Instruction: Generate impression based on findings.

Input: Examination is limited by motion artifact, and lack of dedicated anosmia protocol. There is mild global volume loss. The cisterns remain patent. There is no midline shift or mass effect. There are no definite areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. The T2 appearance of the olfactory bulbs is grossly unremarkable, however the postcontrast images are nondiagnostic due to motion artifact. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is trace fluid in the bilateral mastoid air cells, right greater than left. Moderate to severe developmental cervical spine stenosis is partially visualized.

Output: 1. The T2 appearance of the olfactory bulbs is grossly unremarkable, however the postcontrast images are nondiagnostic due to motion artifact. If there is persistent concern, dedicated anosmia protocol imaging can be performed.2. Moderate to severe overall cervical spine stenosis is partially visualized with underlying developmental narrowing. An MRI of the cervical spine can be obtained for further evaluation.3. There is trace fluid in the bilateral mastoid air cells, right greater than left. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 25 years Female (DOB:12/26/1991)Reason: seizure workup and r/o tumor History: seizure workupPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI There is right-sided dural thickening associated with some leptomeningeal enhancement. Adjacent to the temporal lobe, thickness of the dura is up to 9 mm. There is associated enhancement and opacification of the mastoid air cells bilaterally as well as the right sphenoid bone including foramen ovale. Looking at the recent head CT there is some associated bone erosion. There is an enhancing lesion present along the right masticator space, right parapharyngeal space, which involves the medial pterygoid muscle as and to a lesser degree the right lateral pterygoid muscle and right pharyngeal mucosal space. Additionally there is FLAIR signal hyperintensity present within the right inferior parietal lobule.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 opacified. The visualized portions of the orbits are intact.

Output: 1.There is right sided pachymeningeal and leptomeningeal enhancement present associated with contiguous infiltrative involvement of the right masticator space, right parapharyngeal space, right nasopharyngeal mucosa, right mastoid air cells, adjacent right calvarium and right sphenoid bone. Looking at the recent head CT there is some associated bone erosion. There is additional involvement of the right inferior parietal lobule. Differential considerations include lymphoma, sarcoid, granulomatous disorder, as well as infection including TB and fungal infection. 2.There is a left-sided mastoid air cell single lesion similar to the right-sided mastoid air cell enhancement without the extraosseous extensions. Looking at the recent head CT there is some associated bone erosion.An email was sent to Dr Mastrianni and am alphanumeric text was sent to Dr ALSHAIKH, JUMANA at the time of this dictation.


Instruction: Generate impression based on findings.

Input: Male, 44 years old. Status post right knee arthroscopy, medial meniscectomy 9/2015 with bakers cyst. Pain. MENISCI: There is attenuation of the body and posterior horn of the medial meniscus, likely representing interval partial meniscectomy. Intrameniscal signal contacting the articular surface is noted. We suspect this simply represents residual myxoid degeneration, and we see no fluid signal entering the meniscus to confirm an unstable tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is minimal superficial fraying of the articular cartilage of the medial patellar facet. The remainder of the articular cartilage is intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Medial meniscal abnormalities are most suggestive of prior partial meniscectomy. Although we cannot exclude a tear, we see no fluid signal entering the meniscus to confirm an unstable tear.2.Joint effusion, Baker's cyst, and other findings as above.


Instruction: Generate impression based on findings.

Input: 71 year old female with history of clear cell carcinoma of the uterus, status post chemotherapy. Metastatic uterine cancer with known enlarged retroperitoneal lymph nodes, presents with 3 weeks of progressive bilateral lower extremity edema. Evaluate for IVC clot/compression. CHEST:LUNGS AND PLEURA: Multiple small micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense focus in the dome the liver is unchanged. There are no other focal lesions. Gallstones are unchanged, but the gallbladder is contracted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Double-J stent in the left kidney collecting system is unchanged. Mild left caliectasis is unchanged. On axial image 58/165 of series 3, a 1.8 x 2 cm left midpole renal cortical mass is found. In retrospect this was present on the prior examination, but the timing of contrast bolus was inadequate to delineate the mass. This mass may represent a metastasis or primary renal neoplasm.RETROPERITONEUM, LYMPH NODES: Left para-aortic mass invading the L4 lumbar vertebral body now measures 4.6 x 4.1 cm image number 83, series number 3. The mass encases the left ureter. Adjacent retroperitoneal adenopathy is also slightly smaller. Increasing distraction of the L4 vertebral segment with compression deformity. Increasing periaortic and left mesenteric adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Destruction of the L4 vertebral body is increased.OTHER: No IVC obstruction was found. The IVC is narrowed at the inferior hepatic margin, without change from the prior examination.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Increasing periaortic and mesenteric lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is increasing edema within the dependent portion of the lower extremities on this scan which extends to the proximal thighs bilaterally.OTHER: Periaortic/psoas/L4 vertebral body mass with direct invasion of the psoas and vertebral body is approximately unchanged in size. New compression deformity of the L4 vertebral segment. The spinal canal is difficult to evaluate in MRI may be helpful for further evaluation, if cord compression is a concern.

Output: 2-cm diameter left midpole renal mass may be metastasis versus renal cell cancer.Slight increase in the size of the left psoas/L4 mass and retroperitoneal adenopathy. Increased destruction of L4 vertebral body with compression deformity. No other significant change from previous CT.


Instruction: Generate impression based on findings.

Input: 58 year-old male. History of cholangiocarcinoma. Evaluate for biliary obstruction. Elevated bilirubin, fever. Lack of intravenous contrast limits evaluation of solid organ pathology as well as of the vasculature.ABDOMEN:LIVER, BILIARY TRACT: Infiltrative tumor at Klatskin's point causes obstruction of the bilobar intrahepatic ducts, which are markedly dilated, left lobe greater than right. Two common duct stents drain the central left and right biliary ducts. Cholelithiasis. Patency of the hepatic vasculature cannot be determined without intravenous contrast.SPLEEN: Mild splenomegaly measuring 14 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: Confluent periportal and retroperitoneal lymphadenopathy. Reference aortocaval lymph node is 4 x 2.8 cm (series 601, image 8), unchanged. Diffuse restricting nodularity anterior to the liver and in the midline anterior abdomen (series 800, image 401 and 343) concerning for peritoneal carcinomatosis, new from prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Infiltrative cholangiocarcinoma at Klatskin's point causes marked bilobar intrahepatic biliary ductal dilatation, greater in the left hepatic lobe. Findings concerning for peritoneal carcinomatosis, new from prior.


Instruction: Generate impression based on findings.

Input: Left posterior iliac crest bone marrow biopsy site with persistent pain and left leg numbness. History of AML per epic. Bone marrow signal is within normal limits. The signal within the pelvic musculature is within normal limits. No abnormal enhancement is seen on post-contrast imaging. No discrete fluid collection is identified.

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 67-year-old male with history of prostate cancer status post robotic prostatectomy now with rising PSA. PELVIS:PROSTATE:Prostate: Status post prostatectomy. No nodules or masses in the prostatectomy bed.BLADDER: Small left posterior bladder diverticulum.LYMPH NODES: 4mm bilateral pelvic nodes just superificial to the perirectal fascia. 6 mm right external iliac node.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post prostatectomy with no suspicious nodules, masses, or foci of enhancement. Tiny bilateral pelvic nodes are nonspecific. 6 mm right external iliac node is not enlarged by size criteria, however its location is suspicious and this should be followed.


Instruction: Generate impression based on findings.

Input: Patient with history of squamous cell carcinoma of ethmoid sinus with recurrence.Please evaluate for disease. Metastases. CT of soft tissues of the neck.Images through the skull base and including cavernous sinuses remain within normal limits.Revisualization of extensive opacification of left ethmoid air cells which also demonstrated a small bony defect along its anterior aspect. In comparison with the prior examination there is evidence of reduction in the amount of soft tissue density that was immediately anterior to the bony defect of the lamina procedure and anterior aspect of the floor of the orbit on the left. This may be result of interval improvement of post therapy changes. Two entirely exclude possibility of residual tumor MRI examination in this case would be most helpful.The bony density of the area of the exam demonstrates no evidence of any new area of bony erosion. Images through the rest of the soft tissues of the neck demonstrate a few small nonpathologic lymph nodes which are stable since prior study. No pathologically enlarged lymph node is detected.Limited images through the apices of the lungs demonstrate extensive findings of multiple pulmonary emphysematous bulla (right greater than left. No definitive metastases is detected.CT of brain with infusion.Notice of metastatic disease to the brain, calvarial or leptomeninges is detected. This is study is essentially within normal limits.75 cc of Omnipaque was utilized for these studies.

