface fraying and interstitial tearing. Unremarkable appearance of the supraspinatus muscle. Mild tendinosis of the infraspinatus tendon with interstitial tearing along the myotendinous junction. Mild fatty infiltration of the infraspinatus muscle. Unremarkable appearance of the teres minor muscle and tendon. There is thinning of the subscapularis tendon likely representing attritional subscapularis tendon tearing. There is mild atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: There is spurring of the anterior aspect of the acromion process as well as a small ossicle noted anterior to the acromion. There is also slight lateral downsloping of the acromion process. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Normal alignment of the glenohumeral joint. Evaluation of the labrum is limited by patient motion. The inferior labrum is grossly intact. Apparent detachment of the anterosuperior labrum from the underlying glenoid may represent normal variant sublabral foramen. Compared to the remainder of the labrum, the posterosuperior labrum is poorly defined which may reflect degeneration or a prior SLAP tear.BICEPS TENDON: Superiorly the bicipital groove appears empty. Although evaluation of the biceps tendon is limited by motion we don't clearly see the biceps tendon within the rotator interval. More distally there is a thin low signal intensity structure within the bicipital groove that we assume represents the torn and retracted tendon. MRI HUMERUS:", "output": "1. Findings compatible with a tear of the proximal long head of biceps tendon.2. Partial thickness rotator cuff tears and tendinosis as described above.3. Distal biceps tendon intact as described above.4. Other findings as described above"}
{"instruction": "Generate impression based on findings.", "input": " There are no acute fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: There is a focus of intrinsic cord T2 hyperintensity without obvious adjacent anatomic/degenerative cause.C2/3: Posterior osteophyte disc complex, ligamentum flavum thickening, and moderate bilateral facet hypertrophy. There is moderate bilateral neural foraminal stenosis.C3/4: Mild anterior compression deformity of C3 and C4, extensive posterior osteophyte disc complex, ligamentum flavum thickening, bilateral uncinate hypertrophy, moderate left facet hypertrophy, severe right facet hypertrophy, and right facet fusion. The combination of these features result in circumferential cord flattening associated with intrinsic cord T2 hyperintensity abnormality (predominately on the right). There is moderate central and moderate severe bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, moderate left facet hypertrophy, and mild right facet hypertrophy. There is mild central, severe left neural foraminal, and moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, ligamentum flavum thickening, bilateral uncinate hypertrophy, moderate left facet hypertrophy, and mild right facet hypertrophy. There is mild central and severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and uncinate hypertrophy asymmetric to left, ligamentum flavum thickening, and mild left facet hypertrophy. There is severe left neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex and mild bilateral facet hypertrophy result in mild bilateral neural foraminal stenosis.", "output": "1.C1/2: There is a focus of intrinsic cord T2 hyperintensity without obvious adjacent anatomic/degenerative cause. This is nonspecific in appearance and the differential diagnosis is broad.2.C2/3: Moderate bilateral neural foraminal stenosis.3.C3/4: A combination of degenerative features result in circumferential cord flattening associated with intrinsic cord T2 hyperintensity abnormality (predominately on the right) consistent with myelopathy. There is moderate central and moderate severe bilateral neural foraminal stenosis.4.C4/5: Mild central, severe left neural foraminal, and moderate right neural foraminal stenosis.5.C5/6: Mild central and severe bilateral neural foraminal stenosis.6.C6/7: Severe left neural foraminal stenosis.7.C7/T1: Mild bilateral neural foraminal stenosis."}
{"instruction": "Generate impression based on findings.", "input": " Motion artifact degrades image quality. The ventricles and sulci are prominent, consistent with mild age-related volume loss. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. There are also subcentimeter defects in the bilateral basal ganglia, which likely represent chronic lacunar infarctions. There is no evidence of acute infarction. There are multiple foci of susceptibility artifact, within the bilateral thalami, and to a lesser extent the bilateral cerebral and cerebellar hemispheres and basal ganglia, consistent with chronic microhemorrhages. There is a partially empty sella. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.", "output": "Chronic basal ganglia lacunar infarcts and small vessel ischemic disease, but no acute infarct, midline shift, or mass effect. "}
{"instruction": "Generate impression based on findings.", "input": "Meningioma status post CyberKnife in May 2014 and orbital pseudotumor. There are postoperative findings related to left suboccipital craniotomy for resection of a meningioma with encephalomalacia in the left cerebellar hemisphere. There is perhaps slight interval decrease in size of the tumor, which now measures up to 16 mm in thickness, previously 20 mm. However, the signal characteristics of the mass have changed somewhat, with apparent increased enhancement. There is an unchanged nodular extra-axial lesion that is markedly T2 hypointense with susceptibility effect and mild peripheral enhancement along the floor of the left posterior fossa, adjacent to the craniotomy defect that measures up to 15 mm. There is unchanged mild nonspecific periventricular T2 hyperintensity. There is no evidence of acute infarct or hemorrhage. The ventricular system is stable in size and configuration. There are postoperative findings related to orbitozygomatic craniotomy with persistent diffuse enhancement of the right orbital fat and multiple extra-ocular muscles with associated impingement upon the optic nerve and proptosis, which is not significantly changed, accounting for differences in technique.", "output": "1.Perhaps slight interval decrease in size of the treated left posterior fossa meningioma, with evolution of the enhancement characteristics.2. An unchanged nodular extra-axial lesion min left posterior fossa adjacent to the craniotomy margin may represent an organizing hematoma. 3. Persistent inflammatory process in the right orbit with impingement upon the optic nerve."}
{"instruction": "Generate impression based on findings.", "input": "Newly diagnosed prostate cancer, staging exam PELVIS:PROSTATE:Prostate Size: 3.7 x 4.9 x 3.8 cm (AP x TR x CC).Peripheral Zone: T2 hypointense foci involving predominantly the left base through the apex consistent with prostate cancer. There are small foci of signal abnormality also involving the right mid gland. T1 hyperintensity involving the apex bilaterally and left base consistent with hemorrhage from prior biopsy.Central Gland: Benign prostatic hyperplasia.Seminal Vesicles: Thickening of the left seminal vesicle.Extracapsular Extension: Evidence of focal extracapsular extension in the left mid gland posterolaterally.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Prostate cancer involving the left base peripheral zone through the apex with additional findings suggestive of extracapsular extension in the left mid gland posterolaterally and possible left seminal vesicle invasion."}
{"instruction": "Generate impression based on findings.", "input": "Patient with non-small cell lung cancer history of epilepsy. Status post craniotomy for brain metastases. No needs disease evaluation prior to therapy In comparison with the prior examination residual blood from the left posterior temporal has been absorbed. Area of edema of right frontal lobe has significantly increased since prior study and is concerning for neoplasm and should be further evaluated with a dedicated MRI examination with infusion. Postsurgical changes of left parietal craniotomy is again identified. No evidence of hemorrhage, midline shift or hydrocephalus.", "output": "Significant increase in the amount of vasogenic edema in the right frontal lobe concerning for recurrence of disease and should be further evaluated with an MRI examination."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old male with history of Crohn's disease. 16 years ago, now presenting with new right scrotal pain ABDOMEN:LUNG BASES: There is and 19 x 13 mm air space opacity in the right lower lobe. There are smaller, round opacities in the right lower lobe around this larger opacity. Further evaluation of these lesions with chest CT is recommended. Linear atelectasis at the left lung base.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant ileostomy. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Subtle, linear increased density in the left ischiorectal fossa. This may represent inflammatory changes, however, a fistula tract cannot be excluded. Further evaluation with MRI in helpful.", "output": "Multiple airspace opacities in the right lower lobe, one of them measuring approximately 2 cm.. Given the young age of the patient, these may represent inflammatory/infectious changes, however, neoplasm cannot be excluded. Further evaluation with chest CT is recommended.Inflammatory changes in the pelvis, more prominent on the left side. MRI of the pelvis may be helpful for better characterization of these changes and to evaluate for a possible fistula."}
{"instruction": "Generate impression based on findings.", "input": "Further assessment of a T11 lytic lesion with possible extension into the spinal canal. Cervical spine: There is reversal of the normal lordosis. The vertebral body height is relatively preserved accounting for the due to spondylosis. The vertebral bone marrow signal is diffusely heterogeneous with loss of the normal fatty signal, but there is no osseous expansion. There is a similar appearance of the clivus and sphenoid body. There is no significant spinal canal stenosis. The spinal cord shows normal signal and morphology.Thoracic spine: The vertebral column alignment is within normal limits. There is mild loss of T2 signal and height at the T4-T5 disc. Otherwise, the disc space heights are preserved. The vertebral bone marrow signal is diffusely heterogeneous, with loss of the normal fatty signal. Similar findings are present in the imaged ribs. There is a more intensely T1-hypointense, T2 hyperintense abnormality replacing the T11 vertebral body/pedicle marrow with mild, predominantly left sided posterior expansion/retropulsion, but no significant spinal canal narrowing. This is also associated with central compression/intravertebral disc herniations along the superior and inferior endplates, but without overall vertebral body height loss. The appearance is unchanged since the CT scan. The other vertebral body heights are preserved. A T1 and T2 hyperintense lesion in T9 vertebral body is probably a hemangioma. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Lumbar spine: There is minimal anterior subluxation of L4 relative to L5 which is degenerative, without spondylolysis. The alignment is otherwise anatomic. The vertebral body heights are preserved. The marrow is heterogeneous with loss of the normal fatty signal. Similar involvement is present in the included pelvic bones. There is nonspecific mild T1-hypointense, T2 hyperintense signal just posterior to the lumbar vertebral bodies, displacing the epidural fat posteriorly. There is degenerative stenosis of the spinal canal, which is severe at L4-L5 and moderate at L5-S1, superimposed on congenitally narrow spinal canal. The conus medullaris has normal morphology and signal. The tip of the conus medullaris is at mid L1 level. The paravertebral soft tissues are unremarkable.LEVEL-BY-LEVEL", "output": "1.Diffuse marrow infiltrating process with more focal, destructive involvement of the T11 vertebral body and pedicles associated with mild retropulsion, but no spinal cord compression or significant canal narrowing. The appearance is more suggestive of multiple myeloma rather than prostate cancer metastasis, although the assessment is somewhat limited by the lack of intravenous contrast.2.Multilevel cervical and lumbar degenerative spondylosis, including severe spinal canal narrowing at L4-L5."}
{"instruction": "Generate impression based on findings.", "input": "36 years, Female, Reason: LLQ abdominal pain; palpable nodule LLQ; BRCA2 positive History: LLQ abdominal pain; palpable nodule LLQ; BRCA2 positive. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, 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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left-sided corpus luteum and normal appearing bilateral follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 2.5 x 1.4 cm enhancing lesion in the left rectus abdominis muscle (14/91).OTHER: Small amount of free fluid in the pelvis is likely physiologic.", "output": "Enhancing lesion in the left rectus abdominis muscle is nonspecific but has the typical location and appearance of a desmoid and would be amenable to percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for worsening cerebral edema. Signs and symptoms: Mental status change. Non-enhanced CT brain:There is suggestion of possible cerebral edema in the supratentorial brain parenchyma. The paucity of cortical sulci is similar to prior examination from 4 -- 6 -- 2010. There is no evidence of hemorrhage, midline shift or hydrocephalus. Follow-up exam with an MRI is again recommended.", "output": "Stable exam. Recommend MRI examination."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old male with history of Crohn's disease, status post ileocecectomy. History of recurrent bowel obstructions. History of small bowel resection. Now with severe diarrhea and weight loss. 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: Multiple loops of distended small bowel, no significant dilatation seen to suggest SBO. No focal wall thickening, fistulous connection, or drainable fluid collection. No ascites. The presumed neoterminal ileum (given reported history of ileocecectomy) is unremarkable (axial series 16 image 25).BONES, SOFT TISSUES: Small T2 hyperintense focus which demonstrates loss of signal on fat saturated sequence is most compatible with a benign osseous hemangioma (coronal series 7 image 19).OTHER: No significant abnormality noted.", "output": "No evidence for bowel obstruction or active inflammatory bowel disease."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for cord compression, history of kyphoplasty: sudden onset tingling, numbness, poor rectal tone. There is a metastasis within the T10 vertebral body associated with a pathologic fracture previously treated with kyphoplasty, as evidenced by cement that manifests sa low T1 and T2 signal. The tumor compresses the spinal cord, which appears to contain mild high T2 signal at the T10 level. The tumor also bulges into the paraspinal soft tissues at the T10 level and there is neural foraminal narrowing at the T9-10 and T10-11 levels bilaterally. There is a metastatic lesion that occupies much of the T5 vertebral body, where there is superior endplate concavity, but no retropulsion into the spinal canal. There is a subcentimeter T1 hypointense and T2 hyperintense lesion in the posterior T1 vertebral body. There is a hemangioma in the T6 vertebral body. There is advanced degenerative spondylosis at the L4-5 level, where there is disc space narrowing, fatty endplate marrow signal alterations, and disc bulge with superimposed eccentric left extrusion that results in severe bilateral neural foraminal stenosis, and mild spinal canal stenosis. There is also a focus of high T2 signal in the posterior L4 vertebral body more superiorly.", "output": "1. A metastasis arising from the T10 vertebral body associated with a pathologic fracture previously treated with kyphoplasty compresses the spinal cord. 2. A metastatic lesion that occupies much of the T5 vertebral body, where there is superior endplate concavity. 3. Probable small metastasis within the posterior T1 vertebral body.4. Advanced degenerative spondylosis at the L4-5 level with severe bilateral neural foramen stenosis and signal abnormality in the posterior L4 vertebral body that may be related to the degenerative process, although an underlying metastasis is not excluded."}
{"instruction": "Generate impression based on findings.", "input": "Morbid obesity. Preoperative evaluation for bariatric surgery. Exam limited by patient body habitus.RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 1.9 cmLEFT LOBE MEASUREMENTS: 5.0 x 2.0 x 2.5 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Parenchyma is diffusely heterogeneous. No dominant nodules.LEFT LOBE: Parenchyma is diffusely heterogeneous. There is a isoechoic 1.5 x 1.5 x 1.3 cm nodule located at the lower pole.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid with solitary nodule in the left lower lobe."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Michaels is a 61-year-old female presenting for MRI-directed ultrasound of a right 6:30 enhancing focus on MRI study dated 8/25/2016. A targeted right breast ultrasound was performed at the MRI-directed area of concern. In the right breast 6:30 location, approximately 4 cm from the nipple, no solid or cystic mass identified.", "output": "No sonographic correlate detected for the MRI finding in the right lower outer breast. A short-term (6-month) follow-up MRI is recommended to ensure stability of this finding. Of note, patient is due for a bilateral screening mammogram in December 2016. All results and recommendations were discussed with the patient. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "61 year-old female with right shoulder pain for 15 years, evaluate rotator cuff ROTATOR CUFF: There is a partial articular sided tear of the anterior distal supraspinatus at its insertion without retraction of the tendon or muscular atrophy. There is tendinosis of the surrounding fibrous. The remaining rotator cuff muscles and tendons are intact.SUPRASPINATUS OUTLET: Marked acromioclavicular joint osteoarthritis with fluid noted within the joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is intact. The labrum is grossly intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "1. Partial articular sided tear of the anterior distal supraspinatus.2. Progression of acromioclavicular joint osteoarthritis."}
{"instruction": "Generate impression based on findings.", "input": "59 year old male with a history of Crohn's disease, ileitis presents with perianal pain. Assess for perianal fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BOWEL, MESENTERY: Again seen is a transsphincteric perianal fistula tract extending from the 1 o'clock position to the level of the subcutaneous tissue along the left gluteal crease, tract is less prominent when compared to the prior examination. Tract terminates in a small elongated focus of increased signal abnormality measuring 11 x 6 mm, measuring slightly smaller than on earlier exam. Again seen is a smaller tract extending from the 7 o'clock position to the midline without focal fluid collection to suggest abscess formation. The previously described perianal fistula originating from the 2 o'clock position is also less prominent when compared to the prior examination.Complex fistula formation seen in right lower quadrant on earlier exam not included on current study.BONES, SOFT TISSUES: No significant abnormality noted.", "output": "Persistent perianal fistulae, less pronounced when compared to the prior examination."}
{"instruction": "Generate impression based on findings.", "input": "Pituitary lesion surveillance. There no significant interval change in the enhancing sellar mass with extension into the right cavernous sinus and right sphenoid sinus, measuring up to 18 mm. There is no mass effect upon the optic apparatus. The infundibulum is midline. The internal carotid artery flow voids are intact.", "output": "No interval change in the invasive pituitary mass, which likely represents a macroadenoma."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Low back pain with left-sided radiation. Signs and symptoms: As above. Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical.Lower most visualized thoracic spine and thoracic cord are unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild disk desiccation and mild hypertrophy of ligamentum flavum and minute fluid signal intensity in the right facet space. No spinal stenosis or neural foraminal compromise.L3 -- 4 demonstrate mild disk desiccation and loss of disk height, moderate right and mild to moderate left facet and ligamentum flavum hypertrophy. There is a central and slightly to the right broad-based disk protrusion resulting in subtle flattening and posterior displacement of the cord and mild central spinal stenosis. Mild bilateral neural foraminal compromise secondary to degenerative changes is also present.L5 -- S1 demonstrate moderate disk disease and loss of disk height , moderate left and mild right facet and ligamentum flavum hypertrophy is also noted. There is no central scar stenosis however moderate left and mild right neural foraminal compromise is detected. Bilateral SI joints and perispinal soft tissue/musculature remains unremarkable.", "output": "1.Degenerative changes at L4 -- L5 and a central disk protrusion results in mild central spinal stenosis. Bilateral neural foraminal compromise as detailed.2.Moderate disk disease and loss of disk height without central spinal stenosis however with bilateral neural foraminal compromise at L5 -- S1 is noted.3.Minimal degenerative changes at other levels however without spinal stenosis or neural foraminal compromise."}
{"instruction": "Generate impression based on findings.", "input": " There is a small lesion within the posteromedial left thalamus measuring 7 x 6 mm (as measured on the axial T2 technique), previously 5 x 5 mm. The hypointense rim is slightly larger. Internal signal characteristics now demonstrate less T2 hyperintensity and more T1 hypointensity. As before, there is no perilesional edema. There are no other similar appearing lesions. There are no associated developmental venous anomalies. There are a few scattered punctate foci of T2 hyperintensity in bifrontal subcortical white matter locations without mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.", "output": "Small, 7 x 6 mm, cavernous malformation within the left thalamus as described in detail above. There is no associated perilesional edema or development of venous anomaly."}
{"instruction": "Generate impression based on findings.", "input": "Benign intracranial hypertension [G93.2] / Compression of brain [G93.5] / Headache [R51], Reason for Study: ^Reason: chiari malformation , pseudotumor cerebri, new and worsening headaches, please do with csf flow study History: new and worsening headache Brain MRIRedemonstration of suboccipital craniectomy and stable downward displacement of the cerebellum and the cerebellar tonsils, unchanged.There is also a tubular structure seen through the foramen Luschka to the level of distal aspect of the aqueduct, unchanged since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.CSF Flow studyThere are to and fro flow anterior to the craniocervical junction.Flow signal at the posterior aspect of the foramen magnum appears to be attenuated, unchanged since prior scan.The degree of flow signal was not calculated but the signal intensity appears to be similar to that of prior scan.Cervical spine MRIThere is normal cervical lordosis. The cranial-cervical junction demonstrates post decompression status, unchanged. Spinal cord signal intensity is normal.In particular, no evidence of syrinx.The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal.", "output": "1. Post decompression suboccipital craniectomy of Chiari malformation status, no postoperative unusual finding.2. No evidence of syrinx. Ventricle size is stable and unremarkable.3. No evidence of acute ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": "53 year old female with episodic hypertension, evaluate for intracranial or posterior fossa tumor The ventricles, sulci and cisterns are symmetric and unremarkable. There are a few scattered periventricular and subcortical foci of T2 signal abnormality within the white matter, sparing the posterior fossa, without associated mass effect, restricted diffusion, or susceptibility abnormality. The gray-white matter differentiation is normal. There is no mass, midline shift, intra or extra-axial fluid collection/hemorrhage, or evidence of acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Small right ethmoidal sinus retention cyst or polyp. Fluid within a few right mastoid air cells. The paranasal sinuses and mastoid air cells are otherwise clear.", "output": "Few There are a few scattered periventricular and subcortical foci of T2 signal abnormality within the white matter, sparing the posterior fossa, without associated mass effect, restricted diffusion, or susceptibility abnormality. These are nonspecific in appearance, and the differential diagnosis would most likely include small vessel ischemic disease, migraine sequelae, or the residua of prior head trauma. Given their morphology and location, demyelinating disease is considered unlikely."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Radiculopathy, cervical regionClinical question: R/O cervical disc disease. EMG shows chronic L C8 radiculopathySigns and Symptoms: Weakness L hand The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal. There is disc desiccation and a right lateral recess disc protrusion which encroaches on the right-sided exiting nerve roots at this level. At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is mild posterior ligamentous hypertrophy present at this level. There is disc desiccation present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild posterior ligamentous hypertrophy present at this level. There is disc desiccation present at this level.At C5-6 there is no significant compromise to the spinal canal. There is right-sided uncovertebral osteophyte formation associated with a right lateral recess disc protrusion which extends into the neural foramen and encroaches the right-sided exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal. There is right-sided uncovertebral osteophyte formation associated with a right lateral recess disc protrusion and mild to moderate encroachment of the right-sided exiting nerve roots.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 small relative to the left vertebral artery.", "output": "1.There are multilevel degenerative changes present in the cervical spine with encroachment of right-sided exiting nerve roots at C3-4, C5-6 and to a lesser degree C6-7."}
{"instruction": "Generate impression based on findings.", "input": "30 years Female (DOB:8/30/1985)Reason: Please evaluate for cerebral AVMs, HHT History: HHTPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a T2 and FLAIR hyperintense lesion located in the right temporal lobe white matter behind the right sylvian fissure and just lateral to and adjacent to the right inferior longitudinal fasciculus which measures 8 x 5 mm axial dimensions. It is not associated with any susceptibility effect and it is not associated with contrast enhancement.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium sized. The right posterior communicating arteries is not readily identified. The left posterior communicating artery is small The vertebral arteries are similar in size. The left A1 segment is larger than the right A1 segment. There is triplication of the anterior cerebral artery.", "output": "1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm or arteriovenous malformation.3.There is a small lesion present in the right temporal lobe white matter. In isolation this is nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "Seizure-like activity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal diffuse paranasal sinus mucosal thickening.", "output": "No evidence of seizure foci. "}
{"instruction": "Generate impression based on findings.", "input": " Hemorrhage is redemonstrated in the right lateral ventricle and in the right thalamus appearing similar in quantity and distribution to prior exams. The right lateral ventricle remains widened. There are T2/FLAIR hyperintensities in the corona radiata, representing chronic ischemic small vessel disease. No parenchymal restricted diffusion is seen. There is a ventriculostomy track coursing from a left frontal approach into the left ventricle, reflecting the previously removed ventriculostomy tube. There is a volume loss affecting the right basal ganglia with hemosiderin staining, likely indicating a prior hemorrhagic insult. There is punctate susceptibility signal along the left lateral ventricle and the ventriculostomy track, representing old blood products. There is no definite abnormal enhancement.Ventricular size is stable with no midline shift. Basal cisterns are patent.", "output": "1. As on the previous CT there is redemonstration hemorrhage in the right lateral ventricle and in the right thalamus.2. No definite evidence of any mass or enhancing lesion. Please note that the presence of blood may obscure a small or subtle enhancing lesion.3. Nonspecific T2/FLAIR hyperintensities in the corona radiata, suggestive of chronic ischemic small vessel disease.4. Mild volume loss and hemosiderin staining affecting the right basal ganglia suggests a prior hemorrhagic insult in this location."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Metastatic melanoma, history of brain metastases, now with recent seizure and left-sided weakness. Evaluate for new brain metastases. Signs and symptoms: Recent seizure and left-sided weakness. Nonenhanced brain MRI:Only a single axial FLAIR sequence was obtained which at this point patient was unable to continue with the study and terminated the exam.Examination demonstrates a new focus of vasogenic edema in the right posterior frontal-parietal region containing acute blood products. Considering patient's history of malignancy this finding could represent a new focus of hemorrhagic metastatic lesion and follow-up with a complete exam is recommended.There is also a right posterior temporal hemorrhagic mass measuring approximately at 12 x 12 mm in transaxial dimensions and the sulcal surrounding vasogenic edema which is new since prior exam and consistent with a hemorrhagic metastatic lesion.A surgical cavity with CSF signal intensity in the left artery again posterior frontal and bit surrounding edema/FLAIR hyperintensity remain similar to prior exam.Focus of FLAIR hyperintensity and a cavity formation in the right frontal lobe at the site of previously known metastatic lesion is noted. Left posterior temporal-occipital vasogenic edema is at the site of a previously noted tiny metastatic lesion however lack of intravenous contrast precludes precise assessment for the size of underlying metastases.Mild prominence of lateral ventricles similar to prior exam however with interval decreased mass effect on the right frontal horn of lateral ventricle due to interval decreased vasogenic edema.", "output": "1.Incomplete exam due to patient's inability to continue and only a single axial FLAIR sequences acquired.2.New focus of hemorrhage and surrounding edema in the right posterior frontal-parietal suspicious for a new metastatic lesion.3.New focus of hemorrhagic metastases in the right posterior temporal suspected.4.Multiple additional foci of FLAIR hyperintensity consistent with patient's previously known tumors.5.Interval decreased vasogenic edema in the right frontal lobe with resultant decreased mass effect on the right frontal horn of lateral ventricle."}
{"instruction": "Generate impression based on findings.", "input": "72 year old man with mildly reduced LV systolic function referred to rule out ischemic heart disease. His history is significant for lymphoma which is treated with chemotherapy.  MEDICATIONS: ASA, lisinopril, and simvastatin. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Of note, the native myocardial T1 relaxation time was moderately elevated in the basal inferior and inferolateral walls suggesting the presence of either subtle interstitial fibrosis or myocardial edema. Left VentricleThe left ventricle is normal size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 175 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 81 ml (normal range 47+/-19), the LV mass index is 79 g/m2, and the LV mass is 150 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 71%, the RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVEDV is 145 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 42 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 a trivial pericardial effusion.Extracardiac FindingsLarge right sided pleural effusion with adjacent atelectasis or consolidation is noted. Mediastinal lymphadenopathy is noted. 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. No perfusion defects/ \"ischemia\" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with low normal systolic function (LVEF 54%). There is no late gadolinium enhancement; however, the native myocardial T1 relaxation time was moderately elevated in the basal inferior and inferolateral walls suggesting the presence of either subtle interstitial fibrosis or myocardial edema. 4. Normal RV size and systolic function (RVEF 71%).5. See extra-cardiac findings. "}
{"instruction": "Generate impression based on findings.", "input": "Knee pain. Due to the patient's large body habitus, a knee coil could not be used. An alternative coil was used instead, resulting in suboptimal image quality.MENISCI: Mild intrasubstance signal intensity within both menisci suggests degeneration, but I see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is mild to moderate thinning of the articular cartilage of the lateral facet of the patella, with a near-full-thickness cartilage cleft noted in the median eminence. There is mild thinning of the articular cartilage of the medial facet of the femoral trochlea as well as focal near-full-thickness to full-thickness degeneration of the articular cartilage along the lateral facet. Small patellofemoral subchondral cysts are also noted. There is focal near-full-thickness to full-thickness cartilage degeneration along the weightbearing portion of the medial femoral condyle. There is also a small full-thickness cartilage defect along the weightbearing portion of the lateral femoral condyle. There are small tricompartmental osteophytesLIGAMENTS: Anterior cruciate ligament appears slightly thickened, suggesting mucoid degeneration. The posterior cruciate ligament appears normal. The medial collateral ligament and lateral collateral ligament complex appear normal. EXTENSOR MECHANISM: The extensor mechanism is intact. There is edema of the subcutaneous fat anterior to the patellar tendon extending along the lateral retinaculum that is nonspecific. ADDITIONAL", "output": "1.Tricompartment osteoarthritis.2.Mild edema of the subcutaneous fat anterior to the patellar tendon extending along the lateral retinaculum is nonspecific.3.Findings suggestive of an intra-articular lipoma anteriorly with extension into the patellofemoral articulation.4.Mucoid degeneration of the anterior cruciate ligament."}