Output: 1.Negative CT of brain with infusion.2.Reduction in the amount of soft tissue density at the level of the left ethmoid air cells and left orbit since prior study. Further evaluation to exclude residual tumor with an MRI is recommended.3.No areas of pathologic adenopathy in the neck and stable multiple small bilateral lymph nodes.


Instruction: Generate impression based on findings.

Input: 43-year-old with left breast invasive ductal carcinoma status post chemotherapy presents for bilateral breast MRI to assess treatment response. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: Redemonstrated is a rim-enhancing mass with irregular margins and associated clip artifact in the left breast 11:00 position, posterior depth, measuring 14 x 11 x 12 mm (previously 14 x 11 x 12 mm), consistent with the biopsy-proven cancer. There is a subcentimeter cyst in the left breast 12:00 position which demonstrates mild peripheral enhancement. This appearance was similarly seen in some of her cysts on the initial staging MRI and is benign. There is no additional suspicious enhancing mass or focus of enhancement in the left breast or left axilla region.RIGHT BREAST: No abnormal enhancement is seen in the right breast or right axillary region.

Output: No change in size of left breast cancer measuring 14 x 11 x 12 mm.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 28 year-old female with symptoms of chronic rhinosinusitis. Medtronic nonenhanced CT of sinuses:Frontal sinuses.No evidence of disease.Ethmoid sinuses.Very minimal mucosal thickening in bilateral anterior ethmoid air cells.Sphenoid sinus.Mucosal thickening in the dependent portion of the left chamber sphenoid sinus. Patent ostia of sphenoid sinuses.Maxillary sinuses. Mild mucosal thickening and retention cysts in the dependent portion of bilateral maxillary sinuses. Mucosal thickening at the level of bilateral ostiomeatal units with resultant occlusion of bilateral ostiomeatal units.Nasal cavity.Unremarkable.There is a primarily fatty density tissue posterior to the left pterygoid bone in the infratemporal fossa. There is suggestion of remodeling of the left pterygoid bone likely result of chronic long-standing mass effect. This fatty density measures approximately 17.6 X 22.6-mm in transaxial dimensions measured on axial image 11 of series 4. The finding is believed to represent a lipoma. This mass also causes some thinning of the floor of the left middle cranial fossa at the level of foramina ovale. There is no involvement of the left carotid canal. The musculature immediately adjacent to this fatty tissue demonstrate no abnormality. The fascial planes are well preserved and unremarkable. Recommend follow-up with an enhanced MRI of brain and skull base to entirely exclude the possibility of a mass other than simple lipoma.

Output: 1.Chronic bilateral maxillary sinus disease with occluded bilateral ostiomeatal units. Minimal sinus disease in bilateral ethmoids and left chamber of sphenoid sinus.2.There is a primarily fatty density mass in the left infratemporal fossa immediately posterior to the left pterygoid bone with resultant bony remodeling however with no destruction of bony changes. This is believed to represent a lipoma however to entirely exclude other possibilities recommend follow-up with a pre-and post enhanced MRI of brain and skull base.


Instruction: Generate impression based on findings.

Input: History of abdominal pain and bloating after eating. Evaluate for inflammatory bowel disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size, morphology and signal intensity. No focal 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 unremarkable. It appears normal in caliber and wall thickness. There is no abnormal postcontrast enhancement or restricted diffusion. No significant fibrofatty proliferation. No specific findings of sinus tract or fistula formation. No free or loculated fluid.The colon is normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post cholecystectomy.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 of acute or chronic inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Clinical question: patient needs eval of spinal decompression s/p T8-12 fusion and T10 corpectomy, requires 1.5T scanner to minimize artifact. Signs and Symptoms: patient needs eval of spinal decompression s/p T8-12 fusion and T10 corpectomy, requires 1.5T scanner to minimize artifact. Nonenhanced thoracic MRI:Examination is a status post posterior approach multilevel laminectomy, T10 corpectomy and T8-T12 fusion and including bilateral transpedicular screw placement at T8, T9, T11 and T12 levels.The alignment of vertebral column remains anatomical.There is metallic hardware artifact which obscures the detail and results in distortion of images. Within this limitation however examination demonstrate no residual epidural mass at T10 level. There is extensive post operative changes of the posterior soft tissue of the thoracic spine without discrete fluid collection. There is expected very mild bulge/mass effect of post operative soft tissue changes at the level of laminectomy ( sagittal series images 10 through 12). There is mild uniform effacement of the subarachnoid space extending from T9 through T10 levels. At this level thoracic cord occupies the entire subarachnoid space and demonstrate internal increased T2/T2 STIR signal intensity which appears more conspicuous on current exam compared to prior study. This appearance is concerning for cord edema. The finding however could be at least partially secondary to artifact from metallic hardware. Extensive metallic signal intensity changes within the site of T10 corpectomy is noted. Heights at T10 level however is preserved and the alignment is anatomical.There is no evidence of spinal canal compromise at other levels of thoracic spine. Marrow signal changes consistent with metastatic lesions involving T5 vertebral body and small portion of T1 vertebral body remain similar to prior study.

Output: 1.Extensive postoperative changes of posterior laminectomy and multilevel fusion as detailed.2.Metallic hardware artifacts preclude precise assessment however there is no residual epidural tumor at the level of T10 corpectomy.3.There is mild uniform spinal canal compromise/effacement of subarachnoid space at T9 & T10 levels without detectable mass or postoperative collection.4.Increased T2 signal intensity/edema of thoracic cord at T8 toT11 which is more conspicuous on current exam. This change however could conceivably be at least partially secondary to suboptimal exam with extensive metallic hardware artifact. Correlation with neurological status is recommended.5.Stable foci of marrow signal replacement consistent with metastatic lesions similar to prior and without evidence of fracture, malalignment or spinal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 76 years old, with low back pain radiating to the left leg and numbness of the left foot. Trace anterolistheses of L3 relative to L4 and L4 relative to L5 are seen. Spinal alignment is otherwise anatomic.Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable allowing for mild endplate edema along the anterior/inferior endplates of L4 and L5. Also noted is bilateral pedicle and facet complex edema at L5 and to a less degree at L4 and L3.The spinous processes are irregular with evidence of cortical and/or ligamentous thickening and mild marrow edema as well as scattered bony cysts at several levels.The visualized spinal cord and conus are within normal limits. The nerve roots of the cauda equina are dispersed evenly through the thecal sac.L1-2: Unremarkable. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Mild facet hypertrophy with a small facet effusion on the right and ligamentum flavum thickening. Subchondral cysts are evident along the right facet complex. Mild bulging disk. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Moderate to severe facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Moderate generalized spinal canal stenosis but without significant nerve root crowding. Mild right and moderate left foraminal narrowing. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. No significant spinal stenosis. Moderate left and mild right foraminal narrowing.

Output: 1. Moderate to severe facet hypertrophy at lower lumbar levels with evidence of marrow edema. Abdomen contribute to mild to moderate foraminal narrowing as above.2. Degeneration of the spinous processes and interspinous spaces suggesting Baastrup disease.3. Relatively mild degenerative disk disease with no areas of high-grade spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Back pain, unable to walk secondary to pain and weakness 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 lower L1 level.Multilevel degenerative changes are seen, as described below:L1-L2: There is a central and right paracentral disc extrusion with T2 hypointensity. There is adjacent epidural soft tissue density which extends from the lower L1 level to the mid L2 level which is nonspecific but suspected to represent epidural hematoma and/or extruded disc material. There is severe spinal canal stenosis at this level. No significant neural foraminal narrowing.L2-L3: Diffuse disc bulge eccentric to the left without significant spinal canal stenosis. Mild right and moderate left neural foraminal stenosis.L3-L4: Diffuse disc bulge, ligamentum flavum thickening and facet arthropathy resulting in moderate to severe spinal canal stenosis. There is mild right and moderate to severe left neural foraminal stenosis. Annular fissure is noted at the left foraminal and extraforaminal level.L4-L5: Diffuse disc bulge, ligamentum flavum thickening, and facet arthropathy resulting in moderate spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine with moderate to severe spinal canal stenosis at the L1-L2, L3-L4, and L4-L5 levels. There is a disc extrusion at the L1-L2 level with adjacent epidural soft tissue extending from the lower L1 to the mid L2 levels which may represent epidural hematoma and/or extruded disc material. Other neoplastic/inflammatory etiologies for epidural tissue while possible seem less likely. There is severe spinal canal stenosis at this level.Moderate to severe left L3-L4 neural foraminal stenosis is seen which may be impinging on the left L3 nerve root. Lesser degrees of neural foraminal narrowing as detailed above.


Instruction: Generate impression based on findings.

Input: There is mild dextroscoliosis of the lumbar spine. There is grade 1 approximately 7 mm degenerative anterolisthesis of L4 on L5. There is trace retrolisthesis of L2 on L3. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There are multilevel degenerative disc changes mostly involving L4-L5, with endplate marrow changes and moderate loss of disc height. The spinal cord displays normal signal and morphology with conus terminating at T12-L1. The paravertebral soft tissues are unremarkable. There are bilateral Tarlov's cysts at S1 and S2 level, largest measuring 1.8 x 1.3 cm. At T11-T12: There is trace disc bulge and right facet arthropathy. No significant foraminal or spinal canal stenosis.At T12-L1: There is disc bulge with right foraminal prominence resulting in mild to moderate right neuroforaminal narrowing. There is no left neural foraminal narrowing. There is no significant spinal canal stenosis.At L1-L2, there is mild disc bulge and mild facet arthropathy, resulting in mild right and mild to moderate left neuroforaminal narrowing. There is mild spinal canal stenosis. At L2-3, there is uncovering of the disc, facet arthropathy left more than right, and ligamentum flavum thickening. There is disc bulge resulting in mild right and moderate to severe left neural foraminal narrowing. There is mild spinal canal stenosis. At L3-L4, there is minimal disc bulge and facet arthropathy, resulting in moderate to severe left neural foramina narrowing and mild right neuroforaminal narrowing. There is mild spinal canal stenosis.At L4-L5, there is uncovering of the disc and disc osteophyte complex as well as facet arthropathy, with resultant mild to moderate right and moderate left foraminal narrowing. There is moderate spinal canal stenosis at this level. At L5-S1, there is ligamentum flavum thickening and facet arthropathy. There is a sequestered disc fragment which extends along the right paracentral to proximal foraminal level with effacement of right foramen although this probable disk extrusion is not well delineated. There is a sequestered disc fragment extending along the mid posterior L5 body. There is moderate to severe right neural foraminal narrowing. There is no left neuroforaminal narrowing. There is no spinal canal stenosis. There is impingement of the exiting right L5 nerve root, and dorsal displacement of the descending right S1 nerve root.

Output: 1. Advanced degenerative disc changes in the lumbar spine predominantly involving L5-S1, with a right paracentral sequestrated disc fragment extending posterior to L5 vertebral body and additional disk material extending along right paracentral/proximal foraminal region, with resultant effacement of the right foramen, impingement of the exiting right L5 nerve root, and dorsal displacement of the descending right S1 nerve root. Moderate-severe right foraminal narrowing.2. There is up to moderate spinal canal stenosis at L4-L5, where there is grade 1 anterolisthesis.3. Moderate to severe neuroforaminal stenosis at L3-L4 and L2-L3 on the left.


Instruction: Generate impression based on findings.

Input: 65-year-old woman with breast cancer metastatic to the brain, status post craniotomy and whole brain radiation, with recurrent seizures in the past month. Evaluate for progression.. There are postoperative findings related to left parieto-occipital craniotomy without evidence of nodular enhancement to suggest tumor recurrence. There is unchanged confluent white matter T2 hyperintensity at the treatment bed. Right inferior cerebellar enhancing lesion, previously measuring 3x3 mm, now measures 6x6 mm, series 11 image 18. There is mild surrounding edema which is increased in the interval. There is a new punctate 2 mm right cerebellar lesion, axial image 40 of series 11.4 mm enhancing lesion more posteriorly in the right cerebellar hemisphere is stable to slightly smaller, series 11 image 37.There is a 5 x 4 mm right parietal enhancing lesion with mild surrounding edema which is new, series 11 image 105. There is an unchanged 6 mm enhancing lesion within the fundus of the right internal auditory canal. There is an unchanged developmental venous anomaly in the brainstem associated with cavernous malformations. There is unchanged mild periventricular white matter T2 hyperintensity. There is unchanged mild encephalomalacia in the left cerebellar hemisphere. Previously seen small right cerebral convexity subdural collection has resolved. Mild dural thickening and enhancement along the right frontal convexity may be related to prior subdural. 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. Compared to 12/18/2014, findings are suspicious for progression of intracranial metastatic disease. There is a new 5 x 4 mm right parietal lesion, a new 2 mm right cerebellar lesion, and a 6 mm right cerebellar enhancing lesion which has enlarged from 3 mm. 2. Unchanged subcentimeter lesion within the fundus of the right internal auditory canal, which may represent a schwannoma versus a metastasis. 3. Unchanged brainstem developmental venous anomaly associated with cavernous malformations.4. Resolution of previously seen right convexity subdural collection with right-sided dural thickening which may be reactive.


Instruction: Generate impression based on findings.

Input: 42-year-old woman with history of pelvic swelling and mass. This examination is mildly limited by patient's body habitus.PELVIS:UTERUS, ADNEXA: The patient has multiple, large T2 and T1 hypointense subserosal and intramural masses measuring up to 61 x 53 mm (series 901, image 14). The endometrial canal is distorted.A mass along the left posterior body of the uterus (series 501, image 48) is again seen with high T2 signal but low T1 signal. This mass is unchanged in size and measures 59 x 54 mm, previously 58 x 54 mm.There are multiple T1 hyperintense, T2 hypointense lesions in the right adnexa measuring 85 x 44 mm (series 1301, image 513) and 61 x 39 mm (series 1301, image 48).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The rectosigmoid colon is seen displaced by the uterine masses (series 501, image 48), however with intact fat plane and without evidence of invasion.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right adnexal lesions, not significantly changed, representing endometriomas versus cystic ovarian neoplasms.2.Mass posterior to the uterine body which is unchanged but may represent degenerating leiomyoma versus cystic ovarian neoplasm.3.Fibroid uterus.


Instruction: Generate impression based on findings.

Input: Vomiting alone [787.03], Reason for Study: ^Reason: neuromyelitis optica, posterior fossa demyelination History: nausea and vomit ting No evidence of acute ischemic or hemorrhagic lesion on the scan.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 scan.


Instruction: Generate impression based on findings.

Input: 24-year-old male basketball player with left knee pain and effusion going on for one year. MENISCI: Note is made of linear increased signal abnormality within a blunted posterior horn of the lateral meniscus which extends to the tibial articular surface consistent with a horizontal cleavage tear. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Heterogeneous bone marrow signal abnormality may represent residual islands of red marrow. Note is made of a focal full-thickness articular cartilage defect along the medial facet of the patella.LIGAMENTS: The cruciate and collateral ligaments. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Horizontal cleavage tear of the posterior horn of the lateral meniscus with knee joint effusion as described above.2. Focal full-thickness articular cartilage defect along the medial facet of the patella.


Instruction: Generate impression based on findings.