{"instruction": "Generate impression based on findings.", "input": " The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is minimal pannus at the dens. There is moderate loss of disc height with endplate degenerative changes at C4-5 and mild loss of disc height at C5-6 and C6-7. Aside from the associated degenerative endplate signal alterations, the vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are mild right mastoid air cell effusions. There is a 5 mm wide right thyroid nodule.C2-C3: No significant disc bulge, spinal canal or neural foramen stenosis.C3-C4: No significant disc bulge, spinal canal or neural foramen stenosis.C4-C5: Disc-osteophyte complex with uncovertebral hypertrophy and thickening of the ligamentum flavum, contributing to modearte spinal canal and mild bilateral neural foramen stenosis.C5-C6: Disc-osteophyte complex with uncovertebral hypertrophy and thickening of the ligamentum flavum, contributing to mild spinal canal and mild bilateral neural foramen stenosis.C6-C7: Disc-osteophyte complex with uncovertebral hypertrophy and thickening of the ligamentum flavum, contributing to mild spinal canal and mild bilateral neural foramen stenosis.C7-T1: No significant disc bulge, spinal canal or neural foramen stenosis.", "output": "1. Degenerative cervical spondylosis, contributing to moderate spinal canal stenosis at C4-C5 and mild spinal canal stenosis at C5-C7, as well as mild bilateral neural foramen stenosis at these levels.2. Nonspecific 5 mm wide right thyroid nodule. Thyroid ultrasound may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Proximal visual disturbance, evaluate for structural abnormality. Brain parenchyma appears within normal limits for age. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.", "output": "MRI of the brain is unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "History of weight loss. Ultrasound concerning for chronic liver disease. Evaluate for malignancy or cirrhosis. Significant respiratory motion limits the quality of the images and limits the study.ABDOMEN:LIVER, BILIARY TRACT: The liver morphology and size is unremarkable. There are several predominantly peripherally based wedge-shaped arterial enhancing lesions in the liver which are isointense to liver parenchyma on portal venous and delayed phase imaging. These are not associated with T1/T2 weighted signal abnormality, restricted diffusion or washout and are compatible with THIDs/perfusion anomalies. No focal suspicious liver lesion is evident.There are several T2 weighted hyperintense, T1 weighted hypointense nonenhancing subcentimeter foci compatible with simple cysts. More punctate T2 weighted hyperintense foci diffusely likely represent benign biliary hematomas.No biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal inferior pole 1.3 cm simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid diverticulosis without diverticulitis. Normal appendix. The patient is status post gastric banding with the band in stable orientation within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.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": "No specific evidence of cirrhosis as clinically questioned. No significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RULE OUT OSTEMOMYLITITS History: BACTEREMIA AND FEVER There is no bone marrow signal abnormality to suggest osteomyelitis. There is no frank osteolysis to suggest osteomyelitis. There is peritrochanteric edema bilaterally, left greater than right. Some of this edema becomes confluent along the lateral aspect of the gluteal musculature which may represent a bursitis. No organized fluid collection is identified to suggest abscess formation. There is enhancing increased signal abnormality within the gluteal musculature bilaterally which is nonspecific but appear to correspond with foci of hypermetabolic activity on recent PET/CT examination. Note is made of enhancing lymphadenopathy in the left internal iliac region measuring 2.9 x 2.7 cm suspicious for metastatic disease. There is also right iliac lymphadenopathy measuring approximately 2.5 cm in its greatest dimension. There is associated enhancement in the surrounding area which extends to the level of the anterior aspect of the L5/S1 disc space appearing similar to the prior studies.", "output": "1. Nonspecific edema and foci of enhancement within the gluteal musculature bilaterally which appear to correspond with foci of hypermetabolic activity on recent PET/CT examination. These could represent inflammatory changes related to an infectious etiology in the correct clinical context versus metastatic disease. No drainable fluid collection is identified. No evidence of osteomyelitis. 2. Pelvic lymphadenopathy consistent with the patient's known history of metastatic disease. 3. Findings suggestive of a peritrochanteric bursitis, left greater than right. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Lower extremity weakness and numbness For the purposes of numbering, the most inferior well-defined disc space is labelled L5-S1. Again seen is a severe compression fracture involving the L3 vertebral body with approximately 70% loss of height similar to prior. There is edema involving the L3 vertebral body, also similar to prior. Evidence of cement augmentation at the L3 vertebral body is again seen. No significant osseous retropulsion.Remainder of the vertebral body heights are normal. Alignment is grossly maintained in the lumbar spine. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia. Fat within the thecal sac at the right lateral S1 level is again seen. The spinal cord remains low-lying with the distal neural tissue/conus extending to the L5 level. Prone images demonstrate no appreciable ventral motion. Septations/adhesions are again again noted in the thecal sac from the L5 to S1 levels similar to prior. T2 signal likely reflecting myelomalacia at L2-L3 again seen.Degenerative changes are specified by the intervertebral level as follows and unchanged since 2/22/2016: T12-L1: No spinal canal or neural foraminal stenosis.L1-L2: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is minimal disc bulge. There is unchanged mild central canal stenosis and bilateral mild to moderate neural foraminal stenosis.L2-L3: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge with central protrusion component without significant change in moderate to severe spinal canal stenosis and moderate bilateral foraminal stenosis. L3-L4: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is also mild disc bulge with unchanged mild spinal canal stenosis and mild to moderate bilateral foraminal stenosis.L4-L5: There is bilateral facet hypertrophy. There is central disc protrusion. No significant spinal canal stenosis. There is unchanged mild bilateral foraminal narrowing, relatively worse on the left.L5-S1: There is bilateral facet hypertrophy without neuroforaminal narrowing or spinal stenosis.Fatty atrophy involving the paraspinous musculature again seen, which is predominantly on the right.", "output": "1. Compared to 3/29/2016 and 2/22/2016, there is no significant change in moderate to severe spinal canal stenosis at the L2-L3 level.2. No significant change in compression fracture with approximately 70% height loss of the L3 vertebral body with evidence of cement augmentation.3. Unchanged appearance of the low-lying conus which extends to the L5 level and adhesions within the distal thecal sac. Prone images demonstrate no appreciable ventral motion, which in the appropriate clinical setting suggests possibility of re-tethering. 4. Unchanged T2 hyperintensity within the cord at the L2-L3 level consistent with myelomalacia.5. Degenerative changes at additional levels as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Right hip pain The examination is limited by motion artifact and by the patient's body habitus.There is no evidence of fracture or dislocation of the right hip. The marrow signal of the pelvis is normal. Following contrast administration, there is no abnormal enhancement of the right hip.Abnormal marrow signal affects the L5 and S1 vertebral bodies and disc spaces. This is better evaluated on corresponding dedicated MRI of the lumbar spine.", "output": "No evidence of fracture or acute right hip pathology."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for intracranial abnormalities History: pre-syncope Brain parenchyma appears within normal limits. There are no masses, mass effect or herniation. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. 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. Bone marrow signal and extracranial soft tissues are unremarkable.", "output": "MRI of the brain is within normal limits. Specifically, no evidence of intracranial mass, mass effect or acute infarct..I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Male, 52 years old, with severe right lumbar radiating pain. Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No pathologic marrow replacement or enhancement is seen.The distal spinal cord is unremarkable. The conus tip terminates at the L1 level which is normal. The nerve roots of the cauda equina dispersed evenly through the thecal sac. No pathologic intrathecal enhancement is seen. No epidural abnormalities are suspected.Incidental note is made of mild prominence of the right renal collecting system.Mild loss of disc T2 signal is seen at L2-3 and L4-5 with preservation of disc height. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild bulging disc with a shallow central/right paracentral protrusion. Mild effacement of the ventral thecal sac but no significant generalized canal stenosis. No significant foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Right foraminal and extraforaminal disc protrusion which moderately narrows the neural foramen. The exiting L3 nerve root does not appear to be significantly impinged. However, the protrusion may impinge the descending right L4 nerve root. No significant generalized spinal canal stenosis. No significant left foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. Mild generalized spinal canal stenosis with encroachment of the lateral recesses and crowding of the descending bilateral L5 nerve roots. Superimposed left foraminal/far lateral disc protrusion which moderately narrows the left neural foramen. L5-S1: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis.", "output": "1.A right foraminal/extraforaminal disc protrusion at L3-4 causes moderate narrowing of the neural foramen. The exiting L3 nerve root does not appear to be impinged. However, this protrusion does efface the right lateral recess and may impinge on the descending right L4 nerve root.2.A bulging disc at L4-5 causes encroachment of the lateral recesses and crowding of the descending bilateral L5 nerve roots. A superimposed left foraminal/far lateral disc protrusion causes moderate left neuroforaminal narrowing."}
{"instruction": "Generate impression based on findings.", "input": "Acinic cell carcinoma of the right parotid gland, metastatic to the skull base, status post treatment. There are postoperative findings related to right parotidectomy and mastoidectomy, which are partially imaged. There is no significant interval change in the extent of the ill-defined heterogeneously enhancing mass that involves the right basiocciput, petrous ridge, and condylar and squamous portions of the occipital bone. The areas of non-enhancement within the skull base likely represent necrosis and are not significantly changed. Portions of the tumor still abut the right internal carotid artery and surround the right internal jugular vein. There is also persistent enhancement within the lateral mass of the C1 vertebra. There are a few unchanged nonspecific scattered foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits are unremarkable. The remaining salivary glands are unremarkable.", "output": "No significant interval change in the treated acinic cell carcinoma metastasis involving the right lateral skull base and craniocervical junction, perhaps superimposed upon osteonecrosis."}
{"instruction": "Generate impression based on findings.", "input": "Newly diagnosed cholangiocarcinoma. Evaluate for metastases. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size. There is abnormal soft tissue infiltration along the porta hepatis into the central hepatic parenchyma and infiltrating segment 5 of the liver. There is severe right hepatic lobe biliary ductal dilatation. There are additional satellite lesions in the right hepatic lobe (including series 8, image 55, 56).The common bile duct is essentially obliterated by the periductal tumor with associated intrahepatic biliary ductal dilatation.Hydropic gallbladder containing numerous gallstones. Nonspecific pericholecystic fluid. No significant gallbladder wall thickening.A biliary stent is 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: Moderate volume ascites. Perihepatic soft tissue nodule suspicious for peritoneal carcinomatosis, see measurement below.BONES, SOFT TISSUES: Mild anasarca. Well-defined hypoechoic uterine masses likely represents fibroids.OTHER: No significant abnormality noted.", "output": "1. Extensive soft tissue infiltration along the porta hepatis and into the right hepatic lobe with associated suspected hepatic satellite metastases compatible with the stated history of cholangiocarcinoma. Associated marked right hepatic lobe biliary ductal dilatation.2. Hydropic gallbladder with cholelithiasis.INDEX LESION MEASUREMENTS (Current exam date/time: 1/11/2016 22:00:00)PERIHEPATIC SOFT TISSUE NODULE: 1.2 x 1.0 cm (Image 151, Series 8).INFILTRATING PORTAHEPATIS MASS: 10.8 x 5.1 cm (Image 143, Series 8)."}
{"instruction": "Generate impression based on findings.", "input": "Urinary incontinence, decreased bladder capacity, thick-walled bladder. Evaluate for tethered cord. Five lumbar type vertebral bodies are presumed to be present. The conus medullaris is normal in appearance and terminates at the L1-2 level. There is no T1 hyperintensity along the filum. There is no evidence of intraspinal tumors. The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is no significant spinal canal or neural foraminal stenosis at T12-L1 through L5-S1. The vertebral body and disk heights are well-maintained. The vertebral marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.", "output": "No evidence of low-lying conus medullaris, fibrofatty filum, or other developmental anomalies in the lumbar spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: History of meningioma. Status post surgery and cyber knife for recurrence. Signs and symptoms: Surveillance scan. Pre-and post-enhanced brain MRI:Examination demonstrate bone marrow signal placement (T1 isointense and T2 hypointense) and thickening of the right skull base and including the right occipital condyle with uniform enhancement similar to prior exams.Additionally there is an associated extra osseous focus of enhancement in the right inferior cerebellopontine angle cistern which abuts the right foramen of Luschka similar to prior exam. This focus of enhancement is within the surgical bed at the level of previously resected meningioma. It measures approximately 10 x 20 mm in transaxial dimensions on axial post enhanced series 11 x 23. There is no significant interval change in the size or the extent of this finding since prior study. Similar to prior exam this focus of enhancement abuts the right lateral aspect of medulla however without detectable signal abnormality to suggest presence of edema.Examination redemonstrates a single punctate focus of flair hyperintensity in the subcortical white matter of right frontal lobe which is a nonspecific finding. Unremarkable and stable pre-and post enhanced brain MRI otherwise.", "output": "1.No evidence of an acute or new finding since prior exam.2.Marrow signal replacement and uniform enhancement of right skull base including right occipital condyle similar to prior exam.3.Associated with above finding is a right inferior cerebellopontine angle extra-axial enhancement measuring approximately 11 x 23-mm without convincing evidence of change since prior study.4.Similar to prior exam the above mentioned enhancement is inseparable from the right lateral aspect of the medulla and right foramen of Luschka as detailed."}
{"instruction": "Generate impression based on findings.", "input": "Complex febrile convulsions [R56.01], Reason for Study: ^Reason: rule out brain structural abnormality History: seizure There are a couple of small (less than 2mm) T2 high and T1 low signal intensity lesions on the right hippocampal head which follow the signal intensity of CSF. There is no MR evidence of focal parenchymal signal abnormality of the hippocampus nor evidence of volume loss. Constellation of above findings suggest possible hippocampal sulcus cysts. The left side hippocampus appears to be normal.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "1. No evidence of acute ischemic or hemorrhagic lesion.2. Hippocampal sulcus cysts on the right hippocampal head, otherwise no remarkable finding."}
{"instruction": "Generate impression based on findings.", "input": "Female 63 years old. Reason: eval for RA, pain/swelling in joints. History: eval for RA, pain/swelling in joints. Three views of the right hand are provided. The bones appear normal for age without erosions or other specific findings of rheumatoid arthritis. Three views of the left hand are provided. The bones appear normal for age without erosions or other specific findings of rheumatoid arthritis. There is a tiny ossicle distal to the ulnar styloid which may be secondary to prior injury. Four views of the right knee demonstrate tiny osteophytes indicating minimal osteoarthritis. There is no joint effusion or erosion. There is a lucency partially traversing the fibular styloid, probably representing a normal variant. If there is clinical concern for fracture in this location, further imaging with MRI can be obtained.Four views of the left knee demonstrate small osteophytes indicating mild osteoarthritis. There is no joint effusion or erosion. Three views of the right foot demonstrate bone demineralization but no erosions or other specific findings of rheumatoid arthritis. There is soft tissue swelling along the dorsal aspect of the foot. There are small plantar and posterior calcaneal spurs.Three views of the left foot demonstrate bone demineralization but no erosions or other specific findings of rheumatoid arthritis. There is a bipartite medial sesamoid bone, which is a normal variant. There is a small plantar calcaneal spur.", "output": "1. No specific findings to suggest rheumatoid arthritis.2. Mild knee joint osteoarthritis, right foot soft tissue swelling and other findings as described above.3. Lucency partially traversing the right fibular styloid. This finding likely represents a normal variant, however, if there is clinical concern for a fracture in this location, further imaging with MRI can be obtained."}
{"instruction": "Generate impression based on findings.", "input": "Reason: signs of pseudotumor and pineal cyst. History: headaches. MRI: There is a cystic pineal gland that measures up to 10 mm. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRV: There is no evidence of venous sinus thrombosis.", "output": "1. The cystic pineal gland measures up to 10 mm.2. No evidence of venous sinus thrombosis."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female with elbow pain status post fall. Small linear calcific density with questionable small joint effusion. Appears most consistent with more remote/chronic changes to the ulnar collateral ligament. Follow-up advanced imaging, such as with MRI, should be considered if more acute injury is clinically appropriate. No acute fracture or malalignment.", "output": "Probable remote trauma/chronic degenerative changes of the ulnar collateral ligament. Consider follow-up advanced imaging if more acute injury is clinically suspected."}
{"instruction": "Generate impression based on findings.", "input": "Multiple uterine fibroids. PELVIS:UTERUS, ADNEXA: Enlarged lobular uterus containing multiple well-defined T2 hypointense and T2 heterogeneous masses compatible with multiple leiomyomata. The uterus measures 12.2 x 9.4 cm in the sagittal plane.A right anterior fundal subserosal fibroid measures 9.6 x 5.7 cm. An anterior intramural body fibroid measures 7.9 x 6.1 cm. A dorsal intramural body fibroid measures 3.7 x 3.3 cm. Note is made of an anterior body/fundal submucosal fibroid measuring 1.6 x 1.5 cm.All the fibroids aside from the posterior/dorsal 3.7 cm fibroid demonstrate postcontrast enhancement.The endometrium/endometrial cavity is distorted by the fibroids but is normal in thickness and is homogeneously T2 weighted hyperintense in signal intensity, normal. The inner myometrium/junctional zone is well-defined and is normal in thickness.The left ovary is normal in size but contains a T2 mildly hyperintense 2.2 x 1.7 cm lesion which demonstrates peripheral thick rim enhancement and crenulated margins. The right adnexa is unremarkable.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": "1.Multiple large fibroids most of which demonstrate contrast enhancement as described above.2.2.2 cm left adnexal lesion is likely a corpus luteal cyst, however 4-6 week pelvic ultrasound is recommended to confirm resolution."}
{"instruction": "Generate impression based on findings.", "input": "Cognitive decline with prior strokes and Parkinson disease: please assess for burden of cerebrovascular disease. There are small areas of encephalomalacia in the bilateral deep grey matter structures and anterior right frontal lobe superimposed upon a background of diffuse bilateral cerebral hemisphere white matter T2 hyperintensity, primarily in a periventricular distribution. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse cerebral volume loss. There is an unchanged subcentimeter extra-axial lesion with susceptibility effect along the anterior right frontal convexity. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable. There is a subcentimeter nodule in the left occipital scalp, which may represent an inclusion cyst, but has gradually increased in size.", "output": "1. Small chronic infarcts in the bilateral deep grey matter structures and anterior right frontal lobe superimposed upon a background of chronic small vessel ischemic disease, but no evidence of acute acute infarct.2. An unchanged subcentimeter extra-axial lesion with susceptibility effect along the anterior right frontal convexity may represent a calcified meningioma.3. A subcentimeter nodule in the left occipital scalp may represent an inclusion cyst, but has gradually increased in size and is incompletely characterized. "}
{"instruction": "Generate impression based on findings.", "input": "38-year-old male with popping of left knee, inability to bear weight and severe left knee pain. MENISCI: The lateral meniscus appears intact. There is a bucket-handle tear of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is a focus of fluid signal intensity within the proximal aspect of the medial tibial plateau which may represent a subchondral cyst. There is partial-thickness articular cartilage degeneration along the lateral facet of the patella with underlying degenerative subchondral signal abnormality. Note is made of a 5 mm focus of decreased signal abnormality along the anterior aspect of the medial femoral condyle which may represent a loose body within the joint.LIGAMENTS: There is increased signal abnormality within the proximal fibers of the meniscofemoral ligament indicating a sprain. The superficial band of the MCL appears intact. The LCL appears intact. The ACL and PCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intactADDITIONAL", "output": "1. Bucket handle tear of the medial meniscus as described above.2. Articular cartilage degeneration as described above. Subcentimeter focus of signal abnormality may represent a loose body/articular cartilage fragment as described above.3. Joint effusion and Baker's cyst.4. Sprain of the meniscofemoral component of the deep fibers of the MCL. "}
{"instruction": "Generate impression based on findings.", "input": "History of cholangiohepatitis with known biliary stricture. History of hepatolithiasis status post left hepatic resection at outside hospital. Recurrent stone formation. Presents with abdominal pain and nausea. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from left hepatectomy and cholecystectomy.There is apparent persistence of the hepatic-gastric cardia fistula as seen on the ERCP dated 8/13/2015 (series 7/11) at the level of the proximal common hepatic duct/confluence of the right hepatic duct. There is narrowing at the confluence of the right hepatic ducts with mild intrahepatic biliary ductal dilatation, a narrow smooth short segment stricture of the proximal common hepatic duct measuring 1.9 cm in length (series 9/2) and an approximately 1.4 cm stricture of the distal common hepatic duct at the level of the head of the pancreas. Proximally the common duct measures 8 mm in caliber. Overall the morphology of the biliary duct system is unchanged from the prior study.No focal lesion or abnormal postcontrast enhancement. No hepatolithiasis or choledocholithiasis.Subcentimeter punctate arterial enhancing focus at the dome of the liver is unchanged and likely represents a flash filling hemangioma.Suspected artifact at the orifice of the right hepatic vein. The vessels are otherwise patent.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No significant change in the morphology of the biliary ductal system including focal stenosis at Klatskin's point, short focal stricture of the proximal common hepatic duct and short focal stricture at the level of the head of the pancreas.2.Persistent fistulous communication between the proximal common duct and the gastric cardia.3.No suspicious hepatic lesion, hepatolithiasis or choledocholithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Pain. Left ilium lesion. There is a mixed sclerotic/lucent lesion within the left ilium adjacent to the sacroiliac joint corresponding to that seen on prior CT and MRI studies measuring approximately 5 cm in maximum dimension. Based on the previous studies I suspect that this represents an intraosseous lipoma which would showed fat signal intensity, suggestive of a suspect this represent an intraosseous lipoma at or potentially a intraosseous \"hemangioma\". Surgical clips are noted within the pelvis on the left.", "output": "Mixed lucent/sclerotic lesion in the left ilium containing fatty components on prior imaging studies. This may represent an intraosseous lipoma or perhaps a intraosseous \"hemangioma\"."}
{"instruction": "Generate impression based on findings.", "input": "Intermittent shaking spells, history of craniopharyngioma status post resection. There are findings related to left frontal craniotomy with a small areas of anterior left frontal lobe encephalomalacia. There is also minimal diffuse periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions that complete fill the right maxillary sinus. There is a small amount of fluid in the bilateral mastoid air cells.", "output": "Post-treatment findings in the left frontal lobe, but no evidence of intracranial hemorrhage, mass, or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "Cerebellar hemangioblastomatosis treated with surgery in 2002 and SRS in 2004: headache and gait difficulty. There are postoperative findings related to left suboccipital craniotomy. There has been interval increase in size of the left inferior cerebellar hemisphere enhancing lesions, which now measure up to 18 and 8 mm each, previously 15 and 5 mm, respectively. There is also increased associated vasogenic edema and susceptibility effect. There are unchanged nonspecific punctate foci of T2 hyperintensity in the supratentorial brain. There is no evidence of acute infarct. There is an enlarged partially-empty sella. The ventricles are stable in size and configuration. There is no midline shift or herniation. Thre is fluid within the right mastoid air cells. The extracranial soft tissues are unremarkable. There are bilateral lens implants.", "output": "Interval increase in size of the left inferior cerebellar hemisphere hemangioblastomas, along with increased associated vasogenic edema. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o metastatic dz History: h/o lymphoma in remission, night pain The bone marrow signal intensity is within normal limits. No acute fracture or malalignment is evident. The image musculature of the pelvis is normal in appearance there is no evidence of lymphadenopathy. No enhancing mass lesions are identified on postcontrast sequences. Minimal degenerative disc disease affects image lower lumbar spine including intervertebral disc desiccation. Please see the patient's dedicated MRI of lumbar spine examination report for additional details. There is a 2 cm cystic lesion within the right adnexa, likely physiologic in a patient of this age. There is a small amount of peritrochanteric inflammation, right greater than left, which is not necessarily of any clinical significance. There is a small amount of fluid identified within the hips also not necessarily of any clinical significance. The sacroiliac joints are normal in appearance.", "output": "No findings to account for the patient's pain. No evidence of lymphadenopathy or enhancing mass lesion."}
{"instruction": "Generate impression based on findings.", "input": "New onset seizure, CLL patient There is about 5 mm sized enhancing nodule on the left cerebral hemisphere and about 2 mm sized left precuneus enhancing lesion which may indicate possible metastasis. However, left precuneus lesion could be vascular structure since it shows a bit elongated shape and seems to be connected to a vascular structure.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. 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": "About 5mm sized enhancing nodule on the left cerebellar hemisphere, indicating possible metastatic lesion.Another enhancing lesion on the left precuneus which could be an enhancing vascular structure or another metastatic lesion.No evidence of acute ischemic or hemorrhagic lesion on this scan. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for pathology. Signs and symptoms: Bilateral clonus on exam. Nonenhanced total spine MRI:Examination demonstrates normal signal intensity and anatomical alignment of the vertebral column. Examination of cervical spine demonstrate a small disc extrusion at C4-C5 which results in complete effacement of ventral subarachnoid space and subtle flattening deformity of the cord. No evidence of central spinal stenosis. There is however suspected increased T2 signal intensity of the cord on sagittal T2 STIR series 501 image 8. This needs to be further evaluated with dedicated complete MRI of cervical spine. This study was recommended however patient was unwilling to continue with the study and refused.There is normal signal intensity and caliber of the cervical- thoracic cord as well as conus and cauda equina otherwise.No evidence of central spinal stenosis at any level. There is an isolated ligamentum flavum hypertrophy at T2 level.Unremarkable visualized paraspinal soft tissues.", "output": "1.No evidence of mass effect on the cord or central spinal stenosis.2.Small disc protrusion at C4-C5 with effacement of ventral subarachnoid space as detailed. Suspicious tiny focus of cord increased T2 signal intensity at this level. Correlate with neurological exam and consider follow-up with a dedicated cervical MRI.3.Asymmetric prominent ligamentum flavum hypertrophy at T2 and unremarkable exam otherwise."}
{"instruction": "Generate impression based on findings.", "input": " The ventricles and sulci are normal in size. Incidental note is made of persistent FLAIR T2 signal within a left sided perivascular space. 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. Myelination is appropriate. 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": "Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's abnormal movements."}
{"instruction": "Generate impression based on findings.", "input": "5-month-old male with hearing loss. Evaluate for inner ear pathology. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable, aside from what appears to be a punctate focus of fluid in the right mastoid air cells.", "output": "1. No evidence of cochlear nerve deficiency or inner ear lesions.2. No evidence of structural abnormalities in the brain.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Left parieto-occipital intracerebral hemorrhage. Possible diagnosis of arteriovenous malformation. There is a 37 mm x 26 mm x 41 mm sized left parieto-occipital intracerebral hemorrhage with the surrounding edema.There is a mass effect towards left lateral ventricle occipital horn, however, there is no evidence of midline shift or transtentorial herniation.There is no evidence of acute ischemic infarct.There is a prominent vascular structure arising from anterior superior aspect of the intracerebral hemorrhage, otherwise there is no evidence of significantly increased vascularity.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. There are fluid collections on the right mastoid air cells.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, left transverse sinuses, left sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. Right transverse and right sigmoid sinus as well as right jugular bulb are not visualized on this MR venogram but prominent right occipital venous plexus which may indicate hypoplastic right side dural sinuses which is a normal variation..", "output": "1, Acute ICH with surrounding edema on the left parieto occipital lobe.2. A prominent vascular structure was seen on superior and anterior aspect of the ICH, otherwise no remarkable finding. 3. No other abnormal enhancing lesion.4. Normal MR venogram with hypoplastic right side transverse and sigmoid sinuses."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified viral encephalitis [A86], Reason for Study: ^Reason: F/u encephalitis History: seizure 22 years Male (DOB:7/6/1994)Reason: F/u encephalitis History: seizurePROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no abnormal enhancement.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the major intracranial arterial system.The visualized portions of the orbits are intact.Mucosal thickenings on bilateral maxillary sinuses, sphenoid sinus and ethmoid sinus are seen.Bilateral mastoid air cell show near complete opacifications which appear to be progressed since prior scan.", "output": "1. MRI of the brain is within normal limits2. Mucosal thickenings on paranasal sinuses and possible progression of bilateral mastoid air cell opacifications."}
{"instruction": "Generate impression based on findings.", "input": "Soft tissue swelling. Ulceration. Evaluate for osteomyelitis. Evaluation of the right ankle reveals normal bone marrow throughout. There is subcutaneous inflammation and swelling especially on the lateral aspect of the ankle. The Achilles tendon is unremarkable. The tibialis posterior, flexor hallucis longus, flexor digitorum longus tendons are unremarkable. The peroneal tendons are unremarkable. The lateral collateral ligaments are unremarkable.", "output": "Extensive inflammation in the subcutaneous tissues especially of the lateral ankle. No radiographic evidence of osteomyelitis"}