Input: Vision loss, history of pituitary tumor Examination is motion degraded. There is however no appreciable change in heterogeneously enhancing tissue involving the sella, extending greater on the left than the right, and measuring approximately 21 mm in the transverse dimension, 11 mm in the craniocaudal dimension (on the left), and up to 20 mm in the AP dimension(on the left). These measurements are unchanged. As before, lesion extends to abut the left cavernous sinus without clear evidence of invasion. Areas of T2 hyperintensity are again seen and unchanged. The pituitary stalk deviate towards the right also unchanged. No significant extension into the suprasellar cistern. No mass effect on the optic chiasm. Mass approximates the left prechiasmatic optic nerve in its anterosuperolateral aspect similar to prior without mass effect.Limited views of the brain demonstrate diffuse parenchymal volume loss including the bilateral hippocampi. Mild periventricular T2 hyperintensity likely representing small vessel ischemic changes are again seen.

Output: No significant change in size or appearance of the residual pituitary adenoma. No mass effect in the optic chiasm. Mass comes close to the left prechiasmatic optic nerve in its anterosuperolateral aspect similar to prior without mass effect.


Instruction: Generate impression based on findings.

Input: Reason: Evaluation of axilla/chest wall for possible recurrence of sarcoma after recent CT showed change in density of unclear significance. There are surgical changes of left apical lung and chest wall resection as described in prior CT scan reports. Foci of signal void within the adjacent soft tissues reflect metallic susceptibility artifact from surgery. There is enhancement along the apical pleural surface, including the region of concern on recent CT, likely representing scarring and sequela of prior radiation therapy, but we see no dominant nodular focus to confirm tumor recurrence. There is a small collection of rim enhancing fluid along the medial border of the scapula, which may represent seroma or mild bursitis, with mild edema and enhancement extending along an adjacent rib; this adjacent rib is of low signal intensity on all sequences, perhaps representing sclerosis from radiation therapy. Bone marrow signal intensity is otherwise unremarkable. There is mild edema within the deep fat adjacent to the subscapularis muscle, that may reflect prior therapy as well. There is a small glenohumeral joint effusion, which is incompletely imaged on this study.

Output: Postsurgical changes related to left chest wall reconstruction as described above. We see no specific findings to suggest tumor recurrence.


Instruction: Generate impression based on findings.

Input: Male 24 years old Reason: right knee injury while playing basket ball, MRI showing possible lateral femoral condyle osteochondral fractures. History: pain, swelling and decreased ROM The subchondral fracture in the anterior lateral femoral condyle and the osteochondral fracture in the medial patellar facet were better seen on the recent MRI. Moderate lipohemarthrosis is redemonstrated. No dislocation

Output: Lateral femoral condyle subchondral fracture and medial patellar facet osteochondral fracture were better seen on recent MRI.


Instruction: Generate impression based on findings.

Input: Female 42 years old Reason: shoulder pain and deceased ROM after fall ROTATOR CUFF: Increased T2 signal along the bursal surface of the supraspinatus tendon indicates tendinopathy, however there is no discrete tear. The remainder of the rotator cuff is intact.SUPRASPINATUS OUTLET: Type I acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: Irregularity of the anterior superior labrum which appears to separate from the glenoid likely represents a portion of the middle glenohumeral ligament, a normal variant. The remainder of the glenoid labrum is intact.BICEPS TENDON: Biceps tendon is situated within the bicipital groove.ADDITIONAL

Output: Tendinopathy of the supraspinatus tendon near its insertion.


Instruction: Generate impression based on findings.

Input: CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. The CSF spaces are appropriate for the patient's stated age with no midline shift. A focus of diffusion restriction is present in the left pons in a paramedian location.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.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Incidental note is made of partial empty sella.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 demonstrrate old left orbital medial blowout.

Output: 1.There is an acute lacunar cerebral infarction in the left pons.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 nonspecific3.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is thinning and horizontally oriented increased signal intensity involving the posterior horn of the medial meniscus which extends to the tibial articular surface and is compatible with tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is marked full-thickness cartilage loss of the lateral femoral condyle, particularly anteriorly. This is superimposed upon mild diffuse thinning of the lateral compartment. Similar full-thickness loss is noted involving the medial femoral condyle anteriorly with full-thickness loss of the medial tibial plateau. There are areas of near full-thickness loss involving the lateral patellar facet with areas of heterogeneous signal intensity seen more centrally.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Predominantly horizontal tear of the posterior horn of the medial meniscus.2. Full-thickness cartilage loss of both the lateral and medial femoral condyle anteriorly with additional areas of cartilage loss and thinning detailed above.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of frontal lobe [C71.1], Reason for Study: ^Reason: preop planning for tumor resection History: preop planning. Multiple fiducial markers attached on scalp.Previously demonstrated left frontal lobe nodular enhancing lesions as well as T2 high signal intensity lesions are again seen, unchanged since prior scan. The ventricles, sulci and cisterns are unchanged. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Preoperative localization MR shows unchanged left frontal lobe high T2 signal lesion with multiple nodular enhancing lesions, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for any pathology in the head in context of a new pulmonary findings. Signs and symptoms: New pulmonary infiltrate. At top of liver transplant list. Unenhanced head CT:Right cerebellar pica territory cortical stroke is again identified. The age of this stroke cannot be determined due to its small size. To entirely exclude subacute state of stroke recommend MRI exam. No change since prior exam.Subtle patchy areas of low attenuation in the subcortical and periventricular white matter of bilateral cerebral hemispheres are believed to represent small vessel ischemic disease of indeterminate age.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Calvarium, paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable

Output: 1.No interval change since prior exam.2.Small right pica territory cerebellar stroke of indeterminate age.3.Small vessel disease of indeterminate age.4.No detectable acute intracranial process.


Instruction: Generate impression based on findings.

Input: History of pilonidal cyst and perianal abscess: back pain, sacroiliac Crohn's disease. The vertebral column alignment is within normal limits. There are small facet joint effusions at L4-5, with an inferiorly directed left synovial cyst. The vertebral body and disc space heights are preserved, aside from small intravertebral disc herniations in the inferior L1 and T12 endplates. 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 paravertebral soft tissues are unremarkable. There is a tiny right renal cyst. There is a small amount of fluid within the pelvis, which is likely physiological.

Output: 1. Degenerative facet joint arthropathy with a small left synovial cyst at L4-5.2. No evidence of pilonidal cyst in the imaged lower back.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for bony dehiscence in the left lamina papyracea and left medial orbital wall seen on recent sinus CT. Pre- and post enhanced MRI of orbits:Examination demonstrates diffuse signal abnormality of all paranasal sinuses similar to prior study. The signal intensity of the sinuses mostly suggestive of fungal sinusitis evident by low T2 signal intensity. Diffuse intermixed foci of T2 hyperintensity representing mucosal thickening and fluid examination.As was noted on prior CT there is significant expansion of the left ethmoid sinuses with deviation of the lamina papyracea toward the left retroperitoneal space. There is diffuse linear mucosal enhancement of the sinuses and with multiple foci of hypoenhancement corresponding to region of low T2 signal intensity and consistent with fungal infection. There is also bulging of contents of superior ethmoid air cells into the intracranial space bilaterally (left greater than right) without significant change since prior exam. There is however no detectable inflammatory changes are retro-orbital space or any abnormal retro-orbital enhancement. Also no detectable foci of parenchymal edema or abnormal ecchymosis/meningeal enhancement in bilateral frontal region. This observation suggest that the expansion of the sinuses into the left orbit and bilateral infra frontal regions are likely still secondary to remodeling expansion/significant bony thinning of the sinuses and less likely with bony breakthrough as was suspected on CT exam.Images through the retro-orbital spaces demonstrate normal signal intensity and pattern of enhancement of extraocular musculature. Normal signal intensity of retro-orbital fat, optic nerves and without abnormal enhancement. Normal signal intensity and morphology of bilateral globes without abnormal enhancement.

Output: 1.Diffuse opacification of all paranasal sinuses with mixed signal patterns of low T2 and high T2 signal intensity suggestive of fungal sinusitis and with overlapping postobstructive fluid and mucosal thickening.2.There is bulge of the contents of ethmoid sinuses into the left orbit and to a lesser degree in bilateral inferior aspect of anterior cranial fossa (left greater than right) similar to preoperative exam.3.There is no evidence of any inflammatory changes or abnormal enhancement/cavity formation in the retro-orbital spaces or the intracranial spaces.4.Mild mass effect on the left medial rectus muscle and unremarkable images through the orbits otherwise. Please see above comments.