{"instruction": "Generate impression based on findings.", "input": " There are no definite new foci of enhancement. Numerous previously seen bilateral cerebral and cerebellar intra-axial foci of enhancement are stable to questionably minimally smaller. For example, there is a lesion in the anterior left temporal lobe on series 13 image 76 which measures 3 mm today compared to 4 mm previously. There is a lesion in the right medial temporal lobe on series 13 image 93 which measures 4 mm compared to 5 mm previously. There is no significant edema surrounding any of these lesions. There is apparent increased enhancement in the bilateral internal auditory canals which is likely related to normal vascular enhancement.There is no acute infarct, mass effect, midline shift or herniation. There are multiple scattered small to punctate foci of susceptibility effect associated with the lesions in the bilateral cerebral hemispheres which are overall stable, likely representing a combination of mineralization, chronic microhemorrhages and/or post treatment changes.", "output": "Overall interval stability in numerous intra-axial enhancing lesions most consistent with metastases. A few lesions may be questionably minimally smaller as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Pain and effusion, evaluate for torn meniscus. BONES: Osseous alignment is within normal limits. There is increased bone marrow signal in the posterolateral medial tibial plateau with linear hypointense signal on proton density sequence, which likely represents insufficiency fracture.MENISCI: There is truncation and loss of triangular shape of the posterior horn of the medial meniscus, consistent with tear. The lateral meniscus is normal in morphology and signal characteristics.ARTICULAR CARTILAGE AND BONE: Grade II to III chondromalacia of the medial compartment and medial facet of the patella. Grade II chondromalacia of the lateral compartment.LIGAMENTS: Anterior and posterior cruciate ligaments are unremarkable. There is increased signal around the medial collateral ligament suggestive of mild sprain. Lateral collateral ligament is unremarkable. EXTENSOR MECHANISM: Quadriceps mechanism and patellar ligament are within normal limits.ADDITIONAL", "output": "Insufficiency fracture of the posterolateral medial tibial plateau.Tear of the posterior horn of the medial meniscus.Large Baker's cyst.Mild MCL sprain."}
{"instruction": "Generate impression based on findings.", "input": "Female, 43 years old, history of multiple sclerosis, with weakness and urinary incontinence. Brain:Areas of periatrial T2 hyperintensity are unchanged as are a few additional scattered juxtacortical foci of T2 hyperintensity. No new or enhancing lesions are seen. No significant parenchymal edema or mass effect is detected. No abnormal extra axial fluid collections are observed. A focus of susceptibility within the left thalamus compatible with chronic microhemorrhage is unchanged. The ventricular system is stable and normal in size.Lumbar spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No pathologic intrathecal enhancement is seen. No epidural abnormalities are suspected.The intervertebral discs are preserved. No herniation or significant disc bulging is seen. No significant compromise of the spinal canal or neural foramina is noted.", "output": "1.Scattered lesions in the brain compatible with demyelinating disease are unchanged. No findings to suggest new or active lesions are seen.2.Unremarkable evaluation of the lumbar spine with no specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: subarachnoid hemorrhage. Signs and symptoms :subarachnoid hemorrhage. Nonenhanced head CT:Residual blood within the fourth ventricle with interval decrease since prior study.Interval decrease in the supratentorial subarachnoid hemorrhage. Extensive residual hemorrhage is still present.Hematoma in the interhemispheric fissure measuring 28.7-mm in transverse axis not significantly changed since prior study. There is effacement of all cortical sulci. There are one suspected areas of cortical low attenuation in the left frontal and parietal region concerning for air the onset of ischemic stroke. Follow-up with an MRI is recommended.Shunted lateral ventricles remain stable in size since prior study and no evidence of hydrocephalus. Residual blood within the lateral ventricles demonstrate no definitive interval change.", "output": "1.No evidence of new hemorrhage since prior study.2.Slight interval decrease in the amount of subarachnoid hemorrhage and blood within the fourth ventricle.3.Stable size of ventricular system and intraventricular hemorrhage in the lateral and third ventricle.4.Suspected areas of low attenuation of the cortex in the left hemisphere concerning for possible early onset of ischemic strokes. For further evaluation an MRI exam is recommended."}
{"instruction": "Generate impression based on findings.", "input": "79 years, Female, parotid cancer status post chemoradiation, now with brain metastasis. Examination is obtained for treatment planning and limited to SWI and post gadolinium 3-D SPGR sequences. There is an enhancing lesion involving the left medial temporal lobe measuring 15 x 15 x 16 mm (previously 12 x 13 x 13 mm) and abutting the left cerebral peduncle and the left optic tract. There is a second enhancing lesion involving the right superior cerebellar vermis measuring 13 x 11 x 11 mm previously 11 x 12 x 11 mm and abutting the right tentorial surface. No findings to suggest associated hemorrhage. There are however additional foci of susceptibility effect including the left cerebellar hemisphere, right parietal lobe, and right temporal lobes compatible with chronic microhemorrhages and are nonspecific in etiology.No findings to suggest intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections. Major vascular structures are patent. No destructive calvarial lesions are appreciated.There is evidence of right-sided parotidectomy. There is enhancement of the right facial nerve including its labyrinthine, tympanic, and mastoid segments, similar to prior.", "output": "1. Two enhancing lesions involving the left medial temporal lobe and right cerebellar vermis consistent with metastatic disease. These lesions measure slightly larger than on outside study from 8/26/2015. No new lesions.2. Multiple scattered foci of susceptibility effect compatible with chronic microhemorrhages and are nonspecific in etiology. There is no associated enhancement to suggest that these represent active metastases. 3. Evidence of right-sided parotidectomy and enhancement of the right facial nerve. The right facial nerve enhancement appears similar to prior and favored to be related to prior surgery involving the facial nerve. Suggest attention on follow-up however to exclude the small possibility of perineural tumor spread.4. Please note this MRI examination is limited to sequences for radiation treatment planning. "}
{"instruction": "Generate impression based on findings.", "input": "75-year-old female with a history of a left adrenal mass. ABDOMEN:LIVER, BILIARY TRACT: There are multiple scattered subcentimeter hypervascular foci which do not persist on delayed imaging which are too small to characterize but do not demonstrate washout kinetics. There is a 1.3 x 0.9 cm hypervascular focus in segment IVA of the liver which does not demonstrate washout kinetics and has the imaging characteristics of a FNH but also remains too small to characterize. SPLEEN: No significant abnormality noted.PANCREAS: Mildly dilated main pancreatic duct is of unclear etiology. No focal mass lesion is identified. ADRENAL GLANDS: There is a round left adrenal mass which demonstrates heterogeneous but predominately increased T2 signal abnormality and avid enhancement, measuring 2.8 x 2.8 cm.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Left adrenal mass with imaging characteristics suggestive of a pheochromocytoma although a lipid poor adrenal adenoma remains as a differential consideration.2.Multiple scattered nonspecific hypervascular foci in the liver are too small to characterize but may represent focal nodular hyperplasia. 3.Mild dilation of the main pancreatic duct without evidence of a focal mass lesion is of unclear etiology and clinical correlation is indicated. "}
{"instruction": "Generate impression based on findings.", "input": "Female 64 years old; Reason: To reassess for carcinoid mets in liver History: Carcinoid tumor metastatic ABDOMEN:LIVER, BILIARY TRACT: Unchanged resection cavity in segment 4/5, measuring 2.4 x 1.9 cm, previously 2.4 x 1.8 cm (series 4, image 17). Multiple scattered hyperintense foci on diffusion weighted images, consistent with metastases, appear similar in size and distribution compared to the prior study but increased in number when compared to the prior study dating back to 2009. The reference right posterior liver lesion is unchanged at 7 mm, previously 7 mm (series 4, image 17). Again seen is a segment 5/8 lesion which demonstrates washout on delayed contrast enhanced sequences, measuring 1.2 x 1.0 cm, previously 1.1 x 1.0 cm (55; series 13). Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Fat-containing lesion in the inferior left kidney likely represents an angiomyolipoma given loss of signal on fat suppressed imaging and is unchanged from the prior study. T2 hyperintense nonenhancing lesions are seen in the right kidney consistent with simple cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of prior hemicolectomy. Otherwise, no significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No significant interval change when compared to more recent prior imaging in the multiple reference liver lesions suspicious for metastases, see discussion above.2.No interval change in the liver resection cavity."}
{"instruction": "Generate impression based on findings.", "input": " The study is somewhat degraded due to motion artifact. Given this caveat:There is no acute cord compression. Please see lumbar spine MRI dictation for the diagnostic lumbar spine MRI performed earlier today for details of thoracolumbar findings.", "output": "No acute cord compression. Dedicated segment-specific MRI is recommended if symptomology localizes/persists."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Assess probable cavernoma. Signs and symptoms: None Pre-and post-enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrate two round foci of susceptibility and T2-hypointensity in the inferior left cerebellum highly suggestive of cavernous malformation. The lesions measure both at approximately 8.6 mm in size. There is evidence of a large associated developmental venous anomaly of the left cerebellum occupying a large segment of the cerebellum. Post-enhanced images demonstrate enhancement of this large developmental venous. The appearance the developmental venous anomaly on post enhanced images is suggestive of possibly two separate developmental venous anomaly. The largest developmental venous anomaly appears to extend inferiorly and to the midline and is smaller more superior located venous anomaly extends superiorly to the level left tentorial leaf. There is no evidence of prior hemorrhage, parenchymal edema or encephalomalacia with this finding. The fourth ventricle remains within normal and in midline. No evidence of any additional cavernoma.There is a thin band of T2/T2 flair hyperintensity in the left frontal lobe extending from the cortex to the left lateral ventricle without abnormal enhancement. This finding is new since prior exam from Silver Cross hospital dated 11 -- 26 -- 14. Findings to represent a nonspecific focus of encephalomalacia/gliosis.The anatomical morphology and signal intensity brain parenchyma is otherwise within normal on all MRI sequences and without detectable abnormal enhancement.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.", "output": "1.Two small (both approximately at 8.6-mm) cavernomas in the left cerebellum are identified. There is a large single or more likely two adjacent developmental venous anomaly associated with the cavernomas detected. No evidence of associated hemorrhage, surrounding edema or encephalomalacia is present. No significant change since prior study.2.Nonspecific linear encephalomalacia in the left frontal lobe which is new since prior MRI exam from 11 -- 26 -- 14.3.Unremarkable pre-and post enhanced brain MRI otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Anesthesia of skinClinical question: right face numbness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate T2 and FLAIR signal hyperintense lesion present along the anterior aspect of the right external capsule. There are several subcortical white matter lesions present along the frontal lobes.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: HeadacheClinical question: 3T scannerSigns and Symptoms: headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There is no evidence for intracranial mass lesion to explain patient's headaches.2.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. "}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with lumbago and sciatica presents with back and lower extremity pain. Evaluate stability. There is perhaps mild degenerative disc disease of the lower lumbar spine. The alignment is within normal limits with no frank instability between flexion and extension. The vertebral body heights are preserved.", "output": "Mild degenerative disc disease without evidence of instability."}
{"instruction": "Generate impression based on findings.", "input": "Chronic alcoholic pancreatitis. Pancreatic pseudocyst post drainage and stent removal. Evaluate pancreatic parenchyma ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is interval removal of a cystogastrostomy. There is a focal area of necrosis and main pancreatic duct stricture at the site of prior cystogastrostomy. There is discontinuity of the pancreatic duct, with upstream ductal dilatation. There is increased size of a pancreatic tail collection measuring 4.0 x 1.6 cm, which extends superiorly and is contiguous with the main pancreatic duct. ADRENAL GLANDS: There is a small left adrenal nodule measuring 1.0 cm. Normal right adrenal gland. KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Progression of chronic pancreatitis with focal pacreatic necrosis and pancreatic stricture at site of prior cystogastrostomy and increased size of pancreatic tail collection."}
{"instruction": "Generate impression based on findings.", "input": "12-year-old female patient with knee injury/pain. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact. Bone marrow signal is within normal limits.LIGAMENTS: The collateral and cruciate ligaments are intact. The popliteus muscle and tendon are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": " MRI Brain:Examination is motion degraded. There is however no evidence of acute infarct, mass, or mass effect. There is moderate degree of periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease, similar to prior. There is moderate degree of global parenchymal volume loss. Chronic lacunar infarct involving the right cerebellum again seen. No hydrocephalus. No extra-axial collections. There is no midline shift or herniation. The major cerebral flow voids are intact. Bone marrow signal and extra cranial soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms within the limits of motion degradation.", "output": "1. No evidence of acute infarct, edema, or intracranial mass effect. 2. Mild to moderate chronic small vessel ischemic disease which appears similar to prior study.3. No significant stenosis in the intracranial vasculature.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Disequilibrium for 2 - 3 months. Evaluate for evidence of strokes. There is a subcentimeter T2 hyperintense lesion in the left pons. There are also scattered punctate foci of T2 hyperintensity in the cerebral white matter. 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, mass effect, or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. A subcentimeter T2 hyperintense lesion in the left pons may represent a chronic lacunar infarct, but is incompletely characterized. Follow up with a brain MRI with contrast may be useful if there are no contraindications.2. Nonspecific scattered punctate foci of T2 hyperintensity in the cerebral white matter may represent the effects of chronic small vessel ischemic disease.3. No evidence of acute intracranial hemorrhage or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Testicular cancer, status post skull lesion resection: restaging. There is no significant interval change in size of numerous non-enhancing lesions with susceptibility effect in the bilateral cerebral hemispheres and left cerebellar hemisphere. There are no discernible extra-axial lesions. There is no evidence of acute intracranial hemorrhage, edema, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged, including the left frontal cranioplasty site. The orbits and paranasal sinuses are clear.", "output": "Stable treated intracranial metastases, without evidence of progression."}
{"instruction": "Generate impression based on findings.", "input": "28 year old male with history of testicular cancer. Abdomen:LIVER, BILIARY TRACT: Reference lesion in the right liver is T2 hyperintense and demonstrates progressive nodular enhancement pattern suggestive of hemangioma. It measures 7 x 7 mm on series 501, image 33, and measured 8 x 9 mm on prior CT. Additional T2 hyperintense lesion located more superiorly in the right lobe demonstrates similar imaging characteristics and likely represents an additional hemangioma (series 501, image 42). No gallstones or biliary ductal dilatation. Hepatic vasculature patent. 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: Scattered prominent left retroperitoneal/paraaortic lymph nodes, none of which are pathologically enlarged by CT size criteria. BOWEL, MESENTERY: No significant abnormality noted.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No evidence of metastatic disease in the abdomen/pelvis. 2.Scattered T2 hyperintense liver lesions likely represent hemangiomas and are not significantly changed. "}
{"instruction": "Generate impression based on findings.", "input": "Postoperative evaluation of his subdural and epidural empyema andcraniectomy. There is increased depression of the scalp by up to approximately 4 cm through the left frontoparietal craniectomy defect associated with compression of the underlying brain parenchyma and 8 mm of midline shift to the right, as well as partial effacement of the left lateral ventricle. There is persistent diffuse dural thickening and enhancement involving the left cerebral convexity, and to a lesser extent right anterior cerebral convexity. There is a 3 mm wide left cerebral convexity nonenhancing area within the thickened dura anterior to the craniectomy defect. There is also persistent prominent left cerebral hemisphere pial vascularity. There are subcentimeter defects in the right pons, bilateral basal ganglia, and right corona radiata, which likely represent chronic infarcts. There are also patchy areas of cerebral white matter T2 hyperintensity. There is no evidence of acute infarction.", "output": "1. Increased sunken scalp through the left frontoparietal craniectomy defect associated with compression of the underlying brain parenchyma and 8 mm of midline shift to the right.2. Persistent diffuse dural thickening and enhancement involving the left cerebral convexity, and to a lesser extent right anterior cerebral convexity with what appears to be a nonspecific 3 mm wide left cerebral convexity subdural collection anterior to the craniectomy defect, which may represent a residual hematoma, although superimposed infection cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with lymphoma and persistent altered mental status. There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse, mild, confluent, thin, high T2 signal along the bilateral ventricles, with a more focal area of increased T2 signal along the posterior horn of the left lateral ventricle. There is also a focus of increased T2 signal in the left cerebral hemisphere, which measures up to 8 mm. There is a right choroid fissure cyst. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are innumerable enhancing lesions distributed throughout the calvarium, which correspond to lytic lesion seen on the prior CT examination. There is high T2 signal in the bilateral mastoid air cells, suggestive of effusions. The orbits and scalp soft tissues are grossly unremarkable.", "output": "1. Innumerable enhancing lesions throughout the skull are consistent with lymphoma.2. Small lesions in the left cerebellar hemisphere and left periventricular white matter are nonspecific, but may represent sequelae of treated central nervous system lymphoma, prior infection, or chronic ischemia.3. No evidence of intracranial hemorrhage or acute infarct."}
{"instruction": "Generate impression based on findings.", "input": "History of left leg extremity numbness and weakness, evaluate structural lesion, nerve root impingement, disc herniation. Five lumbar type vertebral bodies are presumed to be present. There is mild decrease in height of L5 vertebral body likely of chronic etiology. Rest of the vertebral body heights are within normal limits. Bone marrow signal is benign. There is slight straightening of the normal lumbar lordosis. The conus medullaris is normal in position. There is increased T2 signal within the visualized distal cord along the upper T12 level, although axial images are not available through this level. There is thin linear intrinsic T1 signal at the lower L1 level within the dorsal thecal sac consistent with a fatty filum. There is mild narrowing of L1-L2, L2-L3, and L5-S1 discs with associated mild desiccation. Mild developmental distal narrowing of the lumbosacral spine is noted secondary to shortened pedicles.Multilevel degenerative changes are seen, as described below:T12-L1: On sagittal imaging there is disc bulging seen causing moderate central stenosis.L1-L2: There is ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L2-L3: There is disc bulge with bilateral foraminal prominence. There is mild to moderate bilateral foraminal stenosis. There is ligamentum flavum thickening and mild facet hypertrophy. There is effusion within the bilateral facet joints. There is mild spinal canal stenosis.L3-L4: There is disc bulge with moderate to severe bilateral foraminal narrowing right more than the left. There is no central canal stenosis.L4-L5: There is broad-based disc bulge causing right foraminal prominence. There is moderate right foraminal stenosis and mild to moderate left foraminal stenosis. There is evidence of central annular fissure. There is ligamentum flavum thickening and facet hypertrophy. There is facet effusion. There is moderate spinal canal stenosis at this level.L5-S1: There is evidence of vacuum disc component with broad-based disc bulge causing moderate to severe bilateral foraminal narrowing. There is mild ligamentum flavum thickening and facet hypertrophy with small amount of fluid is seen in the facet joints. There is moderate spinal canal stenosis is seen at this level.Paraspinous soft tissues are within normal limits.", "output": "1. Moderate multilevel degenerative disease mostly affecting L5-S1 causing moderate to severe bilateral foraminal narrowing.2. Moderate spinal canal stenosis at L4-L5 and L5-S1 associated with mild developmental canal l narrowing.3. Abnormal area of increased T2 signal visualized within the distal cord on sagittal imaging at upper T12 vertebral level. Recommend dedicated MRI of the thoracic spine for further evaluation of this finding.4. Linear increased T1 hyperintensity at the lower L1 vertebral level within the dorsal thecal sac most likely representing incidental fatty hilum. However, this can be associated with tethered cord, and clinical correlation is recommended.5. Decreased body height of L5 vertebra most likely chronic in nature."}
{"instruction": "Generate impression based on findings.", "input": " The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE", "output": "1. Mild distention of the left optic nerve sheath and mild flattening of the globes. This finding can be seen with intracranial hypertension and can be correlated with CSF opening pressure, as clinically indicated.2. There is a 4 mm pineal cyst which is incidentally seen. Brain MRI is otherwise unremarkable. No suspicious intracranial mass or evidence of mass effect. Preserved CSF spaces and biphasic CSF flow at the foramen magnum, without evidence of Chiari I information.3. Spine MRI appears within normal limits. "}
{"instruction": "Generate impression based on findings.", "input": "HCC screening. Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. There are numerous varices/collateral vessels. There is evidence of cavernous transformation of the portal vein and recanalization. No lesions suspicious for hepatocellular carcinoma. Cholelithiasis is again noted. There is also a stone in the distal common bile duct.SPLEEN: Severe splenomegaly.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No lesions suspicious for hepatocellular carcinoma.2.Choledocholithiasis."}
{"instruction": "Generate impression based on findings.", "input": "2-day-old male with apnea and multiple bradycardic events. Assess for bleed. Note is made of curvilinear hyperattenuation along the right and left tentorium consistent with a small subdural hematoma layering along the tentorium. Note is made of diffuse generalized hypoattenuation affects the entire right cerebral hemisphere, which may be related to technical artifact, however, if high clinical suspicion for acute ischemia, further evaluation with MRI could be considered. There is no evidence of intracranial mass. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells and paranasal sinuses are within normal limits.", "output": "1. Trace subdural hematoma layering along the tentorium. Close interval follow up examination is recommended. 2. Diffuse generalized hypoattenuation affects the entire right cerebral hemisphere, which may be related to technical artifact, however, if high clinical suspicion for acute ischemia, further evaluation with MRI could be considered.These findings and recommendations were discussed via direct phone call with Emily Weiss at 11:00 am on 4/13/13."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male with history of back pain. The cranial-cervical junction is normal. There is slight straightening of the normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body heights are preserved. The bone marrow and end plates demonstrate a normal MR appearance. The spinal canal is developmentally narrowed. At the levels of C2-C7, there is decreased AP spinal cord measurement likely the result of a developmentally narrowed canal as well as mild degenerative disc disease which will be described in detail below. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: C2-C3: There is no significant disc abnormality. No spinal canal or neuroforaminal stenosis.C3-C4: There is a disc bulge resulting in mild spinal canal stenosis. No significant neuroforaminal stenosis.C4-C5: There is moderate disc bulge with a central prominence causing moderate spinal canal stenosis. No significant neuroforaminal stenosis.C5-C6: There is a moderate disc bulge with a right paracentral prominence causing moderate spinal canal stenosis. No significant neuroforaminal stenosis.C6-C7: There is no significant disc abnormality. No spinal canal or neuroforaminal stenosis.C7-T1: There is no significant disc abnormality. No spinal canal or neuroforaminal stenosis.", "output": "1. No evidence of acute cervical cord compression.2. Developmentally narrowed spinal canal with mild degenerative changes resulting in mild to moderate spinal canal stenosis worse at C4-5 and C5-6, with flattening of the cord."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old with history of metastatic renal cell cancer, presurgical for C4 vertebrectomy. Reversal of lordosis of the cervical spine is identified. There is a significant compression fracture at C4, as well multiple metastases seen throughout the posterior elements of the cervical spine as reported on today's MRI. A posterior laminectomy from C3 to C5 is also identified.", "output": "Diffuse posterior element metastases, as well as a significant compression deformity of C4. For better characterization, please see today's dedicated MRI report."}
{"instruction": "Generate impression based on findings.", "input": "Stage 4 neuroblastoma with recurrent disease to posterior fossa; assess for progression of disease. Brain: There are postoperative findings related to suboccipital craniotomy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is persistent left mastoid fluid signal.", "output": "No evidence of intracranial neuroblastoma recurrence. "}
{"instruction": "Generate impression based on findings.", "input": "Spells concerning for demyelinating disease: tremors and jerking. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are non-enhancing punctate foci of high T2 signal in the subcortical white matter of the left anterior insula and the anterior left temporal stem. There is a small developmental venous anomaly in the region of the left supramarginal gyrus. 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": "1. Non-enhancing punctate foci of high T2 signal in the subcortical white matter of the left anterior insula and temporal stem are nonspecific. 2. Small developmental venous anomaly in the region of the left supramarginal gyrus. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 59 years old, with neuropathy and right arm weakness and pain. The cervical lordosis is straightened. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. Marrow signal characteristics are slightly heterogeneous but there is no worrisome marrow replacement or marrow edema. The spinal cord demonstrates normal signal intensity and morphology except as discussed below.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C4-5: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C5-6: Posterior disc-osteophyte complex formation asymmetric to the right paracentral and right foraminal regions. There is slight flattening of the ventral cord but no evidence of cord signal abnormality. A mild to moderate generalized spinal canal stenosis is seen. The right neural foramen is moderately narrowed and the left is mildly narrowed. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.", "output": "Multilevel cervical spondylosis is seen most severely affecting C5-6 where there is a disc osteophyte complex asymmetric to the right paracentral and foraminal regions. This results in slight flattening of the ventral cord and a mild to moderate generalized spinal canal stenosis. The right neural foramen is also moderately narrowed at this level."}
{"instruction": "Generate impression based on findings.", "input": "Gait imbalance and veering to the side. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral and pontine white matter T2 hyperintensity. However, there cerebellum is unremarkable. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses are grossly unremarkable. There are bilateral lens implants. There is a 5 mm thick right frontal scalp lipoma. There is a 9 mm wide focus of high T2 and T1 signal in the left parietal calvarium that likely represents a hemangioma.", "output": "1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Scattered cerebral and pontine white matter T2 hyperintensity likely represents chronic small vessel ischemic disease.3. Mld diffuse cerebral volume loss."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Patient with low back pain, elevated CRP/ESR, evaluate for discitis/osteomyelitis. Signs and symptoms: As above. Nonenhanced total spine MRI:Evaluation of cervical region demonstrate normal signal intensity and alignment of vertebral column. Unremarkable signal intensity and caliber of the cervical cord. No evidence of spinal stenosis at any level. No detectable paraspinal soft tissue abnormality.Evaluation of the thoracolumbar spine demonstrate normal signal intensity and anatomical alignment of vertebral column. Unremarkable signal intensity of thoracic cord. No evidence of spinal stenosis at any level.No evidence of perispinal soft tissue abnormalities.", "output": "No evidence of cord compression."}
{"instruction": "Generate impression based on findings.", "input": " There are postoperative findings related to C2 peripheral nerve sheath tumor resection and C2-4 posterior fusion. At C2-C3, there is a 10 x 9 mm enhancing lesion within the right neuroforamen, grossly unchanged in size compared to prior. There is mild facet hypertrophy at several levels. At C5-C6, there is uncovertebral osteophyte which results in moderate bilateral neural foraminal narrowing. There is mild effacement of the ventral thecal space. There is mild loss of disc height at this level. At C6-C7, there is endplate and uncovertebral hypertrophy with resultant bilateral neural foraminal narrowing. There may be minimal narrowing of the spinal canal at this level. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. The spinal cord is of normal caliber and signal. There is no pathological enhancement. There is a partially imaged T2 signal abnormality in the pons, which may be nonspecific and was better visualized on the MRI of the brain from 2/4/2015.", "output": "1. Postoperative findings related to C2 peripheral nerve sheath tumor resection and C2-C4 posterior fusion. Stable enhancing lesion in the right neural foramen at C2-C3, without significant interval change compared to prior and may represent residual or recurrent tumor.2. Degenerative changes in the cervical spine mostly at C5-C6 and C6-C7, unchanged.3. Partially imaged T2 signal abnormality in the pons, which is nonspecific and was better visualized on the MRI of the brain from 2/4/2015. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out stroke. Signs and symptoms: Patient with hemoglobin SC, severe headache. Nonenhanced head CT:No detectable acute intracranial findings. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.If concern for stroke is high recommend follow up with an MRI examination.Calvarium and soft tissues of the scalp are unremarkable.Limited images through the orbits, paranasal sinuses and mastoid air cells are unremarkable.Prominence of adenoids is noted.", "output": "Negative nonenhanced head CT."}
{"instruction": "Generate impression based on findings.", "input": "Medial knee pain for 4 months. Evaluate meniscus. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a distinct linear band of decreased T1 signal within the medial femoral condyle (image 18, series 7) with more diffuse low T1/high T2 signal surrounding it. These findings likely represents an occult stress fracture with surrounding bone edema. The articular cartilage of all three compartments is intact.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Occult fracture of the medial femoral condyle with surrounding edema. "}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with right shoulder pain and impaired movement, history of myeloma ROTATOR CUFF: The supraspinatus appears normal. There is perhaps mild insertional tendinosis of the infraspinatus with associated cysts within the humeral head, but no discrete tear. There is also mild edema type signal along the myotendinous junction of the infraspinatus which may indicate a mild strain. Teres minor tendon is intact. There is mild intermediate signal intensity within the subscapularis tendon which may indicate a mild tendinosis, however we see no discrete tear or abnormality within the musculature.SUPRASPINATUS OUTLET: There is perhaps mild acromioclavicular joint osteoarthritis. A small amount of fluid is present within the subacromial bursa which is of questionable significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is a small amount of fluid within the glenohumeral joint, but no frank effusion. Evaluation of the articular cartilage is limited due to motion and a non-arthrographic study, however there appears to be degeneration of the articular cartilage along the anterior aspect of the glenoid. Given the limitations of a non-arthrographic study, the glenoid labrum appears normal.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL", "output": "1.Heterogeneous bone marrow from multiple myeloma2.Mild rotator cuff tendinosis and strain of the infraspinatus, but no full-thickness rotator cuff tear is evident.3.Mild degeneration of the articular cartilage of the glenohumeral joint.4.A small amount of fluid in the subacromial bursa is of questionable significance."}