Instruction: Generate impression based on findings.

Input: 54 year old with personal history of left breast cancer status post mastectomy. The patient is status post left mastectomy. There is heterogeneous amount of fibroglandular tissue in the right breast. Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in the right breast or left chest wall. 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: MRI: There is a masslike lesion in the right parietal lobe with moderate surrounding edema and regional mass effect. The lesion demonstrates very mild susceptibility, which could represent blood products or mineralization. The ventricles and sulci are within normal limits. The basal cisterns remain patent. 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. MRA: 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.MRV: 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.Mass lesion in the right parietal lobe with moderate surrounding vasogenic edema and regional mass effect without significant midline shift or evidence of herniation.2.Unremarkable intracranial vasculature.Findings discussed with the ordering team. MRI with contrast/perfusion imaging to follow.


Instruction: Generate impression based on findings.

Input: 46 year old man with history of non-ischemic cardiomyopathy, previous PE on anticoagulation, and recent syncope referred for cardiac MRI to evaluate for etiology of his cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%, the LV end diastolic volume index is 343 ml/m2 (normal range: 74+/-15), the LVEDV is 708 ml (normal range 142+/-34), the LV end systolic volume index is 299 ml/m2 (normal range 25+/-9), the LVESV is 617 ml (normal range 47+/-19). There is global hypokinesis with regional variation. 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 severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced function. The overall RV ejection fraction is 13%, the RV end diastolic volume index is 173 ml/m2 (normal range 82+/-16), the RVEDV is 357 ml (normal range 142+/-31), the RV end systolic volume index is 150 ml/m2 (normal range 31+/-9), and the RVESV is 310 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 ValveThere is tethering of the mitral valve leaflets with probable severe mitral regurgitation, which is eccentric.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.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.Pulmonary ArteryThe main pulmonary artery is moderately dilated (34mm).Venous AnatomyThe SVC and IVC normally into the right atrium. There is a catheter in the SVC.PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThere is a small right pleural effusion. There is mediastinal lymphadenopathy consistent with the previous chest 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. Severely dilated left ventricle with severely reduced function (EF 13%). There is global hypokinesis with regional variation.2. Severely dilated right ventricle with severely reduced function (EF 13%). 3. Biatrial dilatation4. Severe mitral regurgitation, eccentric jet is posteriorly directed5. At least moderate tricuspid regurgitation6. No late gadolinium enhancement to suggest an infiltrative, inflammatory or fibrosive 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: Unsteadiness on feet [R26.81], Reason for Study: ^Reason: cerebellar stroke? History: truncal ataxia 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.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.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.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Normal brain MRA and neck MRA


Instruction: Generate impression based on findings.

Input: 68 year old man with ischemic cardiomyopathy, history of CABG, atrial fibrillation who now has lymphoma and is referred for evaluation of ischemia and viability prior to chemotherapy.MEDICATIONS: carvedilol, lisinopril, pradaxa. First Pass PerfusionDuring hyperemia, two large distinct perfusion defects were noted. The first involves the basal to mid inferoseptum and the basal inferior and inferolateral walls. The second involves the mid anteroseptum and all the apical segments.Viability/ Myocardial ScarThere was a transmural myocardial infarction involving the entire LV apex and mid inferoseptal and inferior walls, which corresponds to the second perfusion defect described above. These segments are not likely to be viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. There is hypokinesis of the basal to mid inferior and inferoseptal walls. There is akinesis of all the apical segments. The overall LV ejection fraction is 32%, the LV end diastolic volume index is 125 ml/m2 (normal range: 74+/-15), the LVEDV is 274 ml (normal range 142+/-34), the LV end systolic volume index is 85 ml/m2 (normal range 25+/-9), the LVESV is 186 ml (normal range 47+/-19), the LV mass index is 81 g/m2, and the LV mass is 177 g. No evidence of LV 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 50%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 104 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 mild to moderate 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. Clips for 2 saphenous vein grafts are noted in the ascending aorta. Clips for a left internal mammary artery graft are also noted. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC is normal in size and drains normally into the right atrium. The IVC is dilated suggesting increased right atrial pressure.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. A large burden of mediastinal and axillary lymph nodes noted. Large right pleural effusion. 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. There is akinesis of the distal LAD territory which has a transmural myocardial infarction and is unlikely to be viable.2. There is large amount of ischemia in the usual territory of the right coronary artery. This territory is associated with hypokinesis and is highly likely to be viable. 3. The remainder of the myocardium is viable and without significant ischemia. 4. Moderate LV dilation with moderately reduced systolic function (LVEF 32%) without evidence of LV thrombus.5. Normal RV size and systolic function (RVEF 50%).6. Moderate left atrial dilation.7. Mild dilation of the main pulmonary artery.8. Extra-cardiac findings as described above.


Instruction: Generate impression based on findings.

Input: Previous MRI suggestive of periventricular heterotopias: Head jerking while asleep. There are several subcentimeter nodular foci with grey-matter signal characteristic along the margins of the bilateral lateral ventricles in the temporal and occipital lobes. There appear to be terminal zones of myelination. The degree of myelination is otherwise age-appropriate. There is no evidence of intracranial hemorrhage or infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is extensive diffuse paranasal sinus mucosal thickening and fluid. There is fluid within the right mastoid air cells. The orbits are unremarkable. Enlargement of the right endolymphatic duct is better depicted on the concurrent temporal bone CT.

Output: 1. Multiple nodular foci grey-matter signal within the bilateral periventricular white matter are compatible with grey matter heterotopia. 2. Right mastoid effusions may represent mastoiditis.3. Findings suggestive of acute sinusitis.4. Enlargement of the right endolymphatic duct is better depicted on the concurrent temporal bone CT.


Instruction: Generate impression based on findings.

Input: Breast cancer 10 years ago and new cognitive decline: memory decline and minor hallucinations. There is disproportionate dilatation of the third and lateral ventricles with respect to the sulci. There is diffuse periventricular white matter T2 hyperintensity. There is an enhancing, dural-based right petroclival mass that measures up to approximately 2 cm. There are small areas of encephalomalacia in the right cerebellar hemisphere. 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. Findings suggestive of normal pressure hydrocephalus, with what may represent transependymal flow of cerebrospinal fluid and/or chronic small vessel ischemia.2. A right petroclival mass likely represents a meningioma and less likely a metastasis.3. Chronic lacunar infarcts in the right cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, with Parkinson's disease and . Graft planning for deep brain stimulator. Brain parenchymal morphology is grossly unremarkable. No areas of significant signal abnormality are detected. No enhancing lesions are seen. No evidence of intracranial hemorrhage or any abnormal extra-axial collection is detected. The ventricles are normal in size and shape.

Output: Selected sequences for presurgical planning reveal no gross abnormalities.


Instruction: Generate impression based on findings.

Input: Low back pain, history of breast cancer Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild upper lumbar levocurvature. Alignment is otherwise within normal limits. Bone marrow signal is benign. There is a small enhancing focus involving the anterior/superior corner of the L2 vertebral body which is likely on a degenerative basis. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: Mild disk desiccation and minimal disk bulge. No spinal canal or neural foraminal stenosis.L2-L3: Mild disk desiccation and minimal disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: Mild disk desiccation. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. No evidence of metastatic disease in the lumbar spine.2. Mild multilevel degenerative changes, as detailed above. No significant spinal canal or neural foraminal stenosis at any level.


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. Myelination is appropriate for age. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Minimal inflammatory changes are noted in right mastoid air cells. Left mastoid air cells are clear as are bilateral middle air cavities. There is no abnormal enhancement within the brain.

Output: Minimal inflammatory changes are noted in right mastoid air cells. Otherwise negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 70 year old BRCA 2 mutation carrier. Personal history of stage III ovarian cancer diagnosed at the age of 41. History of breast carcinoma in paternal grandmother, uncle and cousins. 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: 53-year-old male with history of L2 and T12 compression fractures, evaluate progression Again demonstrated are compression fractures at L2 and T12, which appear unchanged from prior MRI but have progressed with continued loss of height when compared to prior radiograph in 2014. Remainder of the vertebral body heights are preserved. There are likely bilateral pars interarticularis defects of the L5 vertebral body with grade 2 anterolisthesis of L5 relative to S1.