{"instruction": "Generate impression based on findings.", "input": "28 year-old female with history of Crohn's colitis complaining of abdominal pain and vomiting. Rule out Crohn's flare, rule out obstruction. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple lymph nodes scattered throughout the mesentery, likely reactive.BOWEL, MESENTERY: Long segment thickening extending from the neoterminal ileum measuring approximately 7 cm may reflect chronic/resolving Crohn's disease. No bowel obstruction as clinically questioned.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse, patchy low-attenuation areas likely represents any infiltration secondary to previous inflammatory disease. No bowel obstruction as clinically questioned.BONES, SOFT TISSUES: Enhancing focus within the perirectal soft tissue extends superiorly to the levator ani terminating at the intersphincteric level may represent an abscess/fistula which appears grossly unchanged when compared to the previous MRI, 5/2005. This area of enhancement measures 9 x 27 mm, (image 141, series 3).OTHER: No significant abnormality noted", "output": "1. Long segment bowel wall thickening of the neoterminal ileum measuring approximately 7 cm may reflect chronic/resolving Crohn's disease, appears to have increased in comparison with prior study. 2. No bowel obstruction as clinically questioned.3. Enhancing focus within the perirectal soft tissue represents an abscess/fistula which appears grossly stable when compared to prior MRI, 5/2005."}
{"instruction": "Generate impression based on findings.", "input": "87-year-old woman with history of elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal hepatic lesions are identified.The gallbladder is full of stones and sludge. The common bile duct measures up to 8 mm in diameter.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small left pleural effusion with adjacent pulmonary edema and atelectasis noted.", "output": "1.Cholelithiasis without evidence of cholecystitis.2.Mild common bile duct dilatation, but at the limits of normal for patient of this age. No ampullary stone or extrinsic mass identified."}
{"instruction": "Generate impression based on findings.", "input": "Female 79 years old Reason: Eval scoliosis History: severe chronic back pain. The bones are demineralized, suggestive of osteopenia. There is a compression fracture of T10 as seen on prior MRI study. There is multilevel degenerative disk disease throughout the spine, particularly affecting the upper and mid lumbar spine. There is grade 1 retrolisthesis of C3.There is approximately 45 degrees of dextroscoliosis of the thoracolumbar spine, as measured from the superior endplate of T5 to the inferior endplate of L2. This decreases to approximately 20 degrees with right bending, and increases to approximately 50 degrees with left bending. There is levorotoscoliosis of the lumbar spine of approximately 30 degrees as measured from the superior endplate of L2 to the inferior endplate of L4. This increases to approximately 32 degrees with right-sided bending, and decreases to approximately 28 degrees with left bending. There is approximately 2.5 cm of positive coronal balance. There is approximately 4.5 cm of positive sagittal balance. Moderate osteoarthritis affects both hips and the acromioclavicular joints. Surgical clips in the right hemiabdomen are likely from a prior cholecystectomy.", "output": "Scoliosis and other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Right neck mass status post biopsy on 5/2015 with pathology as cyst. There is a T2 hyperintense, enhancing, right palatine tonsillar mass measuring 3.9 x 3.4 x 2.7 cm with extension into the soft palate and mild oropharyngeal airway narrowing. There may also be slight extension of tumor across the glossotonsillar sulcus. There is right level 2 lymphadenopathy, including a diffusely enhancing lymph node that measures 2.0 x 1.2 cm. In addition, there is an adjacent cystic lesion with layering debris or hemorrhage measures 2.2 x 2.6 cm. The salivary glands are unremarkable. There are right temporomandibular joint degenerative changes with an associated small effusion and subluxation. There is mild scattered paranasal sinus mucosal thickening. There is mild scattered periventricular and subcortical white matter T2 hyperintensity compatible with chronic small vessel ischemic disease. There is multilevel degenerative cervical spondylosis. The orbits are unremarkable.", "output": "1. A mass in the right palatine tonsil with extension into the soft palate likely represents a squamous cell carcinoma or minor salivary gland neoplasm.2. Right suprahyoid lymphadenopathy likely represents metastatic disease, juxtaposed to what may represent a branchial cleft cyst with prior hemorrhage and possible tumor encroachment.3. Advanced degenerative changes involving the right temporomandibular joint."}
{"instruction": "Generate impression based on findings.", "input": "Male; 70 years old. Reason: eval for lesions History: s/p OLT 10/12 for HCC, elevated AFP LUNG BASES: Status post sternotomy.ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes related to liver transplant. Paradoxical loss of signal on in-and-out of phase images, suggestive of iron deposition. No suspicious hepatic lesion. Stable mild extrahepatic biliary ductal dilation. The portal vein and its branches, as well as the hepatic artery and its branches, appear patent, though evaluation at the porta hepatis is limited by artifact from surgical clips. The hepatic vein and its branches are patent.SPLEEN: No significant abnormality noted.PANCREAS: Stable appearance of two T2 hyperintense lesions within the pancreas with the largest lesion in the pancreatic neck measuring 1 x 0.5 cm, unchanged (series 6/19). 1.0 x 0.5 cm No pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintensities within the kidneys, likely representing cysts.RETROPERITONEUM, LYMPH NODES: Aortic graft, partially visualized.BOWEL, MESENTERY: Susceptibility artifact from metallic hardware in the region of the gastric body, which again limits evaluation of the adjacent structures.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Unilocular fluid collection in the region of the hepatic vein/IVC confluence and anterior to the right diaphragmatic crus measures up to 4.2 x 2.6 cm, unchanged (series 3/11) and again most likely due to a postsurgical fluid collection or seroma.", "output": "1.No suspicious hepatic lesion.2.Stable unilocular probable postsurgical fluid collection or seroma.3.Stable appearance of two cystic lesions in the pancreas, likely representing sidebranch IPMNs."}
{"instruction": "Generate impression based on findings.", "input": "Possible meniscal tear MENISCI: There is marked medial extrusion of the medial meniscus. The lateral meniscus is unremarkable..ARTICULAR CARTILAGE AND BONE: There is marked loss of cartilage of the medial femoral condyle and medial tibial plateau with joint fluid down to the underlying bone. There is associated bone marrow edema. In addition there is marked loss of articular cartilage along the medial facet of the patella with thinning of the articular cartilage on the lateral facet.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "Medial extrusion of the medial meniscus with marked loss of medial articular cartilage. Severe osteoarthritis"}
{"instruction": "Generate impression based on findings.", "input": "60-year-old with personal history of right breast cancer and now known to have BRCA gene mutation. Patient desires prophylactic mastectomy. There is heterogeneous amount of fibroglandular tissue in the left breast. Mild parenchymal enhancement is noted in the left breast. The patient is status post right mastectomy and reconstruction. No suspicious enhancement in the right chest wall.There is a 6 mm reniform enhancing mass in the left lower outer quadrant anterior depth. This is probably an intramammary lymph node. No other enhancing masses or areas of non-mass enhancement are seen. No abnormal axillary lymph nodes are identified in either axillary region. Postoperative changes are identified in the right axilla.", "output": "A 6 mm left breast mass is probably a normal intramammary lymph node, though establishing stability by comparing to prior examinations is recommended. If stability cannot be established, then targeted ultrasound should be performed to ensure that this has the sonographic appearance of a lymph node as well.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison."}
{"instruction": "Generate impression based on findings.", "input": "46 years Female (DOB:10/4/1970)Reason: compare to prior MRI for brain mets History: NonePROVIDER/ATTENDING NAME: STEVEN J. CHMURA SERVICES ANCILLARY The patient status post left frontal craniotomy. There is encephalomalacia present along the left frontal lobe. It is unchanged compared to the prior exam.Patient is status post posterior fossa craniotomy. An enhancing lesion in the vermis has decreased in size compared to the prior exam. It currently measures 16 x 6 mm and previously measured 26 x 11 mm axial dimensions. There is associated enlargement of the fourth ventricle.A right paramedian pontine mass is present which measures 12 x 10 mm axial dimensions and previously measured 12 x 9 mm axial dimensions.There is a punctate right periventricular white matter enhancing lesion which is unchanged compared to the prior exam.There is a right occipital lobe lesion measuring 5 mm in diameter which previously measured the same is stable.There are FLAIR and T2 hyperintense lesions present in the left precentral gyrus, right frontal lobe and right temporal lobe which were also present on the prior exam and have not changed. These presumably related to previously treated lesions.Incidental note is made of a developmental venous anomaly in the right centrum semiovale.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Since the prior exam an enhancing lesion in the vermis has decreased in size and presumably represents postoperative change.2.There are multiple lesions in the brain parenchyma one in the pons and another in the right occipital lobe and one in the right centrum semiovale which are stable compared to the prior exam. Presumably these are related to metastatic disease.3.Since prior exam a pontine mass has remained stable. This is suspicious for neoplasm."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female strong family history of breast carcinoma. Family history of breast cancer in her mother diagnosed at age 37, and a maternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally, somewhat limiting the sensitivity of the examination.Scattered T2 hyperintense cysts are visualized in both breasts. There is stable appearance of a benign morphology mass measuring 0.8 cm in the far inferior left breast, which demonstrates a typically benign kinetic profile, and T2 signal hyperintensity, likely representing fibroadenoma. 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": "Right sided weakness and sensory change. There are punctate foci of restricted diffusion and high T2 signal in the upper left precentral gyrus and paracentral lobule. There is a background of diffuse patchy cerebral, brainstem, and cerebellar white matter T2 hyperintensity. There are punctate foci of encephalomalacia in the bilateral basal ganglia and corona radiata. There is also encephalomalacia and susceptibility effect in the left posterosuperior temporal lobe and inferior parietal lobule. There is a pineal cyst that measures 9 mm in diameter. There is diffuse mild cerebral volume loss. There is no midline shift or herniation. There is a 9 mm diameter basilar tip aneurysm. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "1. Punctate recent infarcts in the left upper left precentral gyrus and paracentral lobule.2. Chronic lacunar infarcts in the bilateral basal ganglia and corona radiata. 3. Area of chronic hemorrhage in the left posterosuperior temporal lobe and inferior parietal lobule. 4. A background of diffuse patchy cerebral, brainstem, and cerebellar white matter T2 hyperintensity may represent chronic small vessel disease. 5. A 9 mm diameter basilar tip aneurysm appears to have gradually increased in size. "}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Rule out cord compression. Signs and symptoms: Pain, right arm weakness and leg pain. Non-enhanced total spine MRI:Examination is performed utilizing cord compression and without dedicated axial images.Examination demonstrate normal height and alignment the vertebral column. There is diffuse marrow signal abnormality or vertebral column consistent with patient's known osseous metastatic lesions. There is no convincing evidence of any significant spinal canal compromise. Very subtle effacement of subarachnoid space at T10 is suggestive of mild epidural spread of tumor. There is no detectable mass effect on the cord and with maintained normal caliber and signal intensity of the cord. This finding can be further assess with a dedicated pre-and post enhanced thoracic MRI. Previously reported suspected signal abnormality of the cord at T3 and T4 is not identified on this exam.A well demarcated near CSF signal intensity collection in the soft tissues of the spine with interval decreased size since prior exam at L1 and L2 is again noted.", "output": "1.Normal signal intensity and caliber of the cord.2.Subtle epidural spread of tumor from diffuse osseous metastatic lesions at T10 with subtle effacement of subarachnoid space is noted. This finding is not associated with any cord signal abnormality.3.Diffuse osseous metastatic lesions without evidence of fracture or malalignment."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate for signs of encephalitis, infection or prior disease. Signs and symptoms: Continued progression of encephalopathy with dystonia and myoclonus. Pre-and post-enhanced brain MRI:Diffusion weighted images are severely compromised due to large metallic fragment/shrapnel artifact obscuring the left hemisphere and the posterior fossa. Beyond the region of artifact no evidence of restricted diffusion.Flair and T2-weighted images are also significantly compromised in particular through the posterior fossa and left temporal secondary to metallic shrapnel artifact.The examination redemonstrates a single punctate focus of flair hyperintensity in the right frontal centrum semiovale similar to prior exam. The anatomical morphology and the signal intensity of brain parenchyma on the artifact remains within normal on all MRI sequences and without interval change. Ventricular system remains within normal and with maintained midline. Lumbosacral cortex, cortical sulci, ventricular system and CSF spaces beyond the artifact.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement. The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits. Note however should be made that there is artifactual T2 hyperintensity of the entire retropatellar space secondary to metallic artifact.", "output": "1.No evidence of an acute or new finding since prior exam.2.Single punctate focus of flair hyperintensity in the right frontal centrum semiovale as was noted on prior exam and of no clinical significance.3.Unremarkable and stable pre-and post enhanced brain MRI otherwise as detailed.4.Note should be made that a large artifact secondary to a shrapnel fragment obscures portions of the left hemisphere and posterior fossa as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 24 years old. History of AML s/p matched sibling stem cell transplant with knee pain. History of steroid treatment. Evaluate for AVN. MENISCI: Medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: The cartilaginous surface is intact. No evidence of avascular necrosis or focal marrow occupying lesion. No bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1. No evidence of avascular necrosis or focal marrow occupying lesion.2. No meniscal, cartilaginous, or ligamental injury."}
{"instruction": "Generate impression based on findings.", "input": "Male, 42 years old, with grade 3 glioma recently started on Avastin plus CCNU, new regimen since prior MRI. Evaluate for interval changes. Redemonstrated is evidence of prior tumor resection with cavities in the right anterior temporal lobe and the inferior right frontal lobe. Evidence of prior stereotactic biopsy is also seen.Since the prior examination, marked T2 hyperintensity, mass effect and enhancement within the right frontal lobe and insula have dramatically improved. Mass effect has essentially resolved and only mild patchy enhancement persists. An area of enhancement along the right lateral ventricular atrium seen on the prior examination has also resolved. Within this area of general improvement, there has been an increase in diffusion restriction.The left cerebral hemisphere, brainstem and cerebellum remain uninvolved by tumor. No new lesions are seen. The size and morphology of the ventricular system have recovered to that seen on the pre-progression examination of 8/5/2015.", "output": "A significant interval response to therapy is seen with much reduced enhancement, T2 signal abnormality and mass effect centered on the right frontal lobe. Progressive diffusion restriction within this tissue likely represents a treatment effect."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for cord compression History: b/l 3/5 weakness in quads, new onset. Hx metastatic urothelial ca The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.Degenerative changes affect the cervical spine, with multilevel disc dessication and bulging, more prominent at the C4-C5, C5-C6 and C6-C7 levels, where there is mild associated neural foraminal narrowing. Degenerative changes also affect the lumbar spine, with mild subluxation at L4-L5 associated with facet arthropathy, as well as disc bulging at L5-S1. There is a mild rightward curvature of the lower thoracic and upper lumbar spine. A small hemangioma within the L1 vertebral body is noted. Bilateral lower pole renal cysts are incompletely characterized on this study.", "output": "1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Multilevel degenerative changes affect the cervical and lumbar spine without significant compromise to the spinal canal. There is some evidence for neural foramen narrowing, however, due to the screening nature of this protocol, further details are not as evident on imaging as dedicated protocols of the spine."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with spinal stenosis and low back pain. Five lumbar type vertebral bodies are identified. Mild retrolisthesis at L3-4. Lumbar levoscoliosis is present. Vertebral body heights are preserved. Disc space narrowing and associated degenerative endplate changes are present at L2-3 and L3-4; the bone marrow signal is otherwise within normal limits aside from some scattered Schmorl's nodes. The conus tip is at the level of L1-L2 and the visualized thoracic cord demonstrates normal caliber and signal. There is fatty atrophy of the paraspinal muscles but no paraspinal soft tissue mass.Multilevel degenerative changes are seen, as described below:T11-T12: Unremarkable.T12-L1: No central canal or foraminal stenosis.L1-L2: Small left paracentral disc protrusion causing mild left foraminal stenosis. No central or right foraminal stenoses.L2-L3: Moderate posterior disc bulge and bilateral facet hypertrophy. Mild central and right foraminal stenoses. No left foraminal stenosis.L3-L4: Mild retrolisthesis and associated disc uncovering. Diffuse disc bulge with superimposed right foraminal prominence. Prominent dorsal epidural fat. Bilateral facet hypertrophy. Moderate right foraminal narrowing. Mild central and left foraminal narrowing.L4-L5: Bilateral facet hypertrophy and ligamentum flavum thickening, left greater than right. Mild left foraminal narrowing. No central or right foraminal narrowing.L5-S1: Moderate facet hypertrophy without central or foraminal stenoses.Well-circumscribed T2 hyperintense lesion in the spinal canal at the level of S1-S2 is compatible with a Tarlov cyst.", "output": "Multilevel degenerative changes as described above. Most notably, there is a diffuse disc bulge with small superimposed right foraminal prominence at L3-L4 which causes moderate right foraminal narrowing."}
{"instruction": "Generate impression based on findings.", "input": "Reason: meniscus injury History: pain and swelling MENISCI: There is a complex tear of the posterior horn of the medial meniscus including a large horizontal and longitudinal component which extends to both the tibial and femoral articular surfaces. The lateral meniscus appears intactARTICULAR CARTILAGE AND BONE: There is blistering of the articular cartilage along the medial facet of the patella. There is relative sparing of the articular cartilage along the medial and lateral tibiofemoral compartments. No bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL", "output": "1. Complex tear of the medial meniscus with both longitudinal and horizontal components.2. Moderate-sized joint effusion and Baker's cyst. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: altered mental status History: altered mental status There are scattered restricted diffusion involving left is a ganglia insular cortex and frontal as well as parietal lobe indicating acute ischemic infarct. There is no evidence of hemorrhagic transformation.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.", "output": "Acute ischemic infarct involving left basal ganglia, insular cortex, frontal lobe and parietal lobe. No evidence of hemorrhagic transformation."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with right meniscus pain MENISCI: Mild globular intermediate signal within the lateral meniscus with blunting of the free edge (series 12, image 18). Loculated fluid along the anterior and lateral tibiofemoral compartment may represent a parameniscal cyst.The medial meniscus is diminutive with degenerative tearing of the posterior horn including a probable radial tear. There is medial extrusion of the body of the medial meniscus. ARTICULAR CARTILAGE AND BONE: Increased edema type marrow signal is noted at the patellofemoral compartment. Diffuse severe chondromalacia of the patellofemoral compartment, lateral worse than medial, with subchondral cysts and edema.Moderate degenerative disease affects the medial tibiofemoral compartment. Moderate degenerative disease affects the lateral tibiofemoral compartment. Bilateral tibiofemoral osteophytes.LIGAMENTS: The cruciate ligaments are intact. High signal at the femoral portion of the ACL may represent a ganglion. The medial collateral ligament is slightly thickened without abnormal signal, possibly chronic. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1.Degenerative tearing of the posterior horn of the medial meniscus as described above. Degenerative tearing of the lateral meniscus. 2.Loculated fluid along the anterior and lateral tibiofemoral compartment may represent a parameniscal cyst.3.Moderate to severe osteoarthritis worst at the patellofemoral compartment as described above. 4.Small joint effusion. Small Baker's cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 6 years old, with history of ependymoma. Brain:Postoperative findings are seen compatible with occipital craniotomy. A right frontal approach EVD is in place. The tip of the catheter sits at the lateral margin of the right frontal horn and appears to have retracted somewhat when compared to the prior CT.Diffuse gyriform cortical restricted diffusion is seen involving the cerebral hemispheres symmetrically. Restricted diffusion is also demonstrated in the basal ganglia bilaterally, in the cerebellum bilaterally, with patchy involvement of the brainstem.Numerous heterogeneously enhancing masses are demonstrated intracranially. These are found primarily within the ventricles or the CSF spaces of the sulci and basal cisterns. Lesions range in size from punctate nodules to a bulky aggregate within the left suprasellar cistern which measures up to 5 cm. In addition to the discrete nodules, there is extensive dural enhancement and diffuse leptomeningeal enhancement particularly along the brainstem. Many of the tumor is demonstrated susceptibility effect and/or T1 signal compatible with blood product. The lateral and third ventricles are dilated similar to that seen on the prior examination. Periventricular T2 hyperintensity may reflect transependymal CSF flow. The fourth ventricle is somewhat distorted due to the presence of tumor and or postoperative changes.Spine:Diffuse dissemination of enhancing tumor is seen within the spine with areas of discrete nodularity as well as leptomeningeal spread. A very longitudinally extensive tumor is seen within the posterior lateral left spinal canal occupying the entire cervical spine and part of the thoracic spine. This lesion displaces and compresses the adjacent spinal cord. There is evidence of extensive spinal cord T2 signal abnormality which may reflect both edema and/or tumor invasion.Spinal alignment is anatomic. Vertebral body heights are preserved. Diffusely fatty marrow replacement may reflect prior radiotherapy. Bilateral airspace opacities and atelectasis of the left lower lobe are seen.", "output": "1.Findings are seen compatible with diffuse CSF dissemination of tumor involving the intracranial space and the spine. Bulky tumor deposits are evident within the ventricular system and in the subarachnoid spaces. Extensive tumor spanning the cervical and upper thoracic spine causes severe displacement and compression of the spinal cord.2.Evidence of diffuse hypoxic ischemic injury of the brain is demonstrated.3.Supratentorial ventricular dilatation appears similar to that seen on the prior CT examination. The right frontal approach EVD tip is positioned just at the lateral margin of the frontal horn and appears to have retracted relative to the prior CT."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question to be answered: Rule out intracranial hemorrhage and airway impingement. Signs and symptoms shortness of breath and anisocoria CT of brain without infusionnotice of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Calvarium remains intact. Examination remains is stable since prior study.Irregular high density material overlapping the cortex of right high convexity frontal -- parietal lobe is nonspecific and was present on the prior exam. There is no evidence of associated edema with this finding. Further evaluation with an MRI is recommended.CT of the soft tissues of the neck.Images through the skull base demonstrate no evidence of destructive lesions. Irregular shape of the left globe with internal calcification is redemonstrated with no interval change since prior exam.Minimal chronic sinus disease.Extensive opacification of left mastoid air cells remains stable since prior study. This finding is not associated with any bony changes.Lack of contrast infusion makes precise evaluation of the soft tissues difficult however within this limitation no definitive evidence of a mass is identified. Three visualization of multiple cervical lymph nodes. Endotracheal tube is identified.Images through the apices of the lungs demonstrate extensive pleural effusion. Please review the dictated report of chest x-ray performed the same date. Bony structures of the area of exam remains unremarkable.", "output": "1.Stable CT examination of brain without infusion. Not a specific cortical calcification in the right parietal with no interval change.2.Endotracheal tube noted on CT of the neck. Extensive pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "right side weakness, occlusion of the left ICA from 2-3cm above the bifurcation. There is no MR evidence of subacute hematoma on the wall of the left extracranial ICA.Instead, the left ICA from the occlusion point to the level of reconstitution (paraclinoid segment) shows luminal iso or slightly high signal intensities indicating intraluminal evolving thrombus. And the left ICA appears to be occluded.There is no other abnormal signal intensity on other craniocervical arterial system.3D MRA neck pre and post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate complete occlusion of the left extracranial ICA and reconstituted at the level of the left ophthalmic artery, no change since prior CT angiography.Otherwise, the right brachiocephalic, left common carotid, right CCA and left subclavian arteries appear to be normal. The vertebral artery origins are normal.", "output": "1. No MR evidence of arterial dissection on the left ICA (extracranial and intracranial).2. Complete occlusion of the left ICA from 2cm above the bifurcation and reconstituted at the level of the left ophthalmic artery. "}
{"instruction": "Generate impression based on findings.", "input": "57 year old male with heart failure with reduced ejection fraction (HFrEF), s/p renal transplant in 2007, COPD, HTN, DM, NSTEMI during neutropenic sepsis recently, cardiac cath deferred due to acute kidney injury, atrial fibrillation. Evaluation for viability/scar. First Pass PerfusionDuring hyperemia, no perfusion defects were presentViability/ Myocardial ScarThere is no evidence of prior myocardial infarction. There is a very small focal region of epicardial late gadolinium enhancement in the apical inferolateral wall which suggests the presence of a small amount of fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is mildly decreased 49%. The LVEDV is 187 ml (normal range 142+/-34), the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVESV is 96 ml (normal range 47+/-19) and the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9). The LV mass is 172 g (normal range 164+/-36) and the LV mass index is 90 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%. The RVEDV is 164 ml (normal range 142+/-31), RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVESV is 80 ml (normal range 54+/-17), and the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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 FindingsThere are small bilateral pleural effusions and a possible right lung infiltrate near the hilum, correlation with recent non-contrast chest CT or chest x-ray suggested. 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. No perfusion defects/ \"ischemia\" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and mildly decreased systolic function (LVEF 49%) with a very small focal region of epicardial late gadolinium enhancement in the apical inferolateral wall which suggests the presence of a small amount of fibrosis, inflammation, or infiltration. The pattern is not consistent with prior myocardial infarction.4. Normal RV size with normal systolic function (RVEF 51%). See extra cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "History of uterine mass and concern for uterine leiomyosarcoma. PELVIS:UTERUS, ADNEXA: Anteverted retroflexed uterus. Arcuate uterus. The endometrium is normal in thickness. The junctional zone measures up to 8 mm, within normal limits. The adnexa are unremarkable.There is a T2 hyperintense partially exophytic lesion extending from the anterior right lower uterine segment which does not demonstrate abnormal postcontrast enhancement. Additional smaller cysts are noted. Small defect in the lower uterine segment consistent prior cesarean section scar. The cervical stroma is unremarkable.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": "1.No suspicious uterine mass as clinically questioned.2.The lesion described on the CT is a simple benign-appearing cystic structure which may represent a post cesarean section benign fluid collection or possibly a large nabothian cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate left knee for loose body, MPFL tear (patellar dislocation), chondromalacia patella History: Recent traumatic patellar dislocation 2 weeks ago Evaluation of the proximal tibia and the surrounding soft tissues is limited due to metallic susceptibility artifact related to the patient's prior tibial tuberosity transfer.MENISCI: The lateral meniscus appears intact. There is poorly defined increased signal intensity within the posterior horn of the medial meniscus suggesting intrasubstance degeneration, appearing similar to the prior study. We see no discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: Moderate osteoarthritis affects the patellofemoral joint with intra-articular osteophytes and foci of cartilage degeneration that appear slightly more prominent on the current study than on the prior examination. There are central patella and trochlear osteophytes which have increased in size with mild underlying bone marrow edema. However, we see no bone contusions within the patella. Subjectively, the superior aspect of the femoral trochlea appears shallow, appearing similar to the prior study. There are intra-articular osteophytes along the medial femoral condyle just above the posterior horn of the meniscus, which appear to have increased in size and there has been progression of articular cartilage degeneration anterior to this osteophyte. There is also relatively mild degeneration of the articular cartilage of the medial tibial plateau. There has been progressive thinning of the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus as well as progression of articular cartilage degeneration more centrally along the weightbearing surface of the lateral femoral condyle and lateral tibial plateau. We see no bone marrow edema to suggest contusions.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The posterior fibers of the medial patellofemoral ligament are not well visualized which may represent a chronic tear, but this appears similar to the prior study. There is irregularity of the lateral retinacular structures likely reflecting prior release. The quadriceps and patellar tendons appear normal.ADDITIONAL", "output": "1. Progression of tricompartmental osteoarthritis of the knee.2. Poor visualization of the posterior fibers of the medial patellofemoral ligament which may represent a chronic tear, appearing unchanged when compared to the prior study.3. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "CLL, recent pericarditis, now with abnormal MRI from outside facility. There is unchanged mild scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild cerebral volume loss and the bilateral Meckel caves are patulous. 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": "Nonspecific unchanged mild scattered cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease, but no evidence of intracranial hemorrhage, mass, or acute infarct. "}
{"instruction": "Generate impression based on findings.", "input": "Female 75 years old with elevated liver enzymes s/p ERCP 7/21/16 with findings suggestive of PSC vs secondary PSC vs PBCs s/p bilateral stents in place . Now recently with worsening LFTs and leukocytosis, evaluate. ABDOMEN:LIVER, BILIARY TRACT: The wall of the common bile duct is thickened and the lumen is irregular with a stricture of the proximal common duct at the level of Klatskin's point. Filling defects within the common bile duct representing either stones or air due to recent sphincterotomy. Multiple intrahepatic biliary strictures are also noted and unchanged. There is mild thickening of the gallbladder wall however the gallbladder is contracted and not well evaluated.Subcentimeter T2 hyperintense lesions near the dome of the liver are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is mildly irregular and dilated up to the level of the ampulla with a maximum diameter of 7 mm. Several subcentimeter side branch IPMNs in the pancreatic body are unchanged (series 3, image 15).ADRENAL GLANDS: Small left adrenal adenoma is redemonstrated.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Again seen within the infrarenal abdominal aorta is an intraluminal linear focus raising the question of focal dissection (series 11, image 28).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thickening, irregularity and narrowing of the common duct appears similar to the previous exam. The differential diagnosis includes PSC, autoimmune cholangitis and infectious etiologies."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Bilateral hip pain going down to knees. Rule out spinal stenosis. Signs and symptoms: As above. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral, however lead exaggerated lumbar lordosis with resultant near horizontal positioning of the sacral spine. Lower most visualized thoracic spine and thoracic cord is unremarkable from T10 inferiorly. Examination at T12-L1 through L2-L3 levels demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc disease and mild ligamentum flavum and facet hypertrophy. There is mild mass effect on the thecal sac secondary to ligamentum flavum and mild central spinal stenosis without neural foraminal compromise..L4-L5 demonstrate mild disc disease and moderate ligamentum flavum and facet hypertrophic changes which includes minimal left facet effusiont. There is mild central spinal and bilateral lateral recess compromise and moderate mild bilateral neural foraminal compromise.L5-S1 demonstrate mild to moderate disc disease and moderate bilateral (left greater than right) facet and ligamentum flavum hypertrophic changes. No evidence of central spinal stenosis however significant left and moderate to significant right neural foraminal compromise as well as lateral recess compromise bilaterally. There is evidence of left-sided facet effusion and minimally on the right.", "output": "1.Examination is unremarkable from T11-T12 through L2-L3 levels without spinal stenosis or neural foramina compromise.2.Degenerative changes at L3-L4 results in mild central spinal stenosis.3.L4-L5 degenerative changes results in mild central spinal stenosis and bilateral neural foraminal and lateral recess compromise.4.L5-S1 demonstrate mild degenerative disc disease and significant hypertrophic changes of posterior elements with resultant significant bilateral (left >t right) neural foraminal compromise as well as lateral recess compromise bilaterally however without central spinal stenosis.5.There is normal anatomical alignment of vertebral column however exaggeration of lower lumbar lordosis results in near horizontal projection of sacral spine in relation to lumbar spine."}
{"instruction": "Generate impression based on findings.", "input": "72 years, Male, Reason: neurodeg disease History: ataxia, cognetive. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss supra and infratentorially without a distribution to suggest a particular neural degenerative process. There is volume loss involving the hippocampi bilaterally which is not disproportional. No focal signal abnormalities involving the basal ganglia or midbrain.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as in the pons, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.", "output": "1. Global parenchymal volume loss. 2. No intracranial mass or mass effect. 3. Mild chronic small vessel ischemic disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: cholestasis, evaluate for biliary obstruction History: cholestasis, history of NHL, anal cancer, panc adenoma with CIS s/p Whipple's ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Probable cyst noted in the right hepatic lobe. There is mild intrahepatic biliary ductal dilatation. There is mild narrowing at the biliary enteric anastomosis. The biliary limb is mildly dilated near the gallbladder fossa.Status post cholecystectomySPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes from a Whipple. There is some atrophy of the remainder pancreas. Pancreatic duct is mildly prominent. There is scarring near the expected location of the head/uncinate process of the pancreas in the region of prior abscess.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney. Left lower pole renal cyst.RETROPERITONEUM, LYMPH NODES: Reference mesenteric lymph node measures 2.1 x 1.6 cm on image 26/series 4 is not significantly changed from prior.BOWEL, MESENTERY: Postsurgical changes from a from a pancreaticoduodenectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mild intrahepatic biliary ductal dilatation with mild narrowing at the level of the biliary enteric anastomosis. The biliary limb is mildly dilated with narrowing near the head of the pancreas in the area of prior abscess formation with associated scarring. The area of obstruction may be at the biliary enteric anastomosis or at the level of the head of the pancreas where there is narrowing of the biliary limb."}
{"instruction": "Generate impression based on findings.", "input": "67 year old male with drug refractory long standing atrial fibrillation s/p ablation x 3, s/p AICD. Referred for cardiac MRI to assess pulmonary vein anatomy and left ventricular function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%. The LVEDV is 134 ml (normal range 142+/-34), the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVESV is 54 ml (normal range 47+/-19) and the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9). The LV mass is 113 g (normal range 164+/-36) and the LV mass index is 52 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, considering limitations due tox magnetic susceptibility artifact from AICD/PM in the anterior chest wall.AICD/PM leads are noted in the right atrium and right ventricle. The distal segment of the right ventricular lead is obscured by artifact. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%. The RVEDV is 207 ml (normal range 142+/-31), RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVESV is 99 ml (normal range 54+/-17), and the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveAssessment is limited. The aortic valve is poorly visualized. Mitral ValveThere is no significant mitral regurgitation.Tricuspid ValveThere 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 VeinsThe right superior, right inferior and left inferior pulmonary veins drain normally into the left atrium without any obvious stenosis. The left superior pulmonary veins were not well visualized due to metallic susceptibility artifact. Complete assessment of the left atrium and pulmonary venous ostia is limited by artifact. Pulmonary ArteryThe main pulmonary artery is mildly dilated (33 mm).Venous AnatomyThe SVC and IVC 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.The left ventricle is normal in size with normal systolic function. LVEF 60%. 2.The right ventricle is normal in size with normal systolic function. RVEF 52%.3.Complete assessment of the left atrium and pulmonary venous ostia is limited by susceptibility artifact. The right upper, right lower and left lower pulmonary veins drain normally into the left atrium. The left upper pulmonary veins were not well visualized due to AICD/PM artifact.4.There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, considering limitations of technique. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Ataxia. Rule out cord compression. The vertebral bodies are appropriate in the overall height. There is grade 1 anterolisthesis of L4 on L5. Alignment is otherwise maintained. No large metastatic lesion is appreciated within the limits of the screening study. T1 shortening involving the lumbosacral spine marrow may be related to prior radiation.Mild multilevel degenerative changes are seen in the cervical spine, relatively worse at the C5-C6 level where a disc osteophyte complex and ligamentum flavum thickening are associated with mild to moderate spinal canal stenosis. There is otherwise no high-grade stenosis in the cervical spine or obvious cord signal abnormality. No significant spinal canal stenosis is evident in the thoracic spine. Mild to mild-to-moderate degree of spinal canal stenosis is also evident at the L3-L4 and L4-L5 levels. Otherwise no high-grade stenosis. There is up to moderate degree of neural foraminal stenosis at the L4-L5 level.", "output": "This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.Due to the screening nature of this protocol, details are not as evident on imaging as dedicated protocols of the spine. Degenerate changes in the cervical and lumbar spine can be better assessed with dedicated cervical and lumbar spine imaging as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are left breast ultrasound dated 4/4/2011, left diagnostic mammogram dated 4/4/2011, and MRI breast dated 4/13/2011 performed at Northwestern Graylake. LEFT DIAGNOSTIC MAMMOGRAM (4/4/2011): Two standard views of the left breast and 2 spot compression views were obtained. The breast parenchyma is heterogeneously dense. The breast tissue in the left upper inner quadrant appears slightly more conspicuous on recent mammogram dated 2/19/2015LEFT BREAST ULTRASOUND (4/4/2011): A cyst was seen in the 12 o'clock position of the left breast that measures 4 mm.BREAST MRI (4/13/2011): There is no significant interval change compared to mammogram dated 12/22/2014.", "output": "Slightly more conspicuous breast parenchyma the left upper inner quadrant compared to examination in 2011 without interval change from breast MRI dated 4/13/2011 and 12/22/2014. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 45 years old Reason: Chronic pelvic pain, menorrhagia, polymenorrhea. Evaluate for adenomyosis. History: heavy menses. Pelvic pain PELVIS:UTERUS, ADNEXA: Uterus measures 9.0 x 5.3 x 5.0 cm. The junctional zone is irregular and thickened measuring in some areas up to 20 mm. There are foci of T2 hyperintensity within the thickened junctional zone.On postcontrast imaging, there is heterogeneous enhancement of the uterus. Right ovary measures 1.9 x 1.5 cm while the left ovary measures 2.7 x 1.1 cm. There are small simple appearing bilateral ovarian cysts, likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic ascites.", "output": "1.Findings most suggestive of adenomyosis of the uterus."}
{"instruction": "Generate impression based on findings.", "input": "Treatment planning MRI for SRS for acoustic neuroma. There is an ovoid enhancing lesion in the left internal auditory canal, which measures up to 10 mm in length and 5 mm in width. There is mild scattered cerebral white matter T2 hyperintensity bilaterally, mainly in a periventricular distribution. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is a 10 mm thick posterior apical scalp lipoma.", "output": "1. A left internal auditory canal vestibular schwannoma measures up to 10 mm.2. Mild scattered cerebral white matter T2 hyperintensity bilaterally may represent a demyelinating disease, perhaps related to Familial Mediterranean fever, but are nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Right shoulder pain, no improvement with NSAIDS, injection and therapy. Evaluate for rotator cuff tear History: Right shoulder pain ROTATOR CUFF: Increased signal intensity of the undersurface fibers of the supraspinatus tendon indicating partial thickness tearing involving approximately 50% of tendon thickness. The tear extends from the tendon insertion on the greater tuberosity approximately 2 cm proximally. There is degenerative cyst formation in the underlying humeral head and greater tuberosity. The tear extends 2 centimeter in AP dimension and involves to anterior fibers of the infraspinatus with underlying degenerative cyst formation. Subscapularis tendon and teres minor tendon are intact. There is no significant rotator cuff muscle atrophy. SUPRASPINATUS OUTLET: There are mild degenerative changes of the AC joint. There is trace fluid in the subacromial/subdeltoid bursa, likely physiologic.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is degenerative cyst formation of the humerus as described above. There is fluid signal undercutting the superior labrum suggestive of superior labral tear. Intermediate signal abnormality of the anterior labrum may represent extension of this tear. There is a small defect in the superior posterior glenoid cartilage.BICEPS TENDON: The long head of the biceps tendon is normal in location. There is small amount of fluid surrounding the tendon, likely related to joint effusion.ADDITIONAL", "output": "1. Partial-thickness undersurface tearing of the supraspinatus tendon.2. SLAP tear of the labrum.3. Mild AC joint osteoarthritis and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: HCC surveillance History: NASH and HCV cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Cholelithiasis without evidence of cholecystitis. No evidence of steatosis. No suspicious enhancing lesions.SPLEEN: Moderate splenomegaly. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged periportal and periaortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Cirrhotic liver morphology without evidence of hepatocellular carcinoma."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic head and neck cancer. Neck CT:The visualized brain demonstrates an enhancing nodule in the right occipital lobe. Post-surgical changes in the right frontal lobe and additional metastatic lesions in the brain are better seen on prior MRI brain dated 7/19/2011.Postsurgical changes of previous laryngectomy is again noted. There is soft tissue thickening at the oropharynx and hypopharynx which is unchanged and presumably represents post treatment granulation.Degenerative changes of the cervical spine is again noted", "output": "1. Postsurgical changes of previous laryngectomy. No evidence of interval change.2. Metastatic brain lesions. Please refer to MRI brain for further details."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Follow-up resection of meningioma. Signs and symptoms: As above. Pre and post gadolinium enhanced brain MRI:Examination demonstrates chronic post operative changes of a bilateral posterior parietal (R<L) craniotomy. There is a focus of encephalomalacia in the right occipital and posterior parietal with minimal cortical mineralization at the surgical site is noted.There is abnormal signal intensity of superior sagittal sinus at this level suggestive of tumor/meningioma within the superior sagittal sinus. This finding demonstrate enhancement and measures maximum of 9 x 11 mm in transaxial dimensions (axial FLAIR and T2 image 22 and axial post enhanced series 1001 images 22 through 24. There are no prior exams for comparison. The superior sagittal sinus beyond this lesion demonstrate normal signal intensity.The overall anatomical morphology and signal intensity of brain parenchyma remains otherwise within normal limits on all MRI sequences and without detectable or abnormal enhancement.Calvarium demonstrates expected postoperative changes and unremarkable otherwise.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.", "output": "1.Examination is status post bilateral posterior parietal-occipital craniotomy ((R<L) with underlying focus of encephalomalacia in the right occipital and posterior parietal.2.Residual signal abnormality and enhancement in the superior sagittal sinus in the occipital and posterior parietal concerning for residual tumor (9 x 11 mm transaxial dimension). No evidence of residual tumor otherwise and no prior exams for comparison.3.Unremarkable pre and post enhanced brain MRI otherwise."}
{"instruction": "Generate impression based on findings.", "input": " Brain MRI:There is a focus of restricted diffusion within the right midbrain with associated T2 signal abnormality consistent with an acute infarct. An additional focus of subtle diffusion hyperintensity in the left posterior frontal corona radiata may also represent an additional focus of subacute ischemia. There is no associated susceptibility artifact to suggest hemorrhage. Encephalomalacia within the right occipital lobe is consistent with a prior right PCA territory infarct. T1 hyperintensity in this region is compatible with laminar necrosis. Periventricular and subcortical white matter abnormal T2 signal is consistent with mild chronic small vessel ischemic disease. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect, or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. A 1.6 x 1.4 cm intermediate signal, round lesion within the midline slightly anterior scalp may represent a sebaceous cyst or epidermal inclusion cyst; correlate with physical exam.Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries with right dominance and the left vertebral artery terminating as the left PICA. Antegrade flow is identified within the basilar artery with fetal morphology of the bilateral posterior cerebral arteries. There is tortuosity at the level of A1/A2 junction and the right A1 segment is not well seen, which is favored to be hypoplastic. Antegrade flow is noted within the middle cerebral arteries and the posterior cerebral arteries. No arterial aneurysmal dilatation is identified. No arteriovenous malformations are identified.Neck MRA:MRA of the neck is suboptimal in quality but there is no significant stenosis of the external or internal carotid arteries. The vertebral artery origins are poorly evaluated, however, the vertebral arteries distally are patent.", "output": "1. Acute infarct within the right midbrain. Possible additional acute to subacute punctate focus of infarct in the left frontal corona radiata.2. Chronic right PCA territory infarct with encephalomalacia within the right occipital lobe.3. Poor visualization of the right A1 segment, which is favored to be hypoplastic. Otherwise, patent intracranial arterial vasculature with bilateral fetal morphology of the PCA's and right vertebral dominance. 4. Suboptimal MRA of the neck with grossly patent vessels within the limitations of the study. The origins of the vertebral arteries are poorly assessed, though patent distally. If further evaluation is warranted, CTA of the neck may be considered."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for cause of right base of second toe pain, particularly Morton Neuroma History: right base of second toe pain Overlying the dorsal aspect of the second metatarsal there is a 6mm oval-shaped moderately well defined focal signal abnormality which is felt to represent synovitis or a small cyst. The soft tissues are otherwise unremarkable. Bone marrow signal is within normal limits. There is no evidence of Morton neuroma. The muscle bodies and tendons of the forefoot appear normal.", "output": "Signal abnormality overlying the dorsal aspect of the second metatarsal is felt to represent synovitis or a small cyst. No evidence of Morton neuroma, as clinically queried."}
{"instruction": "Generate impression based on findings.", "input": "Right shoulder pain ROTATOR CUFF: There is increased signal intensity within the anterior most fibers of the distal supraspinatus tendon at its insertion on the greater tuberosity, indicating an insertional tear. The tear focally involves the majority of the thickness of the tendon but there is no significant retraction and overall, the tear measures approximately 1 cm in the AP dimension. There is no discrete tear of the infraspinatus tendon. The supraspinatus and infraspinatus muscles are normal. The teres minor tendon and muscle are intact. There is mild increased signal intensity of the distal fibers of the subscapularis tendon suggesting tendinosis but we see no discrete tear. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. Fluid is noted within the subacromial subdeltoid bursa containing multiple foci of low signal intensity corresponding to the globular calcific densities seen on the comparison radiographs. An additional focus of low signal intensity is seen anterior to the greater tuberosity and lateral to the long head of the biceps representing additional hydroxyapatite deposition perhaps within the bursa or adjacent soft tissues. Foci of edema-type signal are noted within the greater tuberosity which are likely reactive and degenerative in etiology.GLENOHUMERAL JOINT AND GLENOID LABRUM: The superior labrum is deformed and attenuated compatible with tearing. There is also deformity of the inferior labrum best seen on the coronal oblique sequences which likely represents tearing with adjacent paralabral cysts.BICEPS TENDON: There is intermediate signal intensity within the long head of the biceps tendon as it courses through the rotator interval indicating mild tendinosis.", "output": "1. Calcific subacromial subdeltoid bursitis.2. Focal near full-thickness to full-thickness tear of the anterior insertional fibers of the supraspinatus tendon without retraction.3. Moderate osteoarthritis of the acromioclavicular joint.4. Labral tears as described above."}
{"instruction": "Generate impression based on findings.", "input": "A 73 year old male with personal history of liver transplant, hyperlipidemia, peripheral artery disease. His cardiovascular history includes coronary artery disease with a percutaneous stent implantation in 2010 and a aortic valvular replacement (robotic approach) in 11/2015 (a coronary angiography previous to the surgery showed patents LAD stent, 50% stenosis in ostial 3rd diagonal and mild disease in the LCx and RCA). Recently reported angina of effort with ST depressions in the EKG during exercise. Referred to stress cardiac MRI for further evaluationMEDICATIONS: aspirin, atorvastatin, baraclude, fluticasone, furosemide, lisinopril, metoprolol, prednisone, sildenafil, tacrolimus, tiotropium. First Pass PerfusionDuring hyperemia, no perfusion defects were present; however, stress perfusion acquisition was delayed due to IV infiltration and the diagnostic sensitivity is reduced. Viability/ Myocardial ScarThere was late gadolinium enhancement noted at the mid-myocardium at the basal segments (anteroseptum and inferolateral walls). This pattern suggests fibrosis, inflammation, or infiltration, and is not typical of myocardial infarction. The pattern is most consistent with some sort of myocarditis. The rest of the myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 54 ml (normal range 47+/-19), the LV mass index is 52 g/m2, and the LV mass is 110 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 152 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveA prosthetic aortic valve was seen at the aortic position. 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 mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 pericardial effusion. Significant pericardial fat was noted.Extracardiac FindingsSternal wires were noted. 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. No perfusion defects/ \"ischemia\" present during hyperemia; however, diagnostic sensitivity reduced due to delayed image acquisition.2. There was late gadolinium enhancement noted at the mid-myocardium at the basal anteroseptum and inferoseptal segments. This pattern suggests fibrosis, inflammation, or infiltration, and is not typical of myocardial infarction. The pattern is most consistent with myocarditis; however, the differential diagnosis includes other things as well3. Normal LV size and systolic function (LVEF 64%).4. Normal RV size and systolic function (RVEF 59%).5. A prosthetic aortic valve was seen at the aortic position.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate arachnoid cyst. History of acute lymphoid leukemia. There is an arachnoid cyst in the anterior right middle cranial fossa extending into the anterior cranial fossa which measures 7.8 cm x 6.0 cm axially and 7.0 cm craniocaudally. It is located just lateral to the branches of the right middle cerebral artery. It causes mild mass-effect on the adjacent brain parenchyma and splays the frontal and temporal gyri along the anterior part of the sylvian fissure. It also causes mild uncal herniation. However there is no brain parenchymal signal abnormality. It causes up to 6 mm of midline shift at the level of the septum pellucidum. There is no acute infarct or intracranial hemorrhage. Few dilated prevascular spaces are present within the right frontal white-matter. Major intracranial flow voids are preserved. Following contrast administration, there is no abnormal intracranial contrast enhancement.The arachnoid cyst thins the calvarium and expands the right middle cranial fossa. The remainder of the skull is unremarkable. There is no gross orbital abnormality. There is trace mucosal thickening in the paranasal sinuses.The CSF study performed at the mid sagittal plane shows preserved, ventral and dorsal biphasic CSF flow.", "output": "Right frontotemporal arachnoid cyst with mass-effect as described above. Brain MRI is otherwise unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "75 years Female (DOB:5/15/1941)Reason: r/o cva History: cognitive impairmentPROVIDER/ATTENDING NAME: SHELLIE N. WILLIAMS SHELLIE N. WILLIAMS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. One of these lesions in the left centrum semiovale adjacent left frontal lobe measures 15 x 11 mm axial dimensions. There are some punctate lesions present in the brainstem which are hyperintense on T2 and FLAIR MRI.There is a large flow void present adjacent to the ophthalmic segment of the right internal carotid artery which measures 14 x 10 mm in coronal dimensions. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening at the floor of the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a signal hyperintense lesion on all pulse sequences located in the trigone of the left lateral ventricle which most likely represents calcifications.", "output": "1.There is a large aneurysm present at the distal right internal carotid artery at the proximal ophthalmic segment which is directed superiorly and abuts the right olfactory trigone and posterior olfactory sulcus. An MR angiogram may help further evaluate for this and additional aneurysms. Alternatively an CT angiogram may be useful.2.Periventricular and subcortical white matter lesions of a mild to moderate degree and some punctate lesions in the brainstem are nonspecific. A larger lesion in the left centrum semiovale may represent an old lacunar infarct. At this age they are most likely vascular related. 3.There is no evidence for acute ischemic cerebral infarction.4.Findings were discussed with Dr. Williams."}
{"instruction": "Generate impression based on findings.", "input": "Reason: mass over anterior antecubital fossa-probable lipoma History: soft tissue mass The biceps tendon appears intact. There is minimal intermediate signal intensity within the brachialis tendon at the level of its insertion on the indicating mild tendinosis. There is subchondral signal abnormality within the ulna at the site of the brachialis tendon insertion. The triceps appears intact. There is nonspecific subcutaneous edema along the posterior aspect of the olecranon. There is prominence of the subcutaneous fat along the medial aspect of the distal humerus underlying a skin marker presumably corresponding to the patient's palpable area of concern, however, this is difficult to accurately measure or differentiate from the adjacent subcutaneous fat due to lack of inherent contrast. There is no significant enhancement on postcontrast sequences. No bone marrow signal abnormality is identified.", "output": "Prominence of the subcutaneous fat along the medial aspect of the distal humerus indicating lipoma formation. No enhancing mass lesions are identified."}
{"instruction": "Generate impression based on findings.", "input": "80 year-old female urothelial cancer. Restaging. CHEST:LUNGS AND PLEURA: Bilateral scattered micronodules are predominantly peripheral and some are pleural based. Bibasilar dependent atelectatic changes. No nodule larger than 4 mm was found.MEDIASTINUM AND HILA: Diffuse calcified lymph nodes in the mediastinum. Small amount of coronary artery calcification. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: 1 x 2.6 cm inferior right hepatic lobe cystic lesion appears uniloculated and benign. Subcentimeter hypodensities are bilobar and too small to characterize. SPLEEN: No significant abnormality noted.PANCREAS: 8 x 10 mm distal pancreatic parenchymal cystic focus (coronal image 43, axial image 82 of series 3). If indicated, obtain MRI/MRCP for further evaluation, if indicated. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic calcifications in the aorta. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.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": "Bilateral lung micronodules and subcentimeter liver hypodensities are too small to characterize.Pancreatic tail 1 cm cystic lesion. see above. No measurable metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "11-year-old female with knee pain and swelling for weeks status post fall. MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is normal. Articular cartilage is intact.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "Normal examination."}
{"instruction": "Generate impression based on findings.", "input": "53 years Female (DOB:12/15/1962)Reason: s/p SRS intervention for dural AVM repair-12/12/14 History: SurveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left jugular vein is smaller than the right jugular vein and substantially smaller when compared to pretreatment exams.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate a small opacity in the left mastoid air cells. The visualized portions of the orbits are intact.MRA brain:Compared to the previous exam the left external carotid artery vasculature remains stable compared to the prior exam but has decreased in caliber compared to immediate post treatment exams. The left mastoid artery can be identified extending into the left sigmoid sinus. The left ascending pharyngeal artery jugular branch is also identified extending to the jugular bulb.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The right posterior communicating artery is medium-sized. The left posterior communicating artery is tiny. The anterior communicating artery is small. The vertebral arteries are similar in size. There is extracranial origin of the right posterior inferior cerebellar artery.", "output": "1.Findings suggest a small residual arteriovenous fistula involving the jugular branch of the ascending pharyngeal artery. This has not changed substantially since the prior exam.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "20 old female with with B cell lymphoma and known brain metastasis presents with headache and neck stiffness x 7 days. Interval resolution of the vasogenic edema within the left cerebral hemisphere. No definite evidence of the previously described mass on this study. High density material within the right transverse sinus which appears new when compared to the prior study.There is no evidence of intracranial hemorrhage or midline shift. 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": "1. Interval resolution of the vasogenic edema involving the left hemisphere. No definite evidence of a mass within the limitations of this noncontrast study.2. High density material within the right transverse sinus possibly represents thrombosis. An MRI is recommended for further evaluation.These findings were discussed with Dr. Powell at the time of this dictation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of high grade renal cancer s/p nephrectomy. eval for recurrence or metastasis History: renal cancer ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensities within the liver are unchanged and likely represent cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of local recurrence.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "HCC Study is limited due to lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with caudate lobe hypertrophy and prominent fissures. The predominantly T2 hypointense lesion in segment 4 measures 4.2 x 3.6 cm, previously 4.6 x 3.8 cm. The lesion contains inherent T1 hyperintensity likely representing blood products. Evaluation for hepatocellular carcinoma is significantly limited by the absence of intravenous contrast, however there are no additional areas of T2 signal hyperintensity or diffusion restriction to suggest new lesions.Cholelithiasis. Stable position of the cholecystostomy tube.SPLEEN: Splenomegaly measuring 15 cm. Splenic varices noted. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are again seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ascending colonic wall thickening, likely representing portal colopathy. Otherwise no significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites.", "output": "Limited study due to lack of intravenous contrast. Slightly decreased size of the treated hepatic lesion. No new lesions evident."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old woman with history of oral squamous cell carcinoma and status post liver transplant 5/3/2015, now with increased LFTs. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post liver transplant with cholecystectomy and scattered foci of susceptibility artifact representing surgical clips. The common duct measures 8 mm in diameter and is patent through the hepaticojejunostomy. There is no intrahepatic biliary duct dilatation. The liver is normal in signal without focal hepatic lesion. Flow-voids are present in the portal and hepatic veins.SPLEEN: The spleen appears normal and measures 12 cm in length.PANCREAS: The pancreas appears normal without pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys appear normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Liver transplant without evidence of complication or biliary obstruction."}
{"instruction": "Generate impression based on findings.", "input": " There is mild straightening of the cervical spine, similar to prior examination. There is minimal retrolisthesis of C5 on C6, which are likely degenerative in etiology. The vertebral body heights are well-maintained. There is progression of loss of disc height and disc desiccation throughout the cervical spine with moderate to severe loss of disc height at C5-C6 and C6-C7 and mild to moderate loss of disc height at the remaining levels. The bone marrow signal is mildly heterogeneous. The spinal cord is of normal caliber and signal. Prominence of the thyroid gland is again noted.C2-C3: Left greater than right facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Posterior disc osteophyte complex, thickening of the ligamentum flavum, bilateral uncovertebral hypertrophy and facet arthropathy, contributing to mild spinal canal narrowing and mild bilateral neural foraminal stenosis. Mild progression of spinal canal stenosis. No change in neuroforaminal narrowing.C4-C5: Posterior disc osteophyte complex, thickening of the ligamentum flavum, bilateral uncovertebral hypertrophy and facet arthropathy, contributing to mild spinal canal narrowing and mild right and moderate left neural foraminal stenosis. No significant change in spinal canal or neuroforaminal stenosis.C5-C6: Posterior disc osteophyte complex, thickening of the ligamentum flavum, bilateral uncovertebral hypertrophy and facet arthropathy, contributing to mild spinal canal narrowing and mild to moderate bilateral neural foraminal stenosis. No significant change in spinal canal or neuroforaminal stenosis.C6-C7: Posterior disc osteophyte complex, thickening of the ligamentum flavum, bilateral uncovertebral hypertrophy and facet arthropathy, contributing to mild spinal canal narrowing and minimal bilateral neural foraminal stenosis. No significant change in spinal canal or neuroforaminal stenosis.C7-T1: Posterior disc osteophyte complex, thickening of the ligamentum flavum, bilateral uncovertebral hypertrophy and facet arthropathy. No significant spinal canal stenosis or neural foraminal stenosis.", "output": "Image quality is degraded by motion artifact. Degenerative cervical spondylosis, most prominent at C5-C6, with unchanged mild to moderate bilateral neural foraminal stenosis. Progression of degenerative disc disease at with mild progression of stenosis at C3-4 as described above. Variable multilevel neural foraminal stenoses are not significantly changed.  "}
{"instruction": "Generate impression based on findings.", "input": "6-year-old male with history of brain abscess related to mastoiditis, status post resection. There are unchanged postoperative findings related to prior right tympanomastoidectomy andtemporal craniotomy. There is unchanged high signal within the mastoidectomy bowl consistent with fluid. There is an unchanged T2 hypointense rim-enhancing lesion in the right inferior temporal lobe along the mastoid roof, which measures up to 14 mm. There is confluent high T2 signal in the adjacent white matter, which is also unchanged. No new lesions are identified. 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 are grossly unremarkable. There are skin-based fiducial markers.", "output": "Postoperative findings related to right mastoidectomy and temporal craniotomy without significant change in size right temporal lobe chronic abscess or granuloma and associated vasogenic edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female 25 years old Reason: 24 yo female with left foot pain over dorsum of foot, SCD machine fell on left foot. Still with tingling in goes. History: left toes with tingling, foot pain TENDONS: The imaged portions of the flexor and extensor tendons are intact. No tenosynovitis or tendon thickening.LIGAMENTS: Lisfranc ligament is intact.ARTICULAR SURFACES AND BONE: Marrow signal is normal. There are subchondral cystic changes at the first metatarsal head at the hallux sesamoid complex with reactive changes in the sesamoids indicating osteoarthritis. No acute fracture or malalignment. There is a mild hallux valgus deformity.No joint effusion.ADDITIONAL", "output": "Moderate arthritis at the first MTP joint at the level of the hallux sesamoid complex."}