Output: 1. Compression fractures at L2 and T12, unchanged from prior MRI.2. Grade 2 anterolisthesis of L5 relative to S1.


Instruction: Generate impression based on findings.

Input: Evaluate for lupus cerebritis and venous thrombosis. Right frontal lobe gyriform cortical intrinsic T1 hyperintensity and minimal superimposed enhancement is unchanged from prior. The left basal ganglia lesion is also unchanged. There is no significant surrounding edema, but there is susceptibility artifact compatible with intralesional hemorrhage. Additional scattered foci of microhemorrhage within the frontal lobes, unchanged. No new lesion is identified. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact.

Output: 1.No evidence of new disease or other acute finding.2.Stable right frontal lobe and left basal ganglia lesions, which may be inflammatory in nature.


Instruction: Generate impression based on findings.

Input: 74-year-old man with history of pancreatitis and small gallstones on CT. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic cysts noted. No additional focal hepatic lesions identified.The gallbladder is distended with a small amount of pericholecystic fluid and wall edema (9/17). Additionally, there are small T1 hyperintense, T2 hyperintense stones within the gallbladder.At the level of the ampulla (12/89) there is a 6 mm filling defect with dilation of the upstream common bile duct measuring up to 9 mm.The splenic vein and portal vein appear patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is edematous with diffusion restriction and increased T2 signal. Additionally, there is mild dilation of the main pancreatic duct.There is no evidence of pancreatic necrosis. The splenic artery appears patent without pseudoaneurysm. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are noted including a minimally complex, septated 25 mm cyst in the right superior pole (7/16). There is no enhancement or nodularity within this minimally complex cyst.No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.6 mm obstructing stone in the common bile duct at the level of ampulla.2.Acute pancreatitis without evidence of complication.3.Mild acute cholecystitis.4.Findings text paged to Dr. Stier at 11:45 on 10/17/2016.


Instruction: Generate impression based on findings.

Input: Redemonstrated are scattered punctate foci of T2 hyperintensity within the white matter and pons 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 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. Although there remains stable ill-defined minimal patchy enhancement of the calvarium anteriorly, there is no MRI evidence of recurrent scalp or periorbital nodules. Redemonstrated is the right eye prosthesis.

Output: 1.Stable chronic small vessel ischemic disease.2.No abnormal enhancement of brain.3.Although there remains ill-defined minimal patchy enhancement of the calvarium anteriorly (stable over the past 3 comparison MRI exams dating back to 3/12/2014), there is no MRI evidence of recurrent scalp or periorbital nodules.


Instruction: Generate impression based on findings.

Input: Kaposi's sarcoma treated with CRT, colostomy, and IVC filter, now with severe sepsis improving, but persistently altered mental status. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemia. There is diffuse cerebral volume loss that is most pronounced in the bilateral medial temporal lobes. 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 a fluid level in the right sphenoid sinus. There is right scleral buckling.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Diffuse cerebral volume loss that is most pronounced in the bilateral medial temporal lobes may represent Alzheimer disease. 3. A fluid level in the right sphenoid sinus may represent acute sinusitis.


Instruction: Generate impression based on findings.

Input: Left thigh mass Note that evaluation of the femur is limited by the presence of an intramedullary rod which affixes a fracture of the femoral diaphysis. Within the vastus medialis approximately 17 cm from the femoral head is a well-circumscribed mass measuring 4.5 x 3.7 x 4.7 cm in the greatest transaxial and craniocaudal dimensions. The mass demonstrates slightly hypointense signal on T1 sequences and heterogeneously hyperintense signal on T2 sequences. It approaches the cortex of the femur but the plane between the mass and bone appears preserved. Following contrast administration, the mass enhances demonstrates fairly solid homogeneous enhancement. No additional abnormal enhancement is identified.

Output: Solid intramuscular mass of the thigh suspicious for recurrent malignancy.


Instruction: Generate impression based on findings.

Input: Shoulder pain The examination is significantly limited by motion artifact.ROTATOR CUFF: Within the limits of the exam, there is no evidence of a full-thickness rotator cuff tear. There is mild tendinopathy of the distal supraspinatus.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild articular cartilage thinning of the glenohumeral joint.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Significantly limited exam secondary to motion artifact. Within the limits, there is mild tendinopathy of the supraspinatus but no evidence of a rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Male, 4 years old, with seizures. Assess for intracranial anomaly. The perisylvian cortex on the right is asymmetrically thickened with areas of subtle blurring of the cortex-white matter junction. Portions of the insular cortex as well as the frontal and temporal opercular cortex are involved. In addition, the involved temporal opercular region also shows significant subcortical T2 hyperintensity which extends to involve the far anterior temporal lobe.More posteriorly, there is a relatively focal region of cortical distortion and marked cortical and white matter T2 hyperintensity involving the inferior temporal gyrus. Also noted is subtle abnormal elevated T2 signal involving the right occipital cortex.None of these areas demonstrate any pathologic enhancement. There is no significant generalized mass effect. No discrete lesions or areas of definite cortical irregularity are seen in the left hemisphere.No restricted diffusion is detected. There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is normal in size and morphology. An incidental left parietal developmental venous anomaly is observed.

Output: Right perisylvian cortical thickening is seen with additional areas of involvement in the anterior and inferior right temporal lobe and in the right occipital lobe. In some areas, the cortical abnormalities are associated with T2 hyperintensity.The morphology and distribution of these findings is very suggestive of cortical dysplasia. Lack of enhancement and multiplicity of involved regions argue strongly against a neoplastic process. Apparent sparing of the left cerebral hemisphere likewise argues against a systemic or metabolic process.


Instruction: Generate impression based on findings.

Input: 62 year-old female status post second toe osteotomy with screw fixation Extensive metallic artifact within the proximal phalanx of the great toe as well as in the proximal phalanx of the second toe, limits evaluation and likely represents prior screw placement and second toe fixation. There is marked increased T2 and decreased T1 signal within the distal aspect of the second metatarsal, as well as extending within the proximal phalanx of the second digit. Similar signal abnormality is also present within the phalanges of the toe. There is also edema along the fascia and dorsum of the foot.

Output: Postoperative changes with abnormal marrow signal within the distal metatarsal and proximal phalanx of the second toe and phalanges of the great toe, as described above. These findings are nonspecific, and we recommend correlation with radiographs of the foot. The differential includes postoperative changes, occult fracture, infection or trauma.


Instruction: Generate impression based on findings.

Input: 52-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 2.5 x 5.1 x 3.3 cm.Peripheral Zone: 9 x 12 mm focus of low T2 signal with restricted diffusion and enhancement in the posterolateral left prostate gland base, compatible with prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: Above-described focus of prostate cancer demonstrates mild 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: Left prostate gland base prostate cancer with mild extracapsular extension.


Instruction: Generate impression based on findings.

Input: 63 years Male (DOB:11/3/1952)Reason: Transplant pt with possible pulm nocardia; r/o CNS nocardiosis History: As abovePROVIDER/ATTENDING NAME: NIR Y URIEL NIR Y URIEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There are patchy foci of T2 and FLAIR signal hyperintensity present. One involves gray and white matter in the right inferior frontal gyrus measuring approximately 21 mm one in the right middle frontal gyrus measures approximately 21 mm. One in the left precentral gyrus measures 8 mm. One in the right temporal lobe is associated with encephalomalacia and measures approximately 60 x 26 mm axial dimensions. One in the left inferior parietal lobule measures 12 mm additional small T2 and FLAIR hyperintense lesions are also present in the occipital lobes. These were also present on the prior exam from 11/14/2015.Couple punctate foci of signal hyperintensity are present in the right cerebellar hemisphere.On susceptibility imaging there are multiple punctate foci of signal hypointensity in the cerebellar hemispheres and in the basal ganglia as well as in the periventricular white matter and subcortical white matter of the supratentorial brain. There is gyriform signal hypointensity in the right middle frontal gyrus and right temporal lobe where there are foci of encephalomalaciaNo 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.Since the prior exam there is no significant interval change. 2.There is redemonstration of multiple lesions scattered throughout supratentorial brain which are compatible with small foci of chronic stage infarction.3.There is redemonstration of multiple microhemorrhages scattered throughout the brain. A distinct pattern is not appreciated.