{"instruction": "Generate impression based on findings.", "input": "83-year-old woman with headache. Question intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Right frontal encephalomalacia remains. Extensive periventricular and subcortical white matter hypoattenuation is present. This most likely represents age-indeterminate small vessel ischemic disease. Large vessel calcifications are noted. If acute stroke is suspected, MRI is recommended. The ventricles and basal cisterns are unchanged in size and configuration from the CT scan dated 10/20/2009.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Calcifications of the lateral limbus of the right eye are unchanged.", "output": "1. No CT findings of acute intracranial process. If there is clinical concern for acute stroke, MRI is recommended.2. Findings of small vessel ischemic disease, prior right frontal infarct, and large vessel calcifications."}
{"instruction": "Generate impression based on findings.", "input": "53 years Female (DOB:8/2/1962)Reason: stroke? History: slurred speech and L sided weaknessPROVIDER/ATTENDING NAME: KATIE TATARIS KATIE TATARIS There is a focus of diffusion restriction present along the corpus callosum on the left side associated T2 and FLAIR signal hyperintensity. There are some other foci which are high signal on diffusion-weighted imaging but also high signal on the ADC maps suggesting these represent T2 shine through.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.There is an acute lacunar infarct present in the left genu of the corpus callosum.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "76 years, Male, newly diagnosed lung cancer. Evaluate for metastases. There is a 6 mm focus of enhancement along the surface of the inferior cerebellar vermis without associated parenchymal edema or mass effect. There is susceptibility effect involving this lesion with corresponding calcification demonstrated on recent CT. There is no significant abnormal parenchymal or meningeal enhancement in the remainder of the brain. There is minimal smooth enhancement along the right frontal dura which may be related to remote subdural hemorrhage, for example. No significant extra-axial collections are present on the current study. There is global parenchymal volume loss commensurate with patient's age. No intracranial mass effect, midline shift, or herniation. No hydrocephalus.There are multiple punctate foci of susceptibility involving the left paracentral lobule, left parietal and left occipital deep white matter, as well as in the left medial temporal lobe. These are consistent with chronic microhemorrhages. There are minimal foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild senescent white matter changes.There is a small lipoma involving the left anterior frontal scalp. No destructive lesions in the calvarium. Degenerative changes in the cervical spine with partial ankylosis of the C4 and C5 vertebrae partially imaged.", "output": "1. No definite evidence of intracranial metastatic disease. There is a 6 mm enhancing nodule along the inferior cerebellar vermis which appears to demonstrate calcifications. Imaging appearance would be compatible with a subependymoma although a solitary metastasis is not excluded. 2. Scattered chronic microhemorrhages in the left cerebral hemisphere as described above which are in a nonspecific distribution. Please see additional comments above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 64yoF R rotator cuff injury for 1.5years, please assess for tear, capsulitis, etc ROTATOR CUFF: Full-thickness tear of the supraspinatus tendon (series 10 image 15) with moderate muscle atrophy. There is high-grade articular surface partial tear of the infraspinatus tendon with mild muscle atrophy. There is small fluid signal lesion noted within the infraspinatus tendon measuring approximately 1 cm in transverse dimension and approximately 3 cm from the insertion, likely representing intramuscular ganglion cyst secondary to partial tear. There is mild thickening of the subscapularis tendon suggestive of tendinosis with mild muscle atrophy. Teres minor tendon and muscle are intact.SUPRASPINATUS OUTLET: Moderate degenerative change in the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. Small degenerative subchondral cysts noted in the humeral head. Glenohumeral cartilage without focal defect. Sublabral foramen is noted in the anterior superior labrum. No discrete labral tear is identified on this non-arthrogram study. BICEPS TENDON: Biceps tendon is intact and located within the bicipital groove.ADDITIONAL", "output": "1. Full-thickness tear of the supraspinatus tendon with moderate muscle atrophy. 2. High-grade articular surface partial tear of the infraspinatus tendon with mild muscle atrophy and intramuscular ganglion cyst."}
{"instruction": "Generate impression based on findings.", "input": "Transient cerebral ischemic attack. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening and small fluid levels in the bilateral maxillary sinuses.", "output": "1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Findings suggestive of acute sinusitis."}
{"instruction": "Generate impression based on findings.", "input": "Parkinson's disease: preoperative planning for DBS. The images are degraded by patient motion. Nevertheless, there is no evidence of acute intracranial hemorrhage or tumor. However, there is a left middle cranial fossa arachnoid cyst that measures up to 25 mm with mass effect upon the anterior temporal lobe. There is also scattered cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.", "output": "Left middle cranial fossa arachnoid cyst and probable small vessel ischemic disease of the white matter. Otherwise, unremarkable treatment-planning MRI."}
{"instruction": "Generate impression based on findings.", "input": "18 years old male patient with a L5-S1 left lateral recess soft tissue mass please evaluated for biopsy and perform CT guided biopsy. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the mass within the left lateral recess of the spinal canal. Following needle removal images obtained that demonstrate no complications .", "output": "L5-S1 level biopsy of mass within the spinal canal at the left lateral recess. Seven samples were obtained and delivered to pathology."}
{"instruction": "Generate impression based on findings.", "input": "Female, 42 years old, with multiple sclerosis. Assess for progression. Brain:Extensive nearly confluent T2 hyperintensity is present within the periventricular regions of the cerebral hemispheres with multiple additional scattered focal lesions seen elsewhere in the cerebral hemispheres, basal ganglia and cerebellum. No significant interval change in the size or number of these lesions is seen when compared to the prior exam.Ring enhancement of one of the right periventricular lesions has significantly subsided though it is still vaguely detectable. No additional clearly enhancing lesions are seen. There is a generalized pattern of microvascular enhancement in the periventricular regions.No evidence of significant parenchymal edema or mass effect is seen. Mild cerebral volume loss appears similar to prior. No abnormal extra-axial fluid collections are detected. Ventricles are stable in size and morphology. A hypoenhancing right intrasellar lesion is partially visualized on this exam.C-spine:Successful cord T2 signal abnormality is identified at several locations including the dorsal right aspect at C2, the lateral left aspect at C2-3, and the dorsal right aspect at C3. Accounting for differences in technique, no significant change in the size, number or distribution of these lesions is seen. These lesions show no definite pathologic enhancement. Spinal cord morphology and caliber are otherwise within normal limits.Straightening of the cervical lordosis is seen. Spinal alignment is otherwise unremarkable. The vertebral bodies demonstrate normal height and marrow signal characteristics. No significant disc degeneration, spinal canal or neuroforaminal stenosis is seen.", "output": "1.No significant interval change in the size, number or distribution of extensive white matter disease in the brain. Some interval subsidence of enhancement is seen pertaining to one of the right periventricular lesions when compared to the prior examination.2.Multiple scattered cervical spinal cord lesions are redemonstrated showing no significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for posterior tibial tendon rupture right History: pain, edema, with inability to single heel raise right foot TENDONS: There is thickening and intermediate signal intensity within the posterior tibialis tendon indicating mild to moderate tendinosis. There is linear increased fluid signal intensity within the distal fibers of the posterior tibialis tendon at the level of its insertion on the navicular bone likely representing an interstitial insertional tear. There is no significant retraction. The flexor digitorum longus and flexor hallucis longus tendons are intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance. The extensor tendons appear intact.LIGAMENTS: There is thickening of the anterior talofibular ligament which may represent prior injury or sprain. The lateral collateral ligament complex otherwise appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is subchondral cyst formation within the posterior aspect of the tibial plafond with sclerosis, joint space narrowing, and osteophyte formation indicating mild osteoarthritis. Otherwise no bone marrow signal abnormality is identified. No osteochondral defect is seen ADDITIONAL", "output": "1. Tendinosis of the posterior tibialis tendon with partial thickness and interstitial insertional tearing as described above. No evidence of retraction.2. Osteoarthritis of the ankle."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Cervical disc disorder with myelopathy, unspecified cervical regionClinical question: new symptoms of tingling to hands, increased HNP?Signs and Symptoms: increased/new tinging to hand The cervical vertebral bodies are appropriate in overall alignment and height. The patient status post anterior fusion at C6-7. There is a cord syrinx present measuring up to 1.5 mm in diameter which is unchanged since prior exam. Any subtle differences may be accounted for on the basis of difference in scan technique. There are some subtle T2 signal hyperintensity surrounding the central canal just above the C4-5 disc space level.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. There are endplate and uncovertebral osteophytes present at this level associated with the mild encroachment of left-sided exiting nerve roots. This has not changed substantially when compared to the prior exam.At C4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with bilateral uncovertebral osteophytes and endplate osteophytes. There is ligamentum flavum hypertrophy present. There is effacement of spinal fluid ventral and posterior the spinal cord at this level and encroachment of the exiting nerve roots bilaterally within the neural foramina. There is moderate spinal stenosis at this level. There is also present on the prior exam and has not changed substantially. There are endplate reactive changes at this level which are high signal on T1.At C5-6 there is loss of disc space height, disc desiccation and endplate reactive changes of a moderate degree. There are endplate uncovertebral osteophytes present at this level which are worse in the left side when compared to the right. There is encroachment of the exiting nerve roots in the neural foramina. Overall there is no significant change compared to the prior exam.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.", "output": "1.There is redemonstration of a small syrinx (enlarged central canal) in the lower cervical spinal cord which was also present on the prior exam and has not really changed in size. Some subtle signal hyperintensity surrounding the central canal just above the C4-5 disc space level suggests possible edema surrounding the syrinx on the current exam not readily identified on the prior. Differences in scan technique confound comparison of this edematous component.2.There are multilevel degenerative changes present in the cervical spine with moderate spinal stenosis at C4-5 which are stable compared to prior exam. There is encroachment of exiting nerve roots bilaterally at C4-5 and on the left-side at C5-6. There is milder encroachment of the right-sided exiting nerve roots at C5-6 and left-sided exiting nerve roots at C3-4."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male with recurrent left paresthesias. Rule out thrombosis which was possibly seen on MRI/MRA.IMAGE ACQUISITIONS: Brain CTA with contrast, neck CTA with contrast. 120 cc nonionic Omnipaque 350 at 4.5 cc/sec. Left carotid artery: Mild noncalcified stenosis at the origin of the internal carotid artery. There is calcifications of the cavernous portion of the internal carotid artery.Right carotid artery: Calcifications of the cavernous portion of the internal carotid artery. No significant stenosis or septations elsewhere.Left are two artery:Left vertebral artery: Severe narrowing of the left vertebral artery from its origin to the basilar artery with only faint wisps of contrast seen. This is either due to marked hypoplasia or intrinsic disease.Right vertebral artery: No significant stenosis or calcification.BRAIN", "output": "1. Left vertebral artery is severely narrowed, either due to hypoplasia or intrinsic disease.2. P1 segments of the PCAs are not well visualized, either due to absence or hypoplasia3. Mild stenosis of the origin of the left internal carotid artery4. Noncontrast brain CT shows small vessel ischemic disease of indeterminate age and multiple bilateral lacunar infarcts"}
{"instruction": "Generate impression based on findings.", "input": "Lung cancer to bone, worsening back pain, weakness. Evaluate for cord compression. There are numerous lesions throughout the spine including the anterior and posterior elements consistent with known metastatic disease. There is mild effacement of the dorsal thecal sac at the C5-C6 level related to tumor involving the posterior elements without evidence of cord compression. Evidence of multilevel decompressive laminectomies in the cervical spine with fusion are noted. There is also no evidence of cord compression in the thoracic or lumbar spine. No obvious cord signal abnormality.", "output": "Diffuse osseous metastatic disease throughout the spine. No cord compression is identified.Please note this is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol, details are not as evident on imaging as dedicated protocols of the spine."}
{"instruction": "Generate impression based on findings.", "input": "16-year-old male with history of acute on chronic pancreatitis.EXAMINATION: Pancreas MRI and MRCP without /with IV contrast and Secretin1/25/2016 ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. SPLEEN: Small splenule. The splenic vein is attenuated near the confluence, however it is patent.PANCREAS: No evidence of pancreatic divisum or annular pancreas.There is increased internal and peripancreatic T2 signal abnormality as well as diffuse parenchymal restricted diffusion compatible with acute pancreatitis.The pancreatic ductal anatomy is abnormal. There is a persistent duct of Santorini. The main pancreatic duct bifurcates at the level of the pancreatic head with one branch draining into the duct of Santorini and one branch draining into the duct of Wirsung which drain into the minor and major papillae, respectively. After secretin administration, the duct of Santorini and Wirsung dilate equally indicating similar drainage rates.At the level of the pancreatic head, there is a subcentimeter cystic lesion which communicates with the duct of Santorini (image 29 of series 401). No enhancement is appreciated on postcontrast imaging.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Acute pancreatitis.2. Abnormal pancreatic ductal anatomy as described above.3. Focal cystic lesion in the pancreatic head communicating with the accessory duct likely representing focal ductal dilatation secondary to stricture from chronic pancreatitis.4. Patent, but attenuated splenic vein near the confluence."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Malignant neoplasm of unspecified part of unspecified bronchus or lung Secondary malignant neoplasm of unspecified siteClinical question: progression of lung cancerSigns and Symptoms: shortness of breath The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No intracranial lesions are appreciated to suggest metastatic disease to the brain."}
{"instruction": "Generate impression based on findings.", "input": "Patient with worsening confusion and headaches. History of metastatic renal cell cancer with brain metastases. Undergoing whole brain radiation. Rule out bleed, edema, increased intracranial pressure. Nonenhanced CT of brain:Examination demonstrate a slightly high density mass in the basal cistern measuring 13 mm x 16.6-mm in transaxial dimension. There is evidence of edema in the hypothalamic and bilateral basal ganglia. Considering patient's provided clinical history of malignancy this finding could represent a metastatic focus. Further follow-up with an MRI is recommended to exclude other lesions in this location.Shunted lateral ventricles with complete collapse of right lateral ventricle and normal appearing third ventricle and left lateral ventricle.Foci of encephalomalacia in the right frontal lobe under a right frontal craniectomy may represent site of prior surgical intervention for removal of tumor. There is no evidence of hemorrhage or midline shift.Calvarium demonstrates right high convexity frontal craniotomy and is otherwise negative.Limited view of paranasal sinuses and mastoid air cells are unremarkable. Limited view of orbits are negative.", "output": "1.High density mass in the basal cistern/hypothalamic region with surrounding edema highly concerning for metastatic lesion considering provided history of renal cell cancer.2.No evidence of any additional metastatic foci and no evidence of midline shift or hydrocephalus.3.High convexity right posterior frontal encephalomalacia under a right frontal craniectomy.4.Calvarium, paranasal sinuses and mastoid air cells are intact."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male. Pain. Evaluate for medial meniscus pathology. MENISCI: Mild globular signal abnormality in the posterior horn of the medial meniscus suggestive of intrasubstance degeneration. No discrete tear is evident. The lateral meniscus is intact with normal signal and morphology.ARTICULAR CARTILAGE AND BONE: Tibiofemoral compartment cartilage is intact without defects. Mild diffuse thinning of the medial patellar articular cartilage without a full thickness defect. Bone marrow signal intensity is within normal limits. Mild osteoarthritis affects the knee with tiny osteophytes.LIGAMENTS: Collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Intrasubstance degeneration in the medial meniscus without a discrete tear.2. Mild medial patellar facet cartilage thinning without a full thickness defect."}
{"instruction": "Generate impression based on findings.", "input": "Female, 72 years old, with back pain and lumbar stenosis. Preoperative planning for decompression. A grade 1 anterolisthesis of L5 relative to S1 is new compared to the 2006 examination. Sagittal alignment is otherwise unremarkable.A T2 hyperintense and T1 heterogeneous lesion within the anterior aspect of the L3 vertebral body is unchanged and likely represents an atypical hemangioma. No other suspicious marrow space lesions are seen. No evidence of marrow edema is detected.Visualized distal spinal cord, conus and cauda equina are unremarkable except as discussed below. No epidural abnormalities are observed.L1-2: Mild facet arthropathy, progressed. No significant spinal canal or foraminal stenosis. L2-3: Mild facet arthropathy and ligamentum flavum thickening, progressed. Minimal bulging disc, progressed. No significant spinal canal or foraminal stenosis. L3-4: Mild facet arthropathy and ligamentum flavum thickening, progressed. Mild predominantly laterally bulging disc without change. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, unchanged. L4-5: Advanced facet arthropathy and ligamentum flavum thickening, progressed. Minimally bulging disc, slightly progressed. In combination with a congenitally slender spinal canal, there is a significant spinal canal stenosis with crowding of the cauda equina, worse from prior. Mild bilateral foraminal narrowing is unchanged. L5-S1: Advanced facet arthropathy and ligamentum flavum thickening, progressed. Disc uncovering and disc bulging, with mild loss of disc height, progressed. In combination with a congenitally slender spinal canal, there is a significant spinal canal stenosis with crowding of the cauda equina equina nerve roots which is progressed. Mild to moderate bilateral foraminal narrowing is also progressed.", "output": "1.Progressive degenerative disease is seen most notably at L4-5 and L5-S1. In combination with a congenitally slender spinal canal, disc and posterior element degeneration results in a significant spinal canal stenosis at these levels.2.Relatively mild degenerative findings are slightly progressed at other levels, most particularly involving the facet joints."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of metastatic renal cell carcinoma with new brain metastases; evaluate for radiosurgery treatment planning History: brain metastases The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an 11 x 8 mm enhancing nodule superior aspect of the right cerebellar hemisphere and the right superior semi-lunar lobule it is associated susceptibility effect. It is stable compared to the prior exam.The visualized portions of the paranasal sinuses demonstrate a mucus retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.", "output": "1.Right cerebellar lesion is suspected to represent metastatic disease. Associated blood products are identified within the lesion indicating that it is fairly vascular.2.This is a limited exam for the purpose of surgical navigation."}
{"instruction": "Generate impression based on findings.", "input": "6-year-old girl with history of tuberous sclerosis and seizures, evaluate for SEGA. There are numerous T2 hyperintense areas of subcortical and cortical signal in the bilateral cerebrum, stable in extent and size from the prior examinations. Additionally, there are subependymal nodules with increased T2 signal and enhancement. These nodules are stable in size compared to the prior examination, the largest of which measures 9 mm in the left caudothalamic groove (701/16). There is no evidence of ventricular obstruction and the ventricles are normal in size and configuration. The orbits, paranasal sinuses, skull, and scalp soft tissues are unremarkable.", "output": "Stable intracranial findings of tuberous sclerosis."}
{"instruction": "Generate impression based on findings.", "input": "Mild dementia. Severe AIDS. Susceptibility-weighted imaging is limited by patient motion but there is no gross intracranial hemorrhage. There is no evidence of intracranial mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is marked global parenchymal volume loss but no hydrocephalus. There is incidental cavum septa verge. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening, most pronounced in the maxillary and ethmoid sinuses. A small midline nasopharyngeal vault cystic lesion measures up to 7 mm and may represent Thornwaldt cyst. The orbits, skull, and scalp soft tissues are grossly unremarkable.", "output": "1.Moderate global parenchymal volume loss, may be AIDS-related. Brain examination is otherwise unremarkable.2.Nonspecific mild maxillary and ethmoid mucosal thickening."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old male with mental status change There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Normal brain CT."}
{"instruction": "Generate impression based on findings.", "input": "Male, 4 years old, history of Chiari malformation surgery, annual evaluation, please evaluate CSF flow. The cerebellar tonsils remain pointed and herniate approximately 13 to 14 mm below the level of the foramen magnum, unchanged in extent. As before, there is a slight retroflexion of the dens which abuts the cervicomedullary junction causing slight flattening, unchanged. These abnormalities contribute to effacement of the CSF space at the level of the foramen magnum. On CSF flow imaging, there is attenuated but detectable flow along the anterior aspect of the cord, and minimalflow along the posterior aspect of the cord and the tonsils, unchanged.The spinal cord demonstrates normal signal intensity and caliber throughout. No evidence of syrinx formation is seen. A full complement of normally formed vertebral bodies is seen. No dysraphism is detected. The intervertebral disks are normal. No spinal canal or foraminal narrowing is seen.", "output": "1.Stable Chiari I malformation and CSF flow imaging.2.No MRI evidence of spinal cord syrinx."}
{"instruction": "Generate impression based on findings.", "input": "History of HCC status post intra-operative ablation. ABDOMEN:LIVER, BILIARY TRACT: The left hepatic dome ablation cavity measures 5.4 x 4.3 cm. There is intrinsic intermediate and high T1-weighted signal intensity internally suggestive of proteinaceous/blood products. Within the ablation cavity there is a curvilinear region of intrinsic T1-hyperintensity which does not completely null on subtraction imaging, likely due to mis-registration. No evidence of internal enhancement or marginal recurrent and/or residual disease.In the right hepatic dome there is a 7-mm T2-weighted hypointense, T1-weighted hyperintense subcentimeter focus (series 501/35), without associated arterial enhancement. No suspicious arterial enhancing lesion.Numerous punctate siderotic nodules.Cholelithiasis without cholecystitis. No intrahepatic or extrahepatic biliary ductal dilatation. The vessels are patent.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Interval RFA ablation of the left hepatic dome lesion without evidence of residual or recurrent disease.2. 7-mm right hepatic dome lesion may represent a dysplastic nodule; attention to this lesion on follow-up surveillance imaging is recommended. "}
{"instruction": "Generate impression based on findings.", "input": " The internal auditory canals are symmetrical and normal in size. The inner ears are normal. There is no mass or abnormal enhancement. The imaged intracranial structures are unremarkable. There is minimal fluid within the right mastoid air cells and mild ethmoid sinus mucosal thickening.", "output": "1.Normal MRI of the internal auditory canals. 2.Minimal nonspecific fluid within the right mastoid air cells."}
{"instruction": "Generate impression based on findings.", "input": "Diagnosis: Myoclonus Abnormal reflexClinical question: assess for cervical stenosis/myelopathySigns and Symptoms: gait impairment, hyperreflexia, H/O Sjogren syndrome MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disk dessication present. A 7mm T2 hyperintense focus within the C2 vertebral body which enhance following gadolinium is stable since the prior exam.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. There are left sided uncovertebral osteophytes at this level associated with encroachment of the left exiting nerve roots. This is stable since the prior exam.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.", "output": "1.Mild degenerative changes in the cervical spine worse at C3-4 where there is mild to moderate encroachment of left sided exiting nerve roots. This is stable since the prior exam from 20132.C2 lesion is stable since the prior exam from 2013 and most likely benign.3.Several periventricular and subcortical white matter changes of a mild degree are nonspecific. They are likely of likely clinical significance."}
{"instruction": "Generate impression based on findings.", "input": "Diffuse large non-Hodgkin's lymphoma status post 6 cycles chemotherapy. Given the limitations of the lack of contrast material, I see no evidence of pathologic lymphadenopathy within the neck. Visceral structures are unremarkable.Bone windows reveal no osseous abnormality", "output": "No definite lymphadenopathy in the study which is limited by the lack of IV contrast."}
{"instruction": "Generate impression based on findings.", "input": "Worsening headache, evaluate for brain pathology. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several punctate foci of increased T2/FLAIR signal within the periventricular and subcortical white matter which are favored to reflect normal variant perivascular spaces. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.", "output": "No definite abnormalities or specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Benign neoplasm of spinal cord . C1 vertebral mass. Please provide biopsy Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the C1 vertebral lesion. There is a soft tisse mass eroding and replacing the right half of the C1 vertebral body which partially involves right vertebral artery compresses the right jugular vein against the styloid process and displaces the right internal coronary inferiorly. The tumor extends to the dural surface and into the perivertebral space and measures 5.3 by 3.3 cm greatest axial dimensions and 3.3 cm greatest superior inferior dimension with a 5 cm AP dimension. The mass enhances following contrast administration. Follow-up scan indicates the biopsy was obtained from the center of the tumor. The right jugulodigastric node there measures 11 x 11 mm axial dimensions but does not meet the size criteria for lymphadenopathyIncidental note is made of numerous tonsilliths", "output": "1.C1 vertebral bone biopsy under CT guidance. samples were delivered to pathology for analysis. The cytologist preliminarily reported suspected plasmacytoma. The tumor essentially replaces the right sided bony elements of C1 and extends to displace adjacent critical vessels . It compresses RIJV against the styloid, displaces and mildly encases RVA which is the nondominant vertebral artery and displaces RICA."}
{"instruction": "Generate impression based on findings.", "input": "70 year old man with history of multiple VT ablations, suspected cardiac sarcoidosis, referred for repeat cardiac MRI to evaluate Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 73 ml (normal range 47+/-19). There are no regional wall motion abnormalities. There is persistent late gadolinium enhancement in the basal lateral and a small focus of the basal anterior wall, which were seen on the previous study but appear more hyperintense in signal today. This could be clinically consistent with the patient's history of recent previous endocardial ablation, otherwise a prior myocardial infarction could be considered.Left AtriumThe left atrium is normal in size . Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVEDV is 158 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 76 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trivial 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.AortaThe aortic root at the level of the SOV is 4.3 cm (stable from last exam). Ascending aorta at the level of the pulmonary bifurcation is upper normal (3.6cm). There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (33mm).Venous AnatomyThe SVC and IVC 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. Normal LV size with normal systolic function (EF 56%). When compared to the previous study, the volumes are smaller and the function appears visually improved. 2. There is persistent late gadolinium enhancement in the basal lateral and a small focus of the basal anterior wall, which were seen on the previous study but appear more hyperintense in signal today. This could be clinically consistent with the patient's history of recent previous endocardial ablation, otherwise a prior myocardial infarction could be considered.3. Normal size RV with normal systolic function (EF 52%). 4. Stable dimensions of sinus of valsalva and upper normal ascending aorta dimensions.5. Mild main pulmonary artery dilation. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 76 years old. Reason: Neck and shoulder pain with fever History: neck and shoulder pain Cervical spine: The lower cervical spine is not well-seen on the lateral view due to overlying anatomy. Severe degenerative disc disease affects C4-5, C5-6, and C6-7. There is mild multilevel facet joint arthritis. Apparent narrowing of the neuroforamina on the left may in part be an artifact of patient positioning. There is loss of the normal cervical lordosis, but otherwise alignment is within normal limits. Severe osteoarthrosis affects the right shoulder. Calcifications in the neck lateral to the cervical spine likely reside in the carotid vasculature.Thoracic spine: The bones appear demineralized. There is a mild rightward curvature of the thoracic spine which may in part be an artifact of patient positioning. There is mild/moderate multilevel degenerative disc disease. The T11-12 disc space is not well seen, which we suspect is due to relatively severe degenerative disc disease. However, if there is clinical concern for discitis at this location, MRI is recommended for further evaluation.", "output": "1.Degenerative arthritic changes as described above.2.The T11-12 disc space is not well seen, which we suspect is due to relatively severe degenerative disc disease. However, if there is clinical concern for discitis, MRI is recommended for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Chiari I malformation, worsening headaches Brain:Again seen is cerebellar tonsillar ectopia with approximately 6 mm of inferior herniation of the left cerebellar tonsil through the foramen magnum and mild effacement of the dorsal subarachnoid space at this level. CSF flow sequence demonstrates patent biphasic flow ventrally and diminished posteriorly at the foramen magnum, similar to prior.Again seen are several scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. No evidence of acute infarct or intracranial hemorrhage. Again seen is a small CSF intensity lesion measuring 16 x 11 mm in the right cerebellopontine angle compatible with an arachnoid cyst and unchanged. There is minimal if any local mass effect associated with this lesion. No other intracranial mass or mass effect. No hydrocephalus. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement. Paranasal sinuses and mastoid air cells are clear. Calvarium and remainder of the extracranial soft tissue structures are unremarkable.Cervical Spine:No abnormal signal in the cervical cord. No abnormal enhancement. Vertebral body heights are maintained. Mild straightening of the cervical spine and mild retrolisthesis of C5 on C6 remain unchanged. Bone marrow signal is benign. Degenerative changes are seen in the cervical spine as described below:C2/3: No significant spinal canal stenosis or neuroforaminal compromise, unchanged.C3/4: No significant spinal canal stenosis or neuroforaminal compromise, unchanged.C4/5: No significant spinal canal stenosis or neuroforaminal compromise, unchanged.C5/6: There is a disc osteophyte complex, mild ligamentum flavum thickening, and bilateral uncovertebral hypertrophy resulting in mild spinal canal stenosis which is stable to minimally worse since prior along for differences in technique and neck position. There is moderate bilateral neural foraminal narrowing which also appears minimally worse since prior.C6/7: Again seen is small disc osteophyte complex, mild uncovertebral hypertrophy, and ligamentum flavum thickening with minimal narrowing of the spinal canal. There is mild right and minimal left neural foraminal stenosis which is not significant changed.C7/T1: No significant spinal canal stenosis or neuroforaminal compromise, unchanged.", "output": "1. Compared to 10/28/2013 and 12/28/2012, there is no significant change in ectopia of the cerebellar tonsils with the left cerebellar tonsil measuring up to 6 mm below the foramen magnum. There is is mildly diminished CSF space and CSF flow involving the posterior aspect of the foramen magnum similar to prior.2. Unchanged small right cerebellopontine angle arachnoid cyst with minimal, if any, local mass effect.3. Mild chronic small vessel ischemic changes.4. No cord signal abnormality or evidence of syrinx in the cervical cord. 5. Degenerative changes in the cervical spine at C5-C6 and C6-C7 which are minimally worse since 10/28/2013. Please see details above."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic disease: seizures. There is a 7 mm diameter right occipital lobe peripherally enhancing lesion with susceptibility effect and surrounding vasogenic edema. There is an enhancing dural based lesion that measures up to 5 mm along the inferior surface of the left tentorium, near the apex. There are punctate foci of susceptibility effect without associated enhancement in the right cerebellum, left frontal lobe periventricular white matter, and medial right occipital lobe. There is no evidence of acute infarct. There are scattered foci of cerebral white matter T2 hyperintensity without associated enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The skull and scalp soft tissues are grossly unremarkable. There is fluid in the left maxillary and right sphenoid sinuses and scattered paranasal sinus mucosal thickening. There is also fluid within the bilateral mastoid air cells.", "output": "1. A 7 mm diameter right occipital lobe peripherally enhancing lesion with susceptibility effect and surrounding vasogenic edema is compatible with metastatic disease. 2. An enhancing dural based lesion that measures up to 5 mm along the inferior surface of the left tentorium may represent a meningioma or metastasis.3. Punctate foci of susceptibility effect without associated enhancement in the right cerebellum, left frontal lobe periventricular white matter, and medial right occipital lobe are nonspecific and may represent chronic microhemorrhages, perhaps related to amyloid angiopathy.4. Findings suggestive of acute sinusitis and mastoiditis."}