Instruction: Generate impression based on findings.

Input: Past medical history of a seizure, who presents with right lower extremity pain, numbness and decreased sensation, evaluate for cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord displays normal signal characteristics and morphology. There is no compromise of the spinal cord. There is a disc protrusion at L5-S1 with resultant considerable spinal canal stenosis and associated narrowing of the disc space. There is also high T2 signal in the L5-S1 interspinous space, which may indicated Baastrup disease. There is mild straightening of the lumbar spine alignment in the sagittal plane, but no spondylolisthesis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is slight disc bulging at L3-4 and L4-5. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of spinal cord compression. 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. A disc protrusion at L5-S1 results in considerable spinal canal stenosis. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine and a dedicated lumbar spine MRI 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: 63 years Female (DOB:4/9/1953)Reason: evaluate for frontotemporal dementia vs. Alzheimer's type dementia History: short term memory loss and executive dysfunctionPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JENNIFER BURNS The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several 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.

Output: Several periventricular and subcortical white matter lesions are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 30 year old man with Tetralogy of Fallot s/p pulmonic valve replacement. Now with significant pulmonic valve stenosis and regurgitation, biventricular failure, and recent SVT. 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 119 ml/m2 (normal range: 74+/-15), the LVEDV is 265 ml (normal range 142+/-34), the LV end systolic volume index is 65 ml/m2 (normal range 25+/-9), the LVESV is 146 ml (normal range 47+/-19), the LV mass index is 75 g/m2 (normal range 85+/-15), and the LV mass is 168 g (normal range 164+/-36). There is abnormal septal motion consistent with prior sternotomy. A ventricular septal defect patch is noted in the membranous septum and there is no evidence of residual VSD. There is late gadolinium enhancement of the anterior and inferior right ventricular insertion points suggesting the presence of underlying fibrosis from chronic RV pressure overload. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 141 ml/m2 (normal range 82+/-16), the RVEDV is 316 ml (normal range 142+/-31), the RV end systolic volume index is 89 ml/m2 (normal range 31+/-9), and the RVESV is 200 ml (normal range 54+/-17). No mass or thrombus is noted in the RV, the finding seen on echocardiography likely represents prominent muscular bands.Right AtriumThe right atrium is severely dilated without evidence of thrombus or mass.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 bioprosthetic valve is noted in the pulmonic position. There is mild thickening of the prosthetic valve leaflets without significant PS or PI.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. An over-riding aorta is noted. The aortic root is dilated. A very small remnant PDA is noted. Measurements are:Sinus of Valsalva: 41x42x44mmST Junction: 40x40mmAscending Aorta: 40x40mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium. There is a left common pulmonary vein. Pulmonary ArteryThe main pulmonary artery is moderately dilated. The RPA is normal in size. The LPA is aneurysmal.MPA=33x29mmLPA=34x40mmRPA16x20mmVenous 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 LV dilation with mildly reduced systolic function (LVEF 45%) with evidence of fibrosis in the anterior and inferior RV insertion points likely due to chronic RV pressure overload.2. Moderate RV dilation with moderately reduced systolic function (RVEF 37%).3. Mild LA dilation4. Severe RA dilation.5. Moderate tricuspid regurgitation.6. Bioprosthetic pulmonic valve regurgitation without significant stenosis or regurgitation.7. Left pulmonary artery is aneurysmal.8. Over-riding aorta with mild aortic root dilation and mild aortic regurgitation. When compared to study from 5/2015, the pulmonic valve has been replaced and the LV/RV are improving.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: ORBITS: There is questionable minimal T2 hypertensity within the intraorbital segment of the left optic nerve only seen on the axial STIR sequence as well as minimal expansion within it's intracranial segment extending to involve the left aspect of the chiasm which shows asymmetric expansion. There is no associated enhancement. The right optic nerve and right side chiasm are unremarkable. The extraocular muscles are unremarkable. There is a 12 x 12 mm nonenhancing hypothalamic mass located just posterior to, and intimately associated with, the optic chiasm. There is mild splaying of the optic tracts by this lesion that extends posteriorly into the interpeduncular cistern. The infundibulum and pituitary gland are not involved.BRAIN: There are scattered patchy foci of T2 hyperintensity within the basal ganglia, thalami, cerebral peduncles, brainstem, and bilateral cerebellar white matter as well as within the left insula where there is also mild expansion without enhancement. There is a 3 mm focus of enhancement within the right precentral gyrus with subtle corresponding T2 signal abnormality. 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1.Hypothalamic glioma likely extends toward the optic chiasm especially toward left side with resultant mass effect.2.Stigmata of NF1 including intracranial left optic nerve / chiasm enlargement most compatible with glioma and numerous supratentorial and infratentorial foci of signal abnormality compatible with "UBOs". The left hippocampal "UBO" demonstrates mild expansion and mass effect suggestive of low grade glioma. Follow-up imaging is recommended. 3.Small focus of enhancement within the right precentral gyrus with subtle associated T2 hyperintensity is nonspecific and may represent a vascular lesion such as a capillary telangiectasia, a neoplasm, or less likely artifact. Follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. There are multiple, greater than 10, cerebral white matter lesions, predominantly at the callososeptal interfaces and centrum semiovale bilaterally. There is interval subsidence of the enhancement associated with some of the lesions. However, there appears to be a new punctate T2 hyperintense lesion in the right posterior frontal centrum semiovale. 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 subsidence of enhancement associated with some of the demyelinating lesions, but newly apparent lesion in the right posterior frontal centrum semiovale.


Instruction: Generate impression based on findings.

Input: Stage III melanoma of the left neck. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered punctate foci of abnormal T2 hyperintensity within the right periventricular and 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. The right maxillary sinus appears hypoplastic or atelectatic. The skull and extracranial soft tissues are unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 97-year-old male with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. Mild small vessel disease of indeterminate age. No evidence of acute CVA. If clinically indicated, further evaluation by 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.Band-like hypodensity surrounding the right globe is reidentified and likely represents previous banding.

Output: No acute abnormalities. If clinically indicated, further evaluation by MRI may be considered.


Instruction: Generate impression based on findings.

Input: New onset seizure since summer 2014. Seizure 2 protocol. No intracranial mass or mass effect. There is no midline shift or herniation. No evidence of acute infarct or hemorrhage. The bilateral hippocampi are symmetric in size and signal without evidence of mesial temporal sclerosis. There is mildly diffuse pachymeningeal enhancement. No associated brain sagging or extra-axial collections to suggest intracranial hypotension. There are scattered foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific, but most consistent with minimal chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. The skull and extracranial soft tissues are unremarkable. A Tornwaldt cyst is incidentally noted in the nasopharynx.

Output: 1. No intracranial mass or mass effect. No findings to suggest seizure focus are appreciated.2. Mild smooth diffuse dural enhancement which is nonspecific and may be related to recent lumbar puncture or prior subdural collection for example. No associated brain sagging or extra-axial collections to suggest this is related to intracranial hypotension..I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Backache, unspecifiedClinical question: r/o Herniated diskSigns and Symptoms: back pain, numbness of legs and sciatica Five lumbar type nonrib-bearing vertebral bodies are presumed to be present which are appropriate in overall height. We consider L1-L2 to be at the level of the left renal vein. Based on this information, there is some sacralization of L5.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 loss of disc space height, disc desiccation, diffuse disc bulge and bilateral facet hypertrophy of a moderate degree associated with anterior subluxation of L4 and L5. There is effacement of the fat at the lateral recess bilaterally and significant narrowing the spinal canal. Overall there is a a moderate to severe degree of spinal stenosis at this level. The exiting nerve roots within the neural foramina are surrounded by fat at this level. At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with moderate facet and ligamentum flavum hypertrophy. There is effacement of the fat at the left lateral recess at this level. The exiting nerve roots within the neural foramina are surrounded by fat at this level. Overall there is a mild to moderate degree of spinal stenosis present at this level..At L2-3 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with mild to moderate bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level with a mild to moderate degree of spinal stenosisAt L1-2 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disc bulge present this level associated disc desiccation. There is facet hypertrophy and right side at this level.

Output: 1.Please note the variant enumeration of the lumbar vertebrae. There is sacralization of L5 present.2.There is moderate to severe spinal stenosis present at L4-5 due to disc disease, facet disease and mild subluxation.3.There is mild to moderate spinal stenosis at L3-4 associated with encroachment of the nerve roots at the left lateral recess.4.There is mild to moderate spinal stenosis present at L2-3 due to degenerative changes.5.There are multilevel degenerative changes


Instruction: Generate impression based on findings.

Input: 57 year old woman with history of LV dysfunction, coronary disease s/p PCI to circumflex, hypertension and diabetes who presents for cardiac MRI as part of diagnostic evaluation for etiologies of her cardiomyopathy. 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 159 ml/m2 (normal range: 65+/-11), the LVEDV is 326 ml (normal range 109+/-23), the LV end systolic volume index is 127 ml/m2 (normal range 18+/-5), the LVESV is 260 ml (normal range 31+/-10), the LV mass index is 76 g/m2 (normal range 67+/-11), and the LV mass is 157 g (normal range 114+/-24). There is global hypokinesis. There is a small amount of late gadolinium enhancement associated with the RV insertion point on the inferoseptum. This is atypical for myocardial infarction. Based on T2 stir images there is no myocardial wall edema.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with mild-moderately reduced systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 96 ml/m2 (normal range 69+/-14), the RVEDV is 196 ml (normal range 110+/-24), the RV end systolic volume index is 54 ml/m2 (normal range 22+/-8), and the RVESV is 112 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is at least mild 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.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 moderately dilated (34mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion. Otherwise no obvious pericardial disease.Extracardiac FindingsThere is a ovoid area of intermediate signal intensity in the superior portion of the liver with peripheral enhancement consistent with a hemangioma which measures 46 x 39mm. 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 severely reduced systolic function (EF 20%). There is global hypokinesis. There is a small area of late gadolinium enhancement in the insertion point of the RV in the inferoseptal wall. 2. Mildly dilated RV with mild-moderately reduced systolic function. RVEF 43%3. At least mild mitral regurgitation. 4. Dilated main pulmonary artery5. 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: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: ICH History: ICH Brain MRIRestricted diffusion on bilateral inferior parietal lobule with hemorrhagic transformation.There are also scattered restricted diffusion lesions on the right occipital lobe and right periventricular white matter indicating acute ischemic infarction.There are also small lacunar infarction with tissue loss on the right basal ganglia and encephalomalacia with hemosiderin deposition on the left occipital 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. 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.No intracranial arterial aneurysm. No intracranial arterial stenosis.

Output: 1. Acute/subacute ischemic infarctions with hemorrhagic transformation on bilateral inferior parietal lobules with surrounding edema.2. Scattered small restricted diffusion lesions indicating acute ischemic infarctions on the right periventricular white matter and right occipital lobe.3. Chronic ischemic stroke lesions including right basal ganglia and left occipital lobe as described above.4. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease with small and large bowel fistulae. CT scan from February 6, 2016 showed the gas in the fistulae tracking into the spinal canal. The abdomen/pelvis CT scan from February 6, 2016 provides better assessment of the partially included bowel and associated fistulae. Also, the presacral inflammatory soft tissue thickening is better assessed on CT scan but contains foci of poor contrast enhancement on MRI suggesting the presence of abscesses. 8 mm well-circumscribed T2-hyperintense, noncontrast enhancing lesion in the right kidney may represent a small cyst but is not completely characterized.There is a peripherally contrast enhancing anterior epidural fluid collection that also contains gas and extends from the upper L5 level to the upper most S2 level. The associated epidural inflammatory changes extend inferiorly throughout the sacral canal. The fluid collection itself measures craniocaudally 5.0 cm. In transverse at L5 level, the fluid collection measures 12 mm x 9 mm while at S1 level with measures 9 mm x 4 mm. It causes severe spinal canal stenosis at L5-S1 caudad, which is more pronounced on the right side, including the right subarticular recess at L5-S1. This is compatible with an epidural abscess. This collection also involves the L5-S1 neural foramen, more pronounced on the right, where gas tracks within the neural foramen. The epidural gas extension along the L5-S1 and the sacral foramina was more extensive on the CT scan.In addition, there are similar peripherally contrast enhancing fluid collections that contain gas within the posterior paraspinal muscles extending from mid L5 to upper S3 level, measuring more than 7 cm craniocaudally. Axially at mid S1 level, the right-sided one measures 2.5 cm x 2.1 cm while the left-sided one measures 2.1 cm x 1.6 cm. These are associated with edema like signal in the adjacent muscles and fat.The sagittal lumbar spinal alignment is notable for straightening which may reflect patient position or muscle spasm. The vertebral bodies are preserved in height. The marrow signal is diffusely T1/T2-hypointense which probably reflects red marrow reconversion related to chronic anemia or chronic illness. Sacral marrow is heterogeneous and STIR hyperintense which might be reactive to the adjacent presacral and intraspinal epidural inflammatory change. There is no lytic osseous destruction.Besides the above described lower lumbar and sacral spinal canal narrowing by the epidural abscess, there is no significant upper/mid lumbar canal stenosis. The conus medullaris tip is at the lower L1 level. The conus medullaris is unremarkable.

Output: 1.There is an epidural abscess in the lower lumbar and sacral spinal canal with severe spinal canal stenosis. The associated gas also extends along the L5-S1 and the sacral foramina. 2.There are also abscesses within the posterior paraspinal muscles. Gas within these abscesses suggest communication either with skin or bowel.3.The presacral inflammatory tissue is not completely assessed nor the other abdominal or pelvic findings.4.Heterogeneous/edematous sacral marrow signal might be reactive to the adjacent inflammatory change but may also represent early osteomyelitis. No frank osseous destruction is evident.


Instruction: Generate impression based on findings.

Input: SLE: 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.


Instruction: Generate impression based on findings.

Input: Suprasellar mass surveillance. Pituitary: There is a lobulated, enlacing pituitary tumor, eccentric to the right, with suprasellar extension, which measures up to 25 mm in axial width and 30 mm in craniocaudal height. The tumor extends into the right cavernous sinus, encasing the internal carotid artery, and exert mass effect on the adjacent optic apparatus, brain, and brainstem. There is a rounded cystic structure in the right sphenoid sinus with mild peripheral enhancement that measures up to 22 mm.Brain: There appears to be a punctate focus of enhancement in the anterior right thalamus. There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse cerebral volume loss. There are scattered supratentorial and infratentorial foci of white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. A pituitary mass with supersellar extension and regional mass effect measuring up to 30 mm is compatible with a macroadenoma. The tumor appears similar in size as in April 2016, accounting for differences in technique.2. Nonspecific punctate focus of enhancement in the anterior right thalamus. 3. A cystic lesion in the right sphenoid sinus may represent a mucocele.


Instruction: Generate impression based on findings.

Input: Left parapharyngeal mass with myxochondroid tissue, consistent with origin from a neoplasm: oropharyngeal fullness, muffled voice. There is a well-defined, but heterogeneously enhancing mass centered in the left prestyloid parapharyngeal space, which measures up to approximately 6.5 cm. Low T1 and T2 signal intensity foci within the tumor correspond to calcifications. The tumor may arise from the deep lobe of the left parotid gland and appears to be distinct from the left trigeminal nerve trunk. There is narrowing of the oropharyngeal airway due to the mass effect. The left internal carotid artery and internal jugular vein are displaced slightly posteriorly by the mass. The skull base appears to be intact. There is no significant lymphadenopathy in the upper neck. The paranasal sinuses, orbits, and imaged intracranial structures are unremarkable.

Output: A mass measuring up to 6.5 cm and centered in the left prestyloid parapharyngeal space, but perhaps arising from the deep lobe of the left parotid gland, is compatible with a neoplasm, most likely pleomorphic adenoma.