{"instruction": "Generate impression based on findings.", "input": "Male 61 years old; Reason: RUQ with mildly dilated pancreatic and CBD ABDOMEN:Suboptimal study secondary to patient motion artifact.LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Diffuse hepatic steatosis. Mild intrahepatic biliary duct dilatation and CBD measures up to approximately 10 mm. However duct demonstrates smooth circumferential tapering distally, distal portion measuring up to 15 mm, see image 19 series 6. No evidence of obstructing stone or lesion. SPLEEN: No significant abnormality noted.PANCREAS: Intrinsic T1 signal of pancreas preserved. Mildly dilated pancreatic duct measuring up to 4 mm, smooth circumferential tapering seen in distalmost portion of level of pancreatic head (measures 15 mm), see image 19 series 6. No definite pancreas divisum seen. No obstructing masslesion seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered colon diverticula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Very extensive patient motion artifact makes evaluation suboptimal.Mild pancreatic ductal dilatation and CBD and intrahepatic biliary duct dilatation visualized, appearance suggestive of underlying benign ampullary stenosis. No obstructing lesion or stone visualized. Relatively smooth circumferential tapering of distal portions of both main pancreatic duct and CBD as above."}
{"instruction": "Generate impression based on findings.", "input": "Neoplasm of uncertain behavior of brain, unspecified [D43.2], Reason for Study: ^Reason: Post op R crani for tumor resection History: lethargy Post-resection status of the right globus pallidus mass lesion with right frontal approach ventriculostomy tube insertion status.There are susceptibility artifacts within the resection cavity, surrounding bran parenchyme as well as intraventricular space especially on the left lateral ventricle occipital horn indicating operation related blood products.On Gad enhanced scan, there is minimal enhancements especially on the posterolateral aspect of the original mass which may indicate residual tumor. Comparing to pre-operative scan, the degree of midline shift has been significantly improved.And ventricle size also has been decreased likely due to ventriculostomy tube insertion.The extent of surrounding edema on the right frontal lobe appears to be slightly decreased, but grossly no change since prior scan.Other enhancing intra axial lesion on the left temporal lobe does not show any interval change since prior scan in terms of size, enhancement pattern and the extent of surrounding edema,There is no evidence of new acute ischemic or hemorrhagic lesion on this scan.There is about 10.1mm (RL) x 18.1mm (AP) x 20.8mm (CC) sized peripherally enhancing lesion with some central stippled enhancement within the left temporalis muscle associated with temporalis fascial enhancement indicating most likely inflammatory lesion, clinical correlation and follow up scan can be considered.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.", "output": "1. Post resection status of the right globus pallidus lesion with right frontal approach ventriculostomy insertion status.2. Blood products within the resection cavity, surrounding brain parenchyme and left lateral ventricle indicate postoperative changes.3. Interval improvement of midline shift, interval decrease of ventricle size and slightly decreased the extent of surrounding edema of the right globus pallidus lesion.4. No change of the left temporal intra axial enhancing lesion.5. No evidence of new acute ischemic or hemorrhagic lesion.6. Left temporal extracranial enhancing soft tissue lesion involving both temporalis muscle and overlying fascia suggesting inflammatory in nature. Clinical correlation and follow up imaging may need to be considered. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 73 years old, history of metastatic melanoma with brain metastases, now with recent seizure and left-sided weakness. Assess for new brain metastases. Two new rim-enhancing lesions are evident within the right post-central gyrus, each containing blood fluid levels, measuring 13 and 10 mm in diameter. These lesions induce moderate local edema which tracks into the underlying white matter.A lesion within the left inferior parietal lobule has significantly increased in size now measuring up to 17 mm, previously 4 mm. A lesion along the left superior frontal sulcus has increased in size now measuring 7 mm, previously punctate. A new 10 mm lesion is evident within the paramedian right occipital lobe, and a new 16 mm lesion is evident more laterally in the right occipital lobe. The above lesions induce mild local edema. A 2 mm focus of enhancement is new within the left inferior frontal lobe.A lesion in the paramedian right parietal lobe is unchanged. The right frontal lobe resection cavity has collapsed with no significant change in the amount of enhancement and decreasing edema. The left superior frontal resection cavity is stable and free of enhancement.", "output": "Multiple new and/or growing lesions compatible with progression of metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 34 years old s/p arrest, remains comatose, evaluate for extent of brain injury, unresponsive off sedation >24 hrs Focus increased diffusion and mildly decreased ADC signal in the posterior right temporo-occipital lobe (401/271) and left inferior cerebellar vermis (401/264) with associated FLAIR abnormality suspicious for subacute infarctions. Mild susceptibility artifact within the right temporo-occipital lobe suggestive of hemorrhagic conversion. Encephalomalacia with surrounding FLAIR abnormality noted within the left inferior parietal lobe involving the supramarginal and angular gyrus suggestive of remote infarct. There is no evidence of intracranial mass. 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": "1. Subacute infarcts within the right temporo-occipital lobe, which demonstrates hemorrhagic conversion, as well as the left inferior cerebellar vermis. 2. Chronic left parietal infarct involving the supramarginal and angular gyrus."}
{"instruction": "Generate impression based on findings.", "input": "Female, 59 years old, status post craniotomy. A small left convexity craniotomy is seen through which the previously demonstrated enhancing mass in the left posterior frontal lobe has been resected. The surgical cavity contains fluid and a small heme level. Thin diffusion restriction around the cavity margins is compatible with procedural cytotoxic edema. No evidence of residual tumor is seen. Vasogenic edema surrounding the operative bed is similar to that seen preoperatively.Elsewhere, no additional pathologic enhancement or suspicious signal abnormality is seen. Scattered foci of T2 hyperintensity within the white matter are unchanged and nonspecific. Ventricular size and morphology are within normal limits. Partial opacification the right mastoid air cells is seen.", "output": "Expected findings are seen status post resection of a tumor from the high left posterior frontal lobe. No residual tumor is identified."}
{"instruction": "Generate impression based on findings.", "input": "Subdural hemorrhage [432.1], Reason for Study: ^Reason: bilateral hygromas - assess any change in size or rehemorrhage History: headache There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Redemonstration of bihemispheric subdural fluid collections (maximum diameter on coronal scan is about 10mm on the right and about 8mm on the left), no change since prior scan. There is no evidence of internal hemorrhage or enhancement.There are also subdural fluid collections on posterior fossa around cerebellar hemispheres, again no change since prior scan.There is no evidence abnormal enhancement or mass lesion.Ventricular system appears to be normal.There is no mass, 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. There are minimal to mild mucosal thickening on bilateral (left more than right) maxillary sinuses. Interval development of the right mastoid air cell opacifications.", "output": "1. No change of bihemispheric and posterior fossa subdural prominent fluid collections since prior scan.2. No evidence of air acute ischemic or hemorrhagic lesion on the scan.3. No evidence of abnormal enhancement. No mass lesion. "}
{"instruction": "Generate impression based on findings.", "input": "A 56 year old male with suspected hypertrophic cardiomyopathy by echocardiography. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size and systolic function. There is mid to apical chamber obliteration at end systole. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 54 ml/m2 (normal range: 74+/-15), the LVEDV is 114 ml (normal range 142+/-34), the LV end systolic volume index is 21 ml/m2 (normal range 25+/-9), the LVESV is 43 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). Hypertrophy was noted diffusely at the basal and mid segments reaching a maximum of 16 mm at the basal antero-septum. There are no regional wall motion abnormalities present. There is are punctate foci of high signal within the interventricular septum, at the insertion of the right ventricular free wall, most notable at the mid chamber level. No other enhancement is identified.No cardiac iron overload noted.No findings compatible with amyloid.On the 3 chamber view during systole, there is an intracavitary jet which is suggestive of a mild resting gradient within the chamber in the subvalvular LVOT (at site of maximal wall thickness).No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 129 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 54 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. There is a hockey-stick configuration to the anterior leaflet which may be the result of prior rheumatic disease. There is mild to moderate systolic anterior motion of the anterior leaflet of the mitral valve. There is transient non coaptation as a result, at early diastole. No significant mitral regurgitation is identified; dedicated 3 plane imaging was not performed.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 pericardial effusion.", "output": "1. Near concentric basal hypertrophy with additional thickening of the interventricular septum. The maximal thickness is 16 mm at end diastole. Mid to apical chamber obliteration at end systole. Left ventricular ejection fraction equals 62%. Punctate foci of intermediate high signal noted at the interventricular septum at the insertion of the right ventricular free wall. Mitral SAM is present. The consolation of findings are suggestive of hypertrophic cardiomyopathy.2. Right ventricular wall thickness is normal with well-preserved systolic function. The right ventricular ejection fraction equals 58%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female, 23 years old. Assess fracture and proximal femur lesion. ACETABULAR LABRUM: The labrum is grossly intact within the limits of a nonarthrographic study.ARTICULAR CARTILAGE AND BONE: The lesion in the left femur involves the subarticular femoral head (within 1 cm of the cartilage), the greater and lesser trochanters, as well as the proximal femoral diaphysis. The lesion is expansile and shows diffuse T1 hypointensity and heterogeneously increased T2 signal, with thinning of the overlying cortex. There is a minimally displaced fracture through the this lesion in the intertrochanteric region. There is a moderate effusion. The right hip and other visualized bones of the pelvis are normal.SOFT TISSUES: There is edema and fluid in the soft tissues surrounding the fracture. ADDITIONAL", "output": "1.Expansile lesion in the left proximal femur may reflect a unicameral bone cyst versus possibly fibrous dysplasia or giant cell tumor.2.Pathologic fracture through this lesion in the intertrochanteric region."}
{"instruction": "Generate impression based on findings.", "input": "28 year-old female with newly diagnosed left breast inflammatory cancer presents for MRI guided biopsy of the non mass enhancement in the right breast lower inner quadrant. On subtraction images, linear nonmass enhancement were identified in the lower inner quadrant of the posterior right breast. This was chosen as the target.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 12 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show no significant hematoma at the biopsy site. An ATEC clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent ultrasound-guided biopsy of right axillary lymph node which will be dictated in a separate report. After this MRI guided procedure and a ultrasound-guided right axillary lymph node biopsy, a right unilateral mammogram to locate the percutaneously placed clip was performed. The clip is placed at 4 o'clock position with no evidence of any complications due to the procedure. The ultrasound clip is seen in the axilla as well. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Wang under direct supervision of Dr. Schacht who was present throughout the procedure.", "output": "Successful MR guided core needle biopsy of the right breast 4 o'clock enhancing lesion. Successful clip placement. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female 68 years old. Reason: Left shoulder pain, possible RC tear. History: shoulder pain s/p fall on 4/2/15 ROTATOR CUFF: The infraspinatus is edematous with evidence of atrophy. There is a complete tear of the infraspinatus. The supraspinatus and subscapularis appear unremarkableSUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint is unremarkable. The labrum is grossly normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL", "output": "Complete tear of the infraspinatus."}
{"instruction": "Generate impression based on findings.", "input": "Low back and leg pain. There are postoperative findings related to prior right hemilaminectomy at L3-4 and interval right L4-5 laminotomy with medial facetectomy and decompression, with mild edema in the paraspinal muscles along the surgical approach. There is multilevel degenerative spondylosis. At L1/2, there is a disc bulge with mild bilateral neural foraminal narrowing, but no evidence of spinal canal. At L2/3, there is a disc bulge with a left lateral disc protrusion, facet hypertrophy, and ligament flavum thickening that result in severe left neural foraminal narrowing. There is also mild right neural foraminal and mild spinal canal narrowing. At L3/4, there is a disc bulge with superimposed central protrusion, facet hypertrophy with effusions and left synovial cyst formation, and ligament flavum thickening that result in severe left lateral recess and neural foraminal narrowing and mild to moderate right neural foraminal narrowing. There is mild anterior subluxation of L3 on L4. At L4/5, there is left facet and ligamentum flavum hypertrophy and a prominent disc bulge that result in moderate to severe right and severe left neural foraminal narrowing, as well as mild spinal canal stenosis. There is also mild anterior subluxation of L4-L5 and irregularity of the superiroL5 endplate. At L5/S1, there is prominent bilateral facet hypertrophy with impingement upon the neural foraminal nerve roots, but no significant spinal canal stenosis. The imaged portions of the spinal cord are unremarkable.", "output": "Postoperative findings in the lumbar spine and extensive multilevel degenerative spondylosis with impingement upon neural foraminal nerve roots at the left L2/3, left L3/4, bilateral L4/5, and bilateral L5/S1 levels.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female, 58 years old. Right shoulder pain ROTATOR CUFF: Metallic suture material in the humeral head causes artifact, somewhat limiting evaluation. The supraspinatus, infraspinatus, and teres minor tendons and muscles are intact. There is mild to moderate tendinopathy of the subscapularis tendon, without discrete tear identified. There is minimal fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: There is trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact within the limits of a nonarthrographic study.BICEPS TENDON: The tendon of the long head biceps is not well visualized due to metallic artifact.ADDITIONAL", "output": "Postoperative changes with mild rotator cuff tendinopathy as above. No discrete rotator cuff tear identified."}
{"instruction": "Generate impression based on findings.", "input": "Unspecified sequelae of cerebral infarction [I69.30], Reason for Study: ^Reason: r/o stroke and reperfusion injury History: neurological deficit after CEA There interval development of new restricted diffusion lesions on the left parietal lobe inferior parietal lobule indicating acute ischemic infarction.Previously seen left hemispheric ischemic infarction lesions on the left parietal lobe inferior parietal lobule and left frontal lobe show decreased extent of restricted diffusion areas but some still show diffusion restriction. In addition, there are small scattered susceptibility lesions on the left inferior parietal lobule indicating petechial hemorrhages which are more conspicuous on today's scan. However, the extent of susceptibility lesions are unchanged and there is no associated surrounding edema.There are cortical linear T1 high signal intensity lesions on the left frontal and parietal lobes indicating chronic ischemic lesions with laminar necrosis. Scattered right hemispheric chronic ischemic infarctions are seen, unchanged.Right cavernous sinus enhancing lesions indicating meningioma is again seen, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. 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. Interval development of new scattered restricted diffusion lesions involving left parietal lobe (series 202, images 144, 136).2. Evolving acute/subacute ischemic lesions on the left frontal and parietal lobes. Petechial hemorrhagic transformation are suggested but grossly unchanged since prior scan.3. Unchanged right hemispheric chronic ischemic lesions.4. Unchanged right cavernous sinus enhancing mass, meningioma, since prior scan."}
{"instruction": "Generate impression based on findings.", "input": " The last well formed disk space is referred to as L5-S1. There is 4-mm retrolisthesis of L5 on S1. There is no osseous marrow edema. The conus terminates at L1.T12-L1: No spinal stenosis or disk herniation.L1-2: No disk herniation or spinal stenosis.L2-3: Mild disk bulge and facet arthropathy with no spinal stenosis.L3-4: Disk desiccation with moderate loss of disk height, and mild disk bulge with no significant spinal stenosis.L4-5: Disk desiccation with moderate loss of disk height, moderate bilateral facet arthropathy causing mild bilateral neural foraminal stenosis and no significant spinal canal stenosis.L5-S1: Disk desiccation with severe loss of disk height, type II endplate degenerative changes, retrolisthesis of L5 on S1 causing no significant spinal canal stenosis and mild bilateral neural foraminal stenosis.There is a right renal cyst incompletely imaged measuring up to 18 mm.", "output": "1.Multilevel lumbar spondylosis with mild bilateral neural foraminal stenoses at L4-5 and L5-S1.2.Incompletely imaged right renal cyst measuring up to 18 mm."}
{"instruction": "Generate impression based on findings.", "input": " CERVICAL: The vertebral body alignment, heights and marrow signal are normal. The spinal cord signal is within normal limits. Minimal degenerative changes are seen at C4-C5, C5-C6 without significant spinal canal or neural foraminal stenosis.THORACIC: There are postoperative findings related to prior right T1-2 intradural-extramedullary mass resection with right laminectomy at T1 and T2. Previously seen fluid collection in the posterior soft tissue operative bed is nearly resolved. Lack of intravenous contrast somewhat limits evaluation however, there is no evidence of residual or recurrent tumor. Again seen is mild rotation of the upper thoracic cord likely related to scarring/thecal sac adhesions. Minimal T2 hyperintense signal in the upper thoracic cord is again seen. The vertebral body alignment, heights and marrow signal are normal. There is no significant spinal canal or neural foraminal stenosis.", "output": "1. No evidence of recurrent tumor within the limitations of noncontrast MRI. 2. Please see note in technique section. Patient will return for postgadolinium sequences at a later time."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Evaluate grade 3 oligodendroglioma status post RT and TMZ. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination redemonstrates extensive postoperative changes of right anterior temporal lobectomy since prior study. There is stable FLAIR and T2 hyperintensity of the right temporal lobe immediately posterior to the surgical resection site which extends into the left basal ganglia consistent with encephalomalacia/gliosis and postoperative changes. There is no detectable focus of abnormal enhancement at the surgical site or remote to the surgical site. This is a similar observation is prior exam.Moderate to be enlarged supratentorial ventricular system with maintained midline remain similar to prior study.Focus of encephalomalacia in the left anterior frontal lobe without abnormal enhancement or interval change since prior study.Scattered periventricular and subcortical FLAIR and T2 hyperintensity foci suggestive of chronic small vessel ischemic strokes are again noted without interval change. Possibility of overlapping post treatment/radiation changes cannot be excluded. Correlate with clinical history.Diffusely prominent cortical sulci and CSF spaces also remains identical to prior exam.", "output": "1.No evidence of an acute or definitive new finding since prior exam.2.Stable postoperative/therapy changes of the right anterior temporal lobectomy without abnormal enhancement to suggest recurrence of tumor.3.Stable scattered foci of FLAIR hyperintensity in the subcortical and periventricular white matter and a focus of encephalomalacia in the left anterior and inferior frontal lobe similar to prior exam.4.Stable scattered foci of FLAIR hyperintensity and localized focus of encephalomalacia in the left frontal lobe since prior study.5.Stable moderately enlarged supratentorial ventricular system and generalized prominence of cerebral cortical sulci likely representing ex vacuo dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Female, 73 years old, with bilateral uveitis, headache, blurry vision, possible TB versus GCA versus other. The dura overlying the bilateral frontal and anterior temporal lobes remains smoothly thickened and enhancing. More posteriorly, these findings diminish and the dura is becomes relatively unremarkable. In the areas where dural thickening is most pronounced, thin bilateral subdural collections are redemonstrated measuring up to 5 mm in thickness, previously 6 mm. The collections overlie the lateral aspects of the frontal lobes and do not extend more superiorly or posteriorly. No enhancement is seen along the inner margins of these collections and there is no convincing associated susceptibility effect.No evidence of any pathologic leptomeningeal or parenchymal enhancement is seen. No acute intracranial hemorrhage is detected. Diffusion-weighted images are within normal limits. Scattered foci of periventricular and subcortical FLAIR hyperintensity are redemonstrated, similar to prior. Ventricular size morphology are within normal limits.", "output": "Smooth dural thickening and enhancement persists, similar to the prior examination, predominantly affecting the frontal and anterior temporal regions. Small subdural collections along the lateral aspects of the frontal lobes are slightly reduced in size. Scattered parenchymal foci of signal abnormality are unchanged and nonspecific.The etiology of the above findings remains uncertain. The differential diagnosis would include changes in intracranial pressure which could account for both the dural thickening and the small bilateral subdural collections. Alternately, the dural thickening may be reactive to the collections. The collections themselves do not demonstrate typical features of empyema, though an atypical infectious etiology could certainly be considered. Finally, noninfectious inflammatory, granulomatous and/or autoimmune conditions remain in the differential."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for osteochondroma. A broadbase osteochondroma arising from the posterolateral distal tibial diaphysis has a three cm base and protrudes two cm towards the anteromedial aspect of the fibula. The osteochondroma abuts the fibula and causes chronic pressure effect with resultant concavity of the fibular surface and narrowing of the fibular diameter. The osteochondroma has a thin cartilaginous cap measuring eight mm in thickness and which demonstrates minimal enhancement on post-contrast images. The cortex of both the tibia and fibula is intact. No fracture is evident. No evidence of abnormal enhancement within the soft tissues of the right leg.", "output": "Broadbase osteochondroma minimally larger when compared to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Right thigh mass post incisional biopsy 9/2/2015. Evaluate remaining mass. BONE MARROW: No significant abnormality noted.SOFT TISSUES: There is a T2 hyperintense linear area of enhancement measuring 1.7 x 0.6 x 2.7 cm within the lateral right upper thigh subcutaneous tissue extending to the skin surface (series 1201, image 43). JOINTS: No significant abnormality noted.ADDITIONAL", "output": "T2 hyperintense linear focus within the lateral aspect of the right upper thigh subcutaneous tissue, may be secondary to recent excisional biopsy. Unable to exclude residual lesion."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with left knee pain, medial joint line tenderness, no improvement with injections or conservative treatment MENISCI: Globular intermediate signal within the outer third of the anterior horn of the lateral meniscus extending to the femoral articular surface consistent with degenerative fraying. Blunting of the free edge of the posterior horn of the lateral meniscus compatible with a tear.The medial meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: A focal chondral defect is noted in the lateral tibial articular cartilage measuring up to 4 mm in AP dimension, directly beneath the aforementioned meniscal tear. Grade 1-2 chondromalacia medial tibiofemoral compartment. There is severe thinning of the lateral patellar facet articular cartilage. Subchondral cysts are noted in the lateral tibial plateau/spine. Otherwise, there is no abnormal marrow signal. Mild tricompartmental osteophytosis is noted.LIGAMENTS: Cruciate ligaments are intact. Collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL", "output": "1.Blunting of the free edge of the posterior horn of the lateral meniscus compatible with a tear. Underlying focal chondral defect is also noted in the lateral tibial articular cartilage measuring up to 4 mm in AP dimension2.Globular intermediate signal within the outer third of the anterior horn of the lateral meniscus extending to the femoral articular surface consistent with degenerative fraying. 3.Focal 4 mm loose body is also noted in the pocket of fluid posterior to the femoral metaphysis.4.Mild to moderate osteoarthritis affects the left knee. "}
{"instruction": "Generate impression based on findings.", "input": "Right thumb pain LIGAMENTS: No significant abnormality noted. Specifically, the ulnar and radial collateral ligaments of the thumb appear intact.TENDONS: No significant abnormality noted. BONES: There is a cortical defect of the dorsal aspect of the base of the proximal phalanx of the thumb likely reflecting a subacute or chronic avulsion fracture. There is no significant surrounding marrow edema to suggest this is acute in nature. There is a slight volar tilt of the proximal phalanx in relation to the metacarpal but otherwise alignment of the thumb is relatively anatomic.ADDITIONAL", "output": "Avulsion fracture at the base of the proximal phalanx of the thumb. Given the lack of surrounding marrow edema, this is most likely subacute or chronic in nature. There is no evidence of collateral ligament tear and aside from mild volar tilt of the proximal phalanx, the thumb is otherwise in anatomic alignment."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal uterine bleeding with clinical picture suggestive of adenomyosis. Pelvic ultrasound with possible endometrial polyps. PELVIS:UTERUS, ADNEXA: The uterus is anteverted in position and measures 4.9 x 8.0 x 6.9 cm. The endometrial stripe is normal in appearance measuring up to 7 mm in thickness. The junctional zone is mildly thickened measuring up to 15 mm anteriorly. A few subcentimeter foci of decreased signal within the anterior myometrium may reflect subcentimeter fibroids. The ovaries are unremarkable in appearance and contain normal-appearing follicles measuring up to 2.2 cm. No adnexal masses are identified.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": "Findings compatible with uterine adenomyosis."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old woman with history of Crohn's disease status post total proctocolectomy on Azathioprine. Patient now has right upper quadrant pain. ABDOMEN:LIVER, BILIARY TRACT: Decreased signal on out of phase imaging suggests diffuse hepatic steatosis with small areas of sparing. No focal hepatic lesion identified. Cholelithiasis without evidence of acute cholecystitis.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: A subcentimeter cyst is seen in the right upper pole. The left kidney is normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy is identified.BOWEL, MESENTERY: The patient is status post proctocolectomy and a right lower quadrant ostomy is identified. No focal bowel wall thickening or abnormal enhancement is identified. There is no evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality is identified.OTHER: No significant abnormality noted.PELVIS:UTERUS/ADNEXA: Nabothian cyst formation noted. BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: Very mild left-sided perineal subcutaneous soft tissue stranding is seen, however previously seen T2 hyperintense fistulous tract appears to have resolved.OTHER: A very small amount of loculated pelvic fluid is seen, predominantly on the right.", "output": "No evidence of active Crohn's disease."}
{"instruction": "Generate impression based on findings.", "input": "History of tuberous sclerosis, evaluate for angiomyolipoma. ABDOMEN:LIVER, BILIARY TRACT: Liver demonstrates normal parenchymal signal intensity without focal lesions. No biliary ductal dilatation.SPLEEN: The spleen is normal in size without focal lesions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys demonstrate normal parenchymal enhancement without focal lesions. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy is identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The bones appear normal.OTHER: No significant abnormality noted.", "output": "Normal examination without renal lesions."}
{"instruction": "Generate impression based on findings.", "input": "Knee pain, loss of range of motion, difficulty with stairs, joint instability, abnormal knee exam. History of meniscal tear age 12, status post surgery. Assess for meniscal tear. The patient's knee would not fit into the high-definition coil and, therefore, an alternative coil was used resulting in suboptimal image quality.MENISCI: There is extensive deformity of the lateral meniscus with moderate attenuation of the posterior horn and marked attenuation of the body as well as displacement of meniscal tissue into the intercondylar notch indicating a bucket handle tear. Furthermore, there is extensive mucoid degeneration of the anterior horn with formation of intrameniscal cyst that extends anteriorly as a parameniscal cyst is noted. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is heterogeneity of the articular cartilage of the lateral compartment indicating degeneration with near full thickness to full-thickness loss of cartilage above the posterior horn of the lateral meniscus. There there are small subchondral foci of signal abnormality in the lateral femoral condyle presumably degenerative in etiology, as well as a cyst in the lateral tibial spine, which is also presumably degenerative in etiology.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL", "output": "1. Deformity and degeneration of the lateral meniscus including a bucket handle tear as described above.2. Degeneration of the cartilage of the lateral femoral compartment."}
{"instruction": "Generate impression based on findings.", "input": "52 year old with a biopsy proven DCIS in the right breast presents for MRI evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a unifocal non-mass enhancement at posterior upper outer quadrant in the right breast (10:00 position), measuring 20 x 11 x 33 mm (AP x LR x CC) showing rapid uptake. Elsewhere, no abnormal enhancing lesion in the right breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.", "output": "1. Unifocal right breast lesion at posterior 10:00 position, consistent with biopsy proven DCIS.2. No MRI evidence for malignancy in the left breast. 3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: metastatic RCC with new brain mets now s/p radiosurgery; please evaluate response History: brain metastases. Previously seen right posterior temporal lesion is not significantly changed in size measuring 20 x 20 x 19 mm, previously 19 x 18 x 19 mm but demonstrates slight interval increase in intrinsic T1 hyperintensity and slight decrease in enhancement. Interval increase in susceptibility effect is also noted within this lesion consistent with increased blood products.Left posterior frontal lobe lesion demonstrates interval increase in intrinsic T1 hyperintensity and susceptibility consistent with blood products. There is slight decrease in associated enhancement. This lesion measures 20 x 21 x 20 , previously 19 x 20 x 18 mm.No new mass or focus of enhancement is seen to suggest progression of metastatic disease. No new edema, mass effect, midline shift or herniation. No hydrocephalus.There are a few punctate foci of increased T2 signal scattered throughout the cerebral white matter without enhancement or mass effect and are nonspecific. The major cerebral flow voids are intact. Bone marrow signal and extracranial soft tissues are unremarkable.", "output": "1.No significant change in size of the left posterior frontal lobe and right posterior temporal lesions. There is however interval increase in blood products within the lesions and mild decrease in enhancement, findings compatible with treatment-related change. No new lesions or findings to suggest progression of metastatic disease.2.No significant edema or mass effect. "}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male with Sjogren's and left orbital mass. Please evaluate interval change. Also has history of sinus disease, frontal sinus retention cyst. Stable postsurgical changes are seen in the left frontal sinus. Stable soft tissue density in the left frontal sinus which again most likely represents a mucous retention cyst versus a polyp. There is increased mucoperiosteal thickening in the ethmoid air cells. Significant mucoperiosteal thickening and retention cyst or polyp formation within the left maxillary sinus. The right exercise also contains a retention cyst or polyp. Ostiomeatal units appear occluded bilaterally. Stable mild nasal septal deviation towards the right. Bilateral orbits are within normal limits. Specifically, no evidence of orbital masses. The left lacrimal gland appears minimally enlarged compared to the right. MRI of the orbits could be obtained if concern for orbital pathology remains.", "output": "Increased ethmoid sinus disease with occluded ostiomeatal units bilaterally. No evidence of orbital mass."}
{"instruction": "Generate impression based on findings.", "input": "Brain mapping for a stereotactic biopsy. Enhanced head CT:80 cc of Omnipaque 350 is administered for this exam.Stealth infused head CT with 1 mm slice thickness is obtained. Reformatted images are also acquired. This exam is performed with patient with stereotactic frame on head.Examination again demonstrates a large area of CSF collection in the right posterior frontal -- parietal region (likely result of prior partial lobectomy) with suggestion of subtle enhancing mass along its anterior edge similar to prior MRI exam from 4 -- 29 -- 2011. Extensive vasogenic edema in the left posterior frontal -- parietal is also again noted. There is an internal focus of enhancement measuring 14.9 x 19.5-mm in size.No evidence of an additional focus of enhancement.Stable size of ventricular system and no midline shift.", "output": "Stereotactic Stealth pulse infused T2 of the brain demonstrate two foci of enhancement one along the anterior aspect of right posterior temporal -- parietal lobectomy and a second one in the right posterior parietal similar to prior MRI exam."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with metastatic breast cancer and known brain metastases with new onset atrial fibrillation. Now with mental status change. Evaluate for acute CVA or hemorrhage. Multiple low attenuation areas correspond to vasogenic edema secondary to known metastatic foci are seen involving both cerebral hemispheres. Some of these lesions correspond to those on MRI from 3 months prior, however all cannot be appreciated on this exam. No definite new lesions identified. There is no evidence of intracranial hemorrhage. 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": "Multiple low attenuation areas correspond to vasogenic edema from known brain metastases are seen. MRI is suggested for further evaluation if clinical concern remains for acute CVA."}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: Eval GBM. This will be 3 mo post RT. History: GBM on TMZ There is no evidence of acute ischemic or hemorrhagic lesion.There is evidence of left parieto-occipital craniotomy with left occipital tissue defect associated with nodular wall enhancements. The tissue defect size is measured about 30.3mm (AP) x 28.3mm (RL) and 25.1mm (CC). In addition, there are scattered susceptibility artifacts on the peripheral aspect of the cavity and overlying brain surface indicating operation related blood products. At least 3 discrete nodular enhancing lesions are seen on the margin of the resection cavity which are measured about 7-8mm in longest diameter.In particular, there is a focal nodular enhancing lesion at the junction of the resection cavity and left lateral ventricle occipital horn. However, there is no evidence of associated adjacent ependymal enhancement. On FLAIR images, those enhancing lesions are associated with surrounding edema indicating possible residual or recurrent tumors. In particular, there is brain edema on the left corpus callosum splenium. The ventricles, sulci and cisterns are symmetric and unremarkable. 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. Post resection and post radiation status of the left occipital GBM with at least 3 discrete enhancing nodular lesions on the resection margin as described above.2. Enhancing lesions on the resection margin could represent residual or recurrent tumor.3. No evidence of acute ischemic or hemorrhagic lesion."}
{"instruction": "Generate impression based on findings.", "input": " The risks (including, but not limited to, those of bleeding, infection, allergic reaction, inability to access the joint, and failure of medication to relieve pain) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural \u201ctime-out\u201d form was completed.The patient was placed supine on the fluoroscopy table. The left shoulder 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 22-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 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 the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient\u2019s 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: 39 seconds", "output": "Successful fluoroscopically guided left shoulder arthrogram and injection of dilute gadolinium. Please see subsequent MRI report for further details."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old male with renal mass. Exam limitations are related to respiratory motion artifacts.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small T1 hypointense and T2 hypointense focus of the upper splenic pole correlates with large calcified granuloma on the 2013 CT exam.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple cysts in the bilateral kidneys. There are multiple bilateral small T2 hyperintense foci that are too small to characterize.In the right kidney, a lower pole exophytic 1.1 cm T1 hyperintense and T2 hypointense lesion demonstrates no contrast enhancement and is favored to be benign. Other: The hyperintense lesions of the right kidney also demonstrate T2 hyperintensity and are felt related to proteinaceous cyst. No hydronephrosis.In the interpolar region of the left kidney, there is a 5 x 4.3 cm lobulated mass that is hypointense on T2, heterogenous on T1, demonstrates contrast enhancement and is concerning for a renal cell carcinoma. No renal vein invasion or left sided retroperitoneal lymphadenopathy is seen.The left kidney also demonstrates multiple T2 hyperintense simple cysts, and a few demonstrate T1 hyperintense signal compatible with proteinaceous material. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: In the anterior aortocaval region, there is a 1.3 x 1.6 cm soft tissue lesion that demonstrates T1 hypointense, T2 hyperintense (axial series 701 image 8), and post contrast enhancement (axial series 1/3/2003 image 68). This lesion is stable in size since the 2013 CT exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Large T2 hyperintense and enhancing lesion of the left kidney measuring 5 x 4.3 cm is consistent with a renal cell carcinoma. No renal vein invasion. No regional lymphadenopathy.2.An aortocaval soft tissue lesion measuring 1.3 x 1.6 cm is stable in size since the 1/7/2013 CT exam. Given the stability and imaging features described above a benign etiology such as an extra-adrenal pheochromocytoma or benign nerve sheath tumor is favored."}
{"instruction": "Generate impression based on findings.", "input": "Female; 40 years old. Reason: 40 yo F no symptoms with newly Dx chronic pancreatitis by EUS r/o ductal or parenchymal changes of CP History: 40 yo F no symptoms with newly Dx chronic pancreatitis by EUS r/o ductal or parenchymal changes of CP ABDOMEN:LIVER, BILIARY TRACT: Scattered small hepatic cysts. No biliary ductal dilation.SPLEEN: Small splenule inferior to the spleen.PANCREAS: Normal volume and T1 signal of the pancreas. Normal homogeneous enhancement. No pancreatic ductal dilation. Normal physiologic response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral breast implants, partially visualized.", "output": "No specific evidence of chronic pancreatitis, as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "51 years Female (DOB:1/13/1965)Reason: lateral recess syndrome at L5/S1 1012 ct recommended: HNP History: left and right sciaticaPROVIDER/ATTENDING NAME: JAMES J. CURRAN JAMES J. CURRAN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.", "output": "No compromise to lumbar spinal canal or neural foramina. There are only minor degenerative changes present lumbar spine."}
{"instruction": "Generate impression based on findings.", "input": "Clinical question: Repeat study, given motion artifact with prior study, persistent altered mental status for unknown reasons. Signs and symptoms: As above. Nonenhanced brain MRI:Diffusion-weighted images demonstrate a tiny focus of restricted diffusion in the left centrum semiovale measuring approximately 5 mm sized. There is no evidence of hemorrhage in this finding. This finding was also utilized flair sequence as a small focus of hyperintensity.Examination condition demonstrate minimal periventricular white matter flair hyperintensity and a tiny focus of similar signal change in the left external capsule which are suspicious for minute chronic non-hemorrhagic small vessel ischemic strokes.The anatomical morphology as well as the signal intensity of brain parenchyma otherwise remains within normal all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits and paranasal sinuses.", "output": "1.5-mm focus of restricted diffusion in the left centrum semiovale noted on diffusion-weighted images.2.Minute chronic nonhemorrhagic small vessel ischemic strokes as detailed.3.Unremarkable exam otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Female, 24 years old, with neurofibromatosis type I, hydrocephalus, aqueduct stenosis. Evaluate for changes, tumors, CSF flow through 3rd VC. A right frontal approach ventriculostomy catheter appears to be in stable position. Ventricular size and morphology are stable and within normal limits. Evidence of third ventriculocisternostomy is again seen with CSF flow demonstrated across the defect.An oval, T2 hyperintense, nonenhancing lesion within the left splenium of the corpus callosum has increased in size now measuring 21 x 13 mm, previously 11 x 6 mm. Several additional small T2 hyperintense lesions are also redemonstrated without evidence of progression. In fact, a lesion in the right cerebral peduncle may even be somewhat smaller. As before, some of these lesions enhance, including those within the left temporal lobe, at the left foramen of Monro, and in the tectum. The tectal lesion causes narrowing of the cerebral aqueduct. A nonenhancing potentially cystic focus is redemonstrated in the pineal gland without significant interval change.No significant generalized parenchymal mass effect is seen. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Diffusion-weighted images are within normal limits.", "output": "1.Interval increase in size of the lesion within the left aspect of the splenium of the corpus callosum.2.Multiple additional stigmata of neurofibromatosis including scattered enhancing and nonenhancing lesions are otherwise unchanged, with one lesion perhaps slightly smaller.3.Stable positioning of the right frontal ventricular catheter. Stable ventricular size and morphology. The third ventriculocisternostomy remains patent."}
{"instruction": "Generate impression based on findings.", "input": "Female, 68 years old, with gait problems and history of obstructive hydrocephalus. No restricted diffusion is seen. Subacute infarction within the left precentral gyrus noted on the prior examination has evolved and now demonstrates chronic appearing T2/FLAIR hyperintensity.Multiple additional foci of periventricular T2/FLAIR hyperintensity are seen with ill-defined hyperintensity is also noted in the pons. These findings have not significantly changed from prior. No pathologic parenchymal or extra-axial enhancement is observed. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. A few scattered foci of susceptibility are seen in association with the left precentral stroke compatible with chronic microhemorrhage.The lateral and third ventricles remain disproportionately enlarged relative to the caliber of the sulci. No interval change is seen in the caliber of the ventricular system. On thin section sagittal imaging, there is no obstruction of the cerebral aqueduct. On CSF flow imaging, robust flow is evident through the cerebral aqueduct, fourth ventricle and foramen of Magendie. A mild blush of flow related signal is also seen adjacent to the foramen of Monro. Robust biphasic CSF flow is seen in the basal cisterns surrounding the brainstem.", "output": "1.Previously seen left precentral infarct has evolved and now appears chronic.2.Evidence of fairly extensive additional microvascular ischemic disease is seen.3.The lateral and third ventricles remain enlarged relative to the fourth ventricle and the sulci which is concerning for normal pressure hydrocephalus. However, no obvious obstructive lesion is seen."}
{"instruction": "Generate impression based on findings.", "input": "Clinical history rectovaginal fistula. Flatus with greenish discharge per vagina. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: The soft tissue interface between the rectum and vagina is unremarkable. The distal most aspect of the rectum/anus is not well visualized due to the inherent lack of spatial resolution of MR. No fistulous tract is evident.", "output": "No rectovaginal fistula is evident. Complementary fluoroscopic evaluation is also recommended to exclude rectovaginal fistula if clinical suspicion persists."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female with history of Chiari malformation experiencing chronic headaches and vision changes Brain MRI:Limited diffusion weighted images are negative. Sagittal T1 weighted images demonstrate stable postoperative changes of suboccipital midline craniectomy and removal of posterior arch of C1 for decompression of the foramina magnum. There is expected expansion of thecal sac and no detectable deformity of the cerebellar tonsils. This finding is similar to prior examination. CSF flow demonstrates biphasic flow posteriorly at the level of the foramen magnum and cerebellar tonsils.The signal intensity and morphology of the brain is within normal limits. There is no evidence of hydrocephalus.Metallic artifact overlapping the left occipital bone producing significant amount of ferromagnetic artifact which obscures adjacent brain parenchyma and calvarium. Overall exam demonstrates no interval change since prior study.Cervical spine MRI: Examination redemonstrates expected postoperative changes of suboccipital midline craniectomy and removal of posterior arch of C1 and resultant expansion of thecal sac.The signal intensity and caliber of the cord remains within normal limits with no evidence of syrinx. There are no significant degenerative changes or stenoses.", "output": "1.Stable postoperative changes of suboccipital craniectomy, unremarkable, and stable since prior study.2.MRI examination of cervical spine demonstrates no evidence of syrinx or stenoses."}
{"instruction": "Generate impression based on findings.", "input": "Female, 35 years old. Reason: R/O TFCC tear History: pain and loss supination LIGAMENTS: Given the limitations of a non-arthrogram study, the scapholunate and lunotriquetral ligaments appear intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Although we see no fluid signal intensity completely traversing the articular disc of the triangular fibrocartilage, there is increased signal intensity within the articular disc near its attachment to the ulnar styloid that may reflect degeneration or a tear. There is edema within the soft tissues both volar and dorsal to the ulnar styloid and triangular fibrocartilage that may represent recent injury. There is also a small amount of fluid within the distal radioulnar joint with a small focus of intermediate signal intensity volarly within the joint that may represent a small cartilaginous fragment. There is also mild edema within the fovea of the distal ulna. There is slight dorsal translation of the ulna relative to the sigmoid notch of the radius, and we cannot entirely exclude the possibility of a partial thickness tear of the volar radioulnar ligament at its ulnar attachment, although its radial attachment appears intact. The volar ulnotriquetral ligament appears intact. The volar ulnolunate ligament is not clearly seen, but the significance of this is uncertain.TENDONS: The extensor carpi ulnaris tendon is appropriately positioned within its groove. Distal to the ulnar styloid the tendon appears slightly thickened with mild increased intrasubstance signal which may reflect a mild tendinosis, but we see no discrete tear of the tendon. The remaining tendons of the wrist are unremarkable. BONES: A side from the aforementioned mild signal abnormality within the distal ulna, the bones appear normal.ADDITIONAL", "output": "Increased signal intensity within the ulnar fibers of the articular disc of the triangular fibrocartilage with edema in the adjacent soft tissues and bone, suggestive of a tear. Other findings as described above."}
{"instruction": "Generate impression based on findings.", "input": "Left posterior oral tongue cancer T4a treated with CRT and 2nd primary T1 excised in 2014. Now with thickening and pain. There are post-treatment findings in the left oral cavity region. There is decreased conspicuity of patchy areas of T2 hyperintensity in the left oral tongue. Otherwise, there is no evidence of measurable oropharyngeal mass lesions or cervical lymphadenopathy. There is an unchanged well-defined T2 hyperintense lesion in the left shoulder region, without convincing enhancement. The thyroid gland and remaining salivary glands are unremarkable. There is minimal fluid within the left mastoid air cells. The orbits and imaged intracranial structures are unremarkable.", "output": "1. Post-treatment findings in the left oral cavity region with decreased conspicuity of nonspecific patchy areas of T2 hyperintensity in the left oral tongue. Otherwise, no evidence of measurable oropharyngeal mass lesions or cervical lymphadenopathy. 2. Unchanged well-defined cystic lesion in the left shoulder region. "}
{"instruction": "Generate impression based on findings.", "input": "GBM on Avastin. There are postsurgical changes of right craniotomy for tumor resection including mild dural thickening and enhancement. The bulk of the heterogeneously enhancing right cerebral hemisphere mass, centered in the deep grey matter nuclei and frontal lobe, appears to have increased in size, with scattered areas of restricted diffusion and susceptibility effect. However, the more peripheral necrotic portions and the surrounding high T2 signal that likely represents at least to some extent vasogenic edema have diminished. The right lateral ventricle and perhaps the third ventricle have increased in size, but the left lateral ventricle remains distended. There is persistent leftward midline shift of approximately 14 mm and right uncal herniation. There is no evidence of acute territorial infarction or hemorrhage. The major cerebral flow voids are intact. The orbits are grossly unremarkable.", "output": "The bulk of the enhancing portions of the large right cerebral hemisphere glioblastoma appears to have increased in size, which may be due to tumor progression, but the necrotic components and associated vasogenic edema has diminished, which may be attributable to Avastin.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "64 year old man with history of AL type amyloidosis who has been treated with chemotherapy with previous MRI suggestive of early cardiac involvement. He was referred for repeat cardiac MRI to evaluate for possible progression. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 71 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 84 ml (normal range 47+/-19), the LV mass index is 59 g/m2 (normal range 85+/-15), and the LV mass is 124 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a focal area of late gadolinium enhancement in the basal inferior subendocardium, which was not seen previously, and the basal inferolateral wall. On the previous study this region was thought to represent fat, but review of images today is consistent with true late gadolinium enhancement. Left AtriumThe left atrium is moderately dilated. There is thickening of the interatrial septum. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 135 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 55 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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 FindingsThere is a right upper lobe nodule which was seen on the previous study; it measures 14mm x 13mm today which is grossly stable compared to last MRI scan. No significant pleural effusion. Small focal inferior splenic hyperintense lesion is also unchanged compared to previous MRI scan, which is reassuring. 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. Normal LV size and systolic function (LVEF = 55%). There is mild left ventricular hypertrophy (posterior wall thickness 12mm) and septal hypertrophy (11mm) which is stable from previous. There is a focal area of late gadolinium enhancement in the basal inferior and inferolateral wall (present on previous study but thought to represent artifact), suspicious for an infiltrative process in this patient with amyloidosis history.2. Normal RV size and systolic function (RVEF = 59%). 3. Moderate biatrial dilatation with interatrial septal thickening. 4. At least mild mitral regurgitation. 5. Stable appearing right upper lobe nodule and stable splenic hyperintense focus. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Septated Renal Cyst Bosniak IIF History: Flank Pain ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion is identified. No evidence of intrahepatic or extrahepatic biliary ductal dilatation. No gallbladder wall thickening or pericholecystic fluid collection.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, largest measuring 2.0 x 1.2 x 2.1-cm in the mid left kidney. There may be fine septation of the largest cyst, which is not visualized very well. There is no contrast enhancement. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral multiple cystic lesions, likely simple cyst. Largest left cyst with possible fine septation but without contrast enhancement, of benign appearance. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: new onset of pain, difficulty ambulating, Multiple myeloma on active chemotherapy. MENISCI: There is an oblique tear through the posterior body and horn of the medial meniscus which contacts the inferior articular surface. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild grade 1/2 chondral thinning in the medial and lateral tibiofemoral compartments. The articular cartilage in the patellofemoral compartment is intact.There are multiple T2 hyperintense and T1/PD hypointense lesions in the proximal tibia, including in the medial and lateral tibial plateau, which are nonspecific, but given history, are concerning for myeloma lesions, which did not appear to be present on the previous PET/CT. The lesion in the lateral tibial plateau causes overlying cortical destruction of the articular surface (series 7, image 20).LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The medial and lateral collateral ligament complex is normal.EXTENSOR MECHANISM: There is mild abnormal T1 and T2 signal hyperintensity at the insertion of the quadriceps tendon, which may reflect mild tendinopathy.ADDITIONAL", "output": "1.Multiple abnormal focal lesions in the proximal tibia which are concerning for myelomatous involvement, including an area of cortical disruption of the articular surface in the lateral tibial plateau.2.Oblique tear of the posterior horn of the medial meniscus.3.Diffuse muscular edema within the quadriceps and hamstring muscles which is nonspecific, but may reflect denervation injury.4.Mild diffuse interfascial and intramuscular edema surrounding the knee."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old male with seizure status post a partial suprasellar mass resection. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. Right frontoparietal craniectomy with overlying skin staples and surgical drain with adjacent frontal and left temporal pneumocephalus consistent with postsurgical procedure. A small amount of hemorrhage is present in the subarachnoid space and overlying the left cerebellar hemisphere. This examination is nondiagnostic for evaluation of the pituitary sella; for evaluation of residual disease, MRI of the pituitary may be considered.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "1. Postsurgical changes as described above without acute abnormality.2. For evaluation of residual disease MRI of the pituitary may be considered."}
{"instruction": "Generate impression based on findings.", "input": "44 year old male with right ankle pain and knee pain has been unable to bear weight for several days. Evaluate for fracture. TENDONS: The Achilles tendon is unremarkable. The medial tendons of the ankle are unremarkable. The peroneus brevis appears normal. The peroneus longus tendon is markedly attenuated as it courses along the lateral margin of the anterior calcaneus compatible with a near full thickness tear. We see no fluid immediately adjacent to this portion of the tendon and therefore suspect this to be a chronic process. The anterior portion of the tendons appear normal.LIGAMENTS: The ATFL appears irregular, likely representing prior injury. The calcaneal fibular ligament appears intact although intermediate signal within the ligament may represent prior injury. The PTFL is unremarkable. The distal tibiofibular syndesmotic complex appears normal. The deltoid ligament is grossly intact.ARTICULAR SURFACES AND BONE: We see no fracture line. There is mild edema within the talar dome medially with focal loss overlying the cartilage. This could represent a small post traumatic osteochondral defect or simply a manifestation of long standing osteoarthritis. There is slight prominence of the \"posterior malleolus\" of the distal tibia which may reflect old trauma. There is associated mild subchondral signal abnormality that we suspect is degenerative. There is a small amount of fluid in the tibiotalar joint but no large effusion. There is an os trigonum posterior to the talus with a small cyst anteriorly. ADDITIONAL", "output": "1. Soft tissue swelling that is nonspecific.2. Mild osteoarthritis affects the tibiotalar joint as described above.3. Marked attenuation of the peroneus longus tendon suggesting a near full thickness tear that we suspect is chronic.3. No fracture line is evident."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with dyspnea on exertion, obstructive and restrictive pattern on pulmonary function testing, normal ejection fraction. Referred for cardiac MRI to rule out cardiac sarcoidosis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%. The LVEDV is 131 ml (normal range 109+/-23), LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), LVESV is 52 ml (normal range 31+/-10), and LV end systolic volume index is 31 ml/m2 (normal range 18+/-5). The LV mass is 70 g (normal range 114+/-24) and the LV mass index is 41 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native T1 myocardial relaxation time is <1050 which is within normal limits..There is no myocardial iron overload. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RVEDV is 158 ml (normal range 110+/-24), the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVESV is 67 ml (normal range 35+/-13), and the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, 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 mild 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 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.Normal sized left ventricle with normal systolic function (LVEF 60%)2.Normal sized right ventricle with normal systolic function (RVEF 58%)3.No late gadolinium enhancement. No evidence of inflammatory or infiltrative disease of the myocardium.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "22 years, Female, Reason: R/O cholangiocarcinoma History: PSC. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Minimally irregularity of the proximal common bile duct is unchanged. Multiple intrahepatic strictures and dilatations are not significantly changed from the prior exam. No suspicious hepatic lesions.SPLEEN: Mild splenomegaly.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.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No suspicious hepatic lesions.2.Multifocal areas of intrahepatic stricturing and dilatation are not significantly changed from the prior exam and consistent with patient's known history of primary sclerosing cholangitis."}
{"instruction": "Generate impression based on findings.", "input": "Other musculoskeletal symptoms referable to limbs(729.89) [729.89] / Dysphagia, unspecified(787.20) [787.20], Reason for Study: ^Reason: see MRA/MRI History: as above There is evidence of restricted diffusion on the left middle cerebral peduncle and anterior inferior aspect of the left cerebellar hemisphere indicating left AICA territorial ischemic infarct. There is no evidence of hemorrhagic transformation.Scattered high signal intensities on periventricular white matter on FLAIR imaging indicating nonspecific small vessel ischemic disease, minimal degree.The ventricles, sulci and cisterns are symmetric and unremarkable.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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate tight stenosis on the proximal basilar artery where the right AICA arises but the left AICA is not seen. The distal right vertebral artery completes with the right PICA. Left PICA is not seen. Bilateral intracranial internal carotid arteries shows tortuosity but without significant (more than 50%) luminal stenosis. No definite evidence of intracranial arterial aneurysm was seen.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate slightly smaller left internal carotid artery comparing to that of right with a subtle linear low intensity across the carotid bulb. Therefore, the diagnostic possibilities of relatively smaller size of the left internal carotid artery include normal variation, and secondary changes due to proximal extracranial cervical segment vascular web. If clinically indicated, CT angiography of the neck could be considered. Right common carotid and extracranial internal carotid as well as bilateral vertebral arteries appear to be normal.", "output": "1. Acute ischemic infarct on the left ACA territory without evidence of hemorrhagic conversion. 2. Tight stenosis of proximal basal artery on the origin of the right AICA, the left ACA is not seen. 3. Atherosclerotic changes of intracranial arterial system.4. Relatively smaller luminal diameter of the left extracranial internal carotid artery, diagnostic possibilities include normal variation and proximal arterial web related secondary changes."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with history of rectal cancer status post resection on 10/23/2015. Patient presents for restaging. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Again redemonstrated is presacral thickening which was noted on the previous CT examination with evidence of diffusion restriction; this area does not demonstrate enhancement on subtraction images. Right lower quadrant ostomy noted.OTHER: No significant abnormality noted.", "output": "1.Stable presacral thickening as above without evidence of enhancement. This likely represents posttreatment changes.2.No definite evidence of residual or recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Female, 37 years old, with past medical history of cerebral venous thrombosis, originally diagnosed in 2000, not currently on anticoagulation, presenting with progressive headache. No evidence of restricted diffusion is seen. No significant parenchymal edema or mass effect is detected. Mild asymmetric T2 hyperintensity within the left ventral pons was present on the prior examination from 2011 and shows no significant interval change.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is normal in size and morphology. Cerebellar tonsillar ectopia is noted, a stable finding.On dedicated MRV imaging, the superior sagittal sinus is of small caliber and not well visualized at its anterior-most extent. The left transverse sinus is not well visualized, and the right shows at least one area of focal caliber change. Collateral venous vessels are evident along both transverse sinuses. The deep cerebral venous system, feeding into the vein of Galen and straight sinus, is prominent. Accounting for differences in scan technique, and for differences between MRV and CTV, no significant or convincing interval change is observed.", "output": "1.No acute intracranial abnormality is suspected.2.MRV imaging demonstrates chronic narrowing of the superior sagittal sinus and transverse sinuses, left more than right, with compensatory engorgement of the deep venous system. This could very well represent the chronic sequelae of prior venous sinus thrombosis or stenosis, but no convincing or significant interval change is appreciated when compared to multiple prior exams."}
{"instruction": "Generate impression based on findings.", "input": "Crohn's disease of small intestine with distal obstruction, underweight Crohn's disease a Significantly limited examination due to artifacts on the MR enterography scan.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: Subcentimeter left renal cysts noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ne0 cecum and ileocecal junction is visualized in the right lower quadrant and demonstrates normal caliber. No definite area of wall thickening or abnormal enhancement identified within the large or small bowel loops. The previously described enhancement involving the rectum has significantly reduced.No free fluid or loculated fluid collection. No evidence of bowel obstruction.No evidence of a sinus tract/fistula formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites", "output": "Suboptimal interpretation due to artifacts during MR enterography scans.Given these limitations the neo- cecum and ileocecal valve appear unremarkable with normal caliber. No evidence of bowel obstruction. No evidence of abnormal wall thickening or enhancement within the larger small bowel loops."